Use PowerShell to Easily Compare the Time Between Two Computers The Scripting Guys November 5 2012 2 0 0 Summary Microsoft Scripting Guy Ed Wilson shows how to use Windows PowerShell to easily compare the time between two computers Microsoft Scripting Guy Ed Wilson is here In two days I will be speaking to the AZPOSH Windows PowerShell user group in Phoenix Arizona No I am not flying out thereI have enough travel coming up Instead I am speaking via Lync Lync does an excellent job and it is just about like being there in person except for missing all the great restaurants they have out there I will be speaking about using the Windows PowerShell 30 remoting capabilities for management purposes It will be a lot of fun If you can not be there in person such as myself you may want to dial in to the Lync meeting Checking local and remote time One of the people who was at the Windows PowerShell user group in Charlotte the other day was asking me about checking the time on remote computers This got me to playing around Note For more information about time synchronization issues see the following Hey Scripting Guy Blog posts Configuring w32Time Service Logging and Configuring an Authoritative Time Server in Windows Server Of course it is possible to use WMI to query for time information from a remote machine To do this use the Win32_LocalTime WMI class The problem with this is that each property is a piece of the time and therefore must be assembled from at least three different properties unless you also want the datethat is another three properties Finding the PDC emulator By default the domains authoritative time server is the server holding the PDC Emulator FSMO role The easiest way to find the name of this server is to use the GetADDomain cmdlet from the Active Directory module On Windows PowerShell 30 it is not necessary to load the Active Directory module prior to running the command Therefore the following command returns the PDC Emulator for my domain PS C GetADDomainpdcemulator dc1iammrednet Check the date time on a remote computer The easiest way to obtain the date and time on a remote computer is to simply use the GetDate cmdlet By using Windows PowerShell remoting it is trivial to obtain the remote time information An example is shown here PS C invokecommand ComputerName dc1 ScriptBlock getdate Wednesday October 31 2012 12342 PM I can shorten the command considerably by taking advantage of the ICM alias for the InvokeCommand cmdlet and by using positional parameters as shown here PS C icm dc1 getdate Wednesday October 31 2012 12424 PM If I would like to see all of the date time information I can pipe the results to the FormatList cmdlet This is shown here PS C icm dc1 getdate fl DisplayHint DateTime PSComputerName dc1 RunspaceId 7cf0452c688a4e1683f5d9b0ec6ded6e PSShowComputerName True DateTime Wednesday October 31 2012 23335 PM Date 10312012 120000 AM Day 31 DayOfWeek Wednesday DayOfYear 305 Hour 14 Kind Local Millisecond 879 Minute 33 Month 10 Second 35 Ticks 634872908158794870 TimeOfDay 1433358794870 Year 2012 On the other hand it is also possible that what I need to do is to see if there is a time offset between my computer and the server To do this I can use the newTimeSpan cmdlet to measure the difference between the two GetDate commands Keep in mind that part of the time offset could be attributable to the time it takes to make the remote connection and to run the command and to return the information How this affects the time however depends on whether my local system time is fast or slow when compared with the remote server The command itself is rather simple I use the GetDate cmdlet from my local computer as the start of the timespan I then use the time from the remote server as the end time The command and associated results are shown here PS C newtimespan Start getdate end icm dc1 getdate Days 0 Hours 0 Minutes 0 Seconds 0 Milliseconds 311 Ticks 3116406 TotalDays 360695138888889E06 TotalHours 865668333333333E05 TotalMinutes 000519401 TotalSeconds 03116406 TotalMilliseconds 3116406 Sync with an external time source The time skew between my computer and the server is less than half of a secondcertainly well within tolerance But what if I had a greater time skew Well I would first resync my server with the external time source To do this I would use the W32tm command Note For more information about the topic of resyncing time sources see this article at the TechNet Library The following command runs W32tm and tells the remote server DC1 to resync with TimeWindowsCom The output states that the results are successful PS C icm dc1 w32tm config syncfromflagsmanual manualpeerlisttimewindowscom The command completed successfully Note By using the command to resync with the time source requires Admin rights Once I have caused the server to resync with the external time source I will resync my local computer with the server This command is shown here PS C w32tm resync Sending resync command to local computer The command completed successfully Once I have resynced both the time server and the workstation I use the NewTimeSpan command to monitor for any difference PS C newtimespan Start getdate end icm dc1 getdate Days 0 Hours 0 Minutes 0 Seconds 0 Milliseconds 270 Ticks 2707415 TotalDays 313358217592593E06 TotalHours 752059722222222E05 TotalMinutes 000451235833333333 TotalSeconds 02707415 TotalMilliseconds 2707415 If I need to doublecheck the time source settings on the remote time server I use the W32tm command to query the configuration The command is shown here icm dc1 w32tm query configuration Join me tomorrow when I will talk about more cool Windows PowerShell stuff I invite you to follow me on and If you have any questions send email to me at scriptermicrosoftcom or post your questions on the Official Scripting Guys Forum See you tomorrow Until then peace Ed Wilson Microsoft Scripting Guy Tags basic information operating system Scripting Guy servers Windows PowerShell Comments 2 You must be logged in to post a comment Maciek October 21 2015 at 333 pm Hey I know this is an old thread so maybe I wont get any response but Im gonna try anyway Im a PS newbie pretty much I know you like me already and Id like to use PS for checking the time on a local machine then set it on a remote one Sounds like a simple scenario so maybe youd like to enlighten me with the proper code Thanks so much Maciek Grzegorz Florek December 30 2015 at 208 pm Better is to at first get time from remote host then from local In other way You always get a delay for invokecommand newtimespan end icm DC1 getdate Start getdate

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Configuring

Delegation

for

Lync

Users

that

are

not

enterprise

voice

enabled

Scott

March

Problem

Overview

Companies

that

deploy

Lync

Enterprise

Voice

EV

have

the

ability

to

easily

leverage

the

delegate

scheduling

feature

However

customers

that

dont

deploy

EV

do

not

get

to

take

advantage

of

the

delegate

functionality

A

delegate

scheduler

should

be

able

to

schedule

a

Lync

meeting

on

behalf

of

their

bossmanage

even

if

both

users

are

not

enabled

for

Enterprise

Voice

Detailed

Description

of

the

Problem

We

will

walk

through

an

example

of

delegation

without

EV

and

show

how

it

works

without

administrative

interaction

In

this

example

we

have

two

users

named

Manager

and

Delegate

As

you

can

see

in

Figure

below

has

shared

his

Outlook

calendar

with

Figure

Delegation

Configuration

is

now

eligible

to

create

meetings

on

behalf

of

Figure

schedules

a

meeting

for

So

far

everything

is

working

as

expected

The

issue

arises

when

attempts

to

schedule

a

Lync

meeting

on

behalf

of

Figure

Error

message

when

tries

to

schedule

a

Lync

meeting

As

you

can

see

in

Figure

above

receives

an

error

that

they

do

not

have

delegate

permissions

for

These

particular

delegate

permissions

are

in

addition

to

the

mailbox

delegate

permissions

that

are

needed

The

issue

here

is

that

is

not

enabled

for

Enterprise

voice

and

therefore

has

no

ability

to

alter

his

delegates

list

Solution

Overview

The

solution

that

we

will

describe

in

this

blog

post

involves

the

Lync

administrator

using

the

SEFAUtil

administrative

tool

to

configure

Player

as

a

delegate

for

This

solution

will

enable

to

be

configured

as

a

delegate

for

while

neither

user

is

enabled

for

Enterprise

Voice

This

solution

requires

some

administrative

input

but

it

is

scalable

and

allows

the

configuration

to

be

easily

changed

after

the

fact

Detailed

Description

of

the

Solution

This

configuration

requires

that

you

are

running

a

minimum

build

of

of

the

SEFAUTIL

that

is

available

via

the

following

URL

This

document

will

only

cover

the

delegation

configuration

using

SEFAUtil

and

it

will

not

cover

the

actual

Lync

server

configuration

required

to

make

the

SEFAUtil

work

For

detailed

steps

on

how

to

enable

SEFAUtil

please

see

this

blog

post

In

this

sample

configuration

we

will

start

with

two

users

named

and

that

are

not

EV

users

and

do

not

have

delegation

in

Lync

configured

At

this

point

we

assume

that

the

Exchange

delegation

has

already

been

completed

and

that

the

EnableExchagneDelegateSync

parameter

has

not

been

set

on

any

client

policies

The

reason

that

we

choose

not

to

use

this

option

is

that

Exchange

Delegate

sync

is

a

one

way

sync

only

in

that

when

someone

is

removed

as

an

Exchange

delegate

they

are

not

automatically

removed

as

a

Lync

delegate

Figure

signed

in

to

Lync

Figure

signed

in

to

Lync

As

you

can

see

in

Figure

and

Figure

above

both

users

are

not

enabled

for

Enterprise

voice

and

as

a

result

do

not

have

the

ability

to

manage

their

call

forwarding

settings

and

the

delegate

access

feature

The

following

steps

assume

that

you

have

configured

the

Lync

infrastructure

see

note

earlier

in

this

document

to

support

the

SEFAUtil

and

are

now

ready

to

configure

the

delegate

relationship

between

these

two

users

Open

a

command

prompt

and

type

the

following

command

syntax

in

this

example

has

already

been

configured

as

a

trusted

application

pool

to

run

the

SEFAUtil

application

SEFAUtilexe

Once

the

command

completes

you

should

see

output

such

as

what

is

shown

below

User

Aor

Display

Name

UM

Enabled

True

Simulring

enabled

False

Simultaneously

Ringing

Delegates

You

should

now

see

a

change

in

the

Lync

client

for

both

and

Figure

showing

as

a

delegate

Figure

showing

as

a

delegate

for

As

you

can

see

in

Figure

above

now

has

listed

under

the

Delegates

group

which

gets

created

automatically

when

you

have

delegates

configured

In

Figure

above

you

can

see

that

has

listed

under

the

People

I

Manage

Calls

For

As

you

can

see

in

Figure

below

is

now

able

to

schedule

a

Lync

conference

on

behalf

of

Figure

schedules

a

meeting

for

If

you

decide

that

you

want

to

reverse

the

changes

made

earlier

you

can

do

that

with

the

SEFAUtil

as

well

Open

a

command

prompt

and

type

the

following

command

syntax

in

this

example

has

already

been

configured

as

a

trusted

application

pool

to

run

the

SEFAutil

application

SEFAUtilexe

Once

the

command

completes

you

should

see

output

such

as

what

is

shown

below

User

Aor

Display

Name

UM

Enabled

True

Simulring

enabled

False

User

Ring

time

Call

Forward

No

Answer

to

voicemail

Summary

This

blog

post

described

how

a

company

that

has

not

deploy

Lync

Enterprise

Voice

EV

can

use

the

SEFAUtil

tool

to

configure

delegate

access

and

allow

their

users

to

leverage

the

delegate

scheduling

feature

B I O B I O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

configuring delegation
lync users
enterprise voice enabled


Your blood pressure is 108 over 54 What your blood pressure values mean Your blood pressure is Too low Hypotension But regarding your systolic upper value your blood pressure is rather Ideal If you are getting two different types of classification for your blood pressure it is more likely to chose the one that is considered worse eg if your systolic upper value is normal and your diastolic lower value is high normal consider high normal as your classification Scale Classification as diagram 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 Ideal 108 Systolic value upper 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 Hypotension 54 Diastolic value lower Your blood pressure is ideal Requirement for an ideal blood pressure is a value of under 120 over 80 Would your systolic upper value increase by 12 mmHg to 120 mmHg and your diastolic lower value would increase by 26 mmHg to 80 your blood pressure was not anymore ideal but normal The normal blood pressure is below 130 over 85 but higher than 120 over 80 Additional information 5 quick and easy ways to immediately lower your blood pressure Why does my chest hurt Which tea lowers my blood pressure Understanding low blood pressure Understanding the ideal blood pressure Low blood pressure the unkown threat

O B I O O O O O O B I O O O B I O O O O O O O O O O O B I O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O B I O O B I O O O B I O B I O O O


Your blood pressure is 142 over 90 What your blood pressure values mean Your blood pressure is Too high Hypertension Stage 1 Your upper and your lower blood pressure value seem to be within the same classification Too high Hypertension Stage 1 Scale Classification as diagram 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 Hypertension Stage I 142 Systolic value upper 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 Hypertension Stage I 90 Diastolic value lower Your blood pressure too high Hypertension Stage 1 Requirement for a blood pressure Hypertension Stage 1 is a value of 140159 over 9099 Would your systolic upper value increase by 18 mmHg to 160 mmHg and your diastolic lower value would increase by 10 mmHg to 100 mmHg your blood pressure was not anymore Hypertension Stage 1 but Hypertension Stage 2 Causes and Risks of Hypertension Stage 1 Doctors consider a stage 1 hypertensive person as hypertensive A case of hypertension could be primary or secondary A primary case of hypertension can be from a persons diet or obesity Hypertension may develop from a high sodium intake as well A secondary case of hypertension may come from a reaction to a medication Secondary hypertension can develop because of a heart liver or kidney disease as well Diabetes may play a role in the development of stage 1 hypertension Doctors will want to control or reduce a patients hypertension before it becomes a case of stage 2 hypertension or Stage 1 hypertension can cause damage to a persons kidneys liver and heart if he or she does not receive treatment for it Therefore a physician will most likely implement a dietary plan for a person with stage 1 hypertension He or she may also prescribe pharmaceutical drugs such as thiazide lisinopril nadolol or diltiazem A person who is over the age of 20 should receive a blood pressure reading a least once every two years to check for high blood pressure Quick action is the best defense against the condition Additional information 5 quick and easy ways to immediately lower your blood pressure Which tea lowers my blood pressure Warning signs of hypertension high blood pressure Why does my chest hurt Understanding Hypertension Stage 1 Understanding Hypertension Stage 2

O B I O O O O O O B I O O O B I O O O B O O O O O O O B I O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O B I O O B O O O O O B I B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O B O O O B O O O O O O B O O O O O O O O O O O O O O B O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O O B O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O B O O O O O O O O B O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O B I O O O O B I O O O B O B I O O O O O O B O O O B O O


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B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O B I I O O O O O O O O O O O B I I O O B I I O O O O O O O O B I I O O O B I I O O O O O O O O O B I I O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Research article Open Peer Review Rehabilitation needs for older adults with stroke living at home perceptions of four populations Claude Vincent Isabelle Deaudelin Line Robichaud Jacqueline Rousseau Chantal Viscogliosi Lise R Talbot Johanne Desrosiers and other members of the BRAD group BMC Geriatrics 2007 7 20 httpsdoiorg10118614712318720 Vincent et al licensee BioMed Central Ltd 2007 Received 11 October 2006 Accepted 13 August 2007 Published 13 August 2007 Open Peer Review reports Abstract Background Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment but only some of them receive inpatient or even outpatient rehabilitation services Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy which increases utilization of health services number of hospitalizations and early institutionalization leading to a significant psychological and financial burden on the patients their families and the health care system The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke Methods Using the focus group technique we met four types of experts living in three geographic areas of the province of Québec Canada older people with stroke caregivers health professionals and health care managers for a total of 12 groups and 72 participants The audio recordings of the meetings were transcribed and NVivo software was used to manage the data The process of reducing categorizing and analyzing the data was conducted using themes from the Disability Creation Process model Results Rehabilitation needs persist for nine capabilities eg related to behaviour or motor activities nine factors related to the environment eg type of teaching adaptation and rehabilitation and 11 life habits eg nutrition interpersonal relationships The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources Conclusion Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers orientation of caregivers towards resources in the community and followup of patients needs in terms of adjustment and rehabilitation whether for improving their skills or for carrying out their activities of daily living Keywords Focus Group Health Professional Personal Factor Family Caregiver Social Participation Background Stroke is the third leading cause of longterm disability 1 and its incidence increases markedly with advancing age 2 With improvements in health care more people survive strokes but many have to cope with the physical psychological social and functional sequelae resulting in increased personal and public costs 1 3 4 5 and a marked decline in their quality of life 6 7 8 9 10 11 After a stroke most elderly people return to their home environment quickly despite suffering from various impairments and disabilities and often without having received any rehabilitation services to reduce or compensate them 12 13 In Canada only about 10 to 15 of people with stroke receive inpatient rehabilitation services 14 The other survivors whose physical deficits are not so severe or whose impairments and disabilities are not properly identified return to their own environment with or without support services 15 16 In order to better plan the offer and delivery of rehabilitation services the partially met or unmet needs of people who live at home after stroke are little known especially from the perspective of the different actors involved in this process Even though many studies have been carried out on recovery from impairments and disabilities after stroke and the consequences of such disabilities very few are interested in exploring partially met and unmet rehabilitation needs that could restrict the social participation of these people in their daily activities and social roles The aim of this study was to explore partially met and unmet needs of adults aged 65 years or over who had suffered a stroke and who live in the community with or without services The emphasis was put on the needs that are considered obstacles to social participation from the point of view of older adults with stroke caregivers health professionals and health care managers Literature review What do we know about social participation and rehabilitation needs for people with stroke Social participation According to the Disability Creation Process DCP model social participation or its opposite handicap situation is identified as a situational result that varies over time depending on the interaction between personal factors the individuals organic system capabilities identity and environmental factors social and physical 17 18 Figure 1 This systemic model of human development which is widely known and used in Canada is based on the interaction between individuals and their environment This model is very useful for identifying and classifying variables under study with greater systematization and consistency Figure 1 The Disability Creation Process conceptual scheme Fougeyrollas Cloutier Bergeron Côté Côté StMichel 1998 CRIPPH 1998 ripphirdpqqcca 14185299141 p6202 Authors of this manuscript have added subcategories to the original scheme to facilitate the understanding of text Stroke highly affects personal factors that include both impairment and disability There is major impairment of the nervous system and other organic systems eg muscular ocular The consequences of these impairments are operationalized through the presence of disabilities in capabilities eg intellectual language behaviour sense and perception motricity and balance Depending on the number and extent of these disabilities people vary in their ability to accomplish daily activities and social roles presence of handicap situations at one end of the spectrum and optimal social participation at the other 19 The characteristics of the persons environment also affect social participation after stroke Social environmental factors include elements such as the support from the family and utilization of health and social services whereas physical environmental factors refer to natural or technological elements eg climate technical aids As obstacles or facilitators these factors can either hinder or help in the accomplishment of daily activities and social roles Finally the different activities and roles that the person values called life habits in the model are divided into 12 domains Six of these domains refer to the persons daily activities nutrition fitness personal care communication housing mobility whereas the other six refer to social roles responsibility interpersonal relationships community life education employment recreation It is in these activities and roles that handicap situations or restriction of participation can arise In the DCP model needs might be considered as the outcome of a lack of congruence between personal factors and different factors in the environment 18 Because of the high incidence of stroke 20 and its potentially negative impact on various aspects of a patients life 5 10 21 22 23 studies on social participation were carried out among people who had suffered a stroke The results of a telephone survey conducted by Mayo et al in 2002 24 among 434 respondents show that participation by this clientele in basic activities such as eating dressing and moving around is less often restricted 39 than participation in domestic tasks such as going shopping and cleaning the house 54 which in turn is less affected than participation in community activities 65 associated with social roles Rehabilitation needs Specific studies on rehabilitation needs are still rare 15 22 25 26 27 28 which means that generic literature on needs is applied to rehabilitation Bradshaws taxonomy of social need 29 as used by Pineault and Daveluy 30 identifies four types of needs felt expressed normative and comparative Felt needs are equated with wants and are limited by the perceptions of the individuals in regard to the health services available 29 Expressed needs are demands or felt needs turned into action They are commonly used in health care services where waiting lists are taken as a measure of unmet need 29 Normative needs are those defined by health professionals administrators or experts in relation to norms or a desirable standard 29 Finally comparative needs refer to a measure established by studying the characteristics of those in receipt of a service in other words populations in which the evaluated needs are generalized 29 The goals of rehabilitation services and programs are currently based on the judgment of professionals who evaluate functional disabilities ability to carry out daily activities and significant leisure occupational and social activities as well as health problems 31 to determine needs These needs assessments are often incomplete because assessments are done only once most often with standardized tests and outside the persons home environment or community context 15 16 32 Furthermore although family members may have more difficulty identifying needs than the patients themselves and the professionals 33 their input is essential to a needs assessment 16 34 35 Consideration both of the needs expressed by individuals and their caregivers and of the normative needs identified by health professionals ensures a more reliable result since many patients can be more passive than expected in expressing their needs 25 32 36 37 38 39 Also expressed needs for rehabilitation services may greatly vary from one area to another 27 40 41 42 possibly because of differences in accessibility In addition repeated measures poststroke show that needs change over time 14 28 38 43 Based on the DCP model there are needs related to personal factors capabilities 9 Indeed motor and sensory problems on the side contralateral to the brain lesion 12 14 16 44 45 as well as perceptual and cognitive 14 47 48 49 50 51 and psychosocial 14 40 46 49 50 51 52 53 54 55 56 57 58 59 disorders disrupt the daily lives of people with stroke Often older adults with stroke do not spontaneously find effective strategies to cope with the affective apathy depression emotional variation and cognitive problems memory attention concentration organization judgment communication 60 61 62 Even after adjusting for the degree of physical disability people with cognitive deficits remain more dependent and this dependence has increased two years after the stroke 49 In a study carried out in Denmark the patients reported the need for supervision and advice to continue proper physical and cognitive training at home 63 Martin et al 2002 19 and Pierce et al 2004 64 presented similar outcomes in their recent works Some needs related to environmental factors are documented in literature but most of them refer mainly to rehabilitation services and education without considering other important environmental elements Following inpatient rehabilitation people who had suffered a stroke expressed unmet needs related to preparation for discharge instructions information and support with referrals to community resources rehabilitation services exercise programs at home support in doing exercise programs support for the individual and couple during the adaptation process nutrition safety and housework 55 60 65 66 67 68 The optimum benefit from rehabilitation is often not achieved during hospitalization because of the stress experienced in the acute phase 11 59 Thus there is a perceived lack of care continuity 23 41 69 one of the aims of the single entry point which is currently being implemented in some regions is to fill this gap 70 During the rehabilitation process some individuals progress more slowly and may need treatment to improve recovery for up to two years poststroke 43 71 72 Education combined with counselling for selfassessment could help people become more aware of their needs which would help them adjust better to their disabilities 27 73 Rehabilitation should focus more on satisfaction with life and leisure activities than simply on independence in daytoday activities 5 32 62 Brandriet and colleagues 60 studied perceived needs poststroke after discharge from inpatient rehabilitation among a small number of individuals n 20 in a single metropolitan area poststroke survivors indicated they needed more therapy physical therapy occupational therapy and speech therapy whereas they and caregivers also reported the need for greater social support The recent focus group study of Hare et al 72 combined two groups of experts 27 patients and 6 caregivers The study concluded that better methods were required for providing information to longterm survivors of stroke and for addressing their emotional and psychological needs 22 46 As mentioned earlier literature concerning other types of needs related to environmental factors is limited In one example Evans and Northwood 73 carried out a study among a heterogeneous population aged 43 to 87 years one of their conclusions was that there exist social assistance needs for adjustment to stroke For needs related to life habits the third component of the DCP model most of the previous studies point out general problems with mobility and instrumental activities of daily life 46 60 61 62 74 In the Brandriet et als study 60 poststroke survivors indicated specific unmet needs for housekeeping financial nutritional and safety aspects as well as for relearning skills maintenancehousehold tasks Between one and four years poststroke balance walking and instrumental activities of daily life such as personal care housekeeping cooking and psychosocial activities have deteriorated 11 75 The present group of authors had previously carried out a preliminary study with four different small groups of experts patients caregivers health professionals and health care managers from a single semiurban area 76 Results showed partial and unmet needs relating to personal factors mainly capabilities environmental factors and life habits Analysis of environmental factors also revealed the need for social support the need for more rehabilitation services and the importance of the caregivers role Results were sufficiently relevant to motivate a more indepth study in different sociogeographic areas including urban and rural areas In summary context of all of the above studies was restricted which limits their external validity Most literature considers capabilities the sociohealth system the education system and some life habits daily activities there is very little information about unmet rehabilitation needs related to social roles and environmental factors such as social assistance public infrastructures community organizations social network and physical factors Also most of the literature refers to normative needs from the health professionals perspective In 2002 when our study began very few studies put emphasis on expressed needs from the standpoint of older adults with stroke and caregivers After 32 34 37 38 77 82 We could not find any literature written from a health care managers perspective except for Talbot et al 76 our pilot study Since most people report a reduction in their activities and interests poststroke 74 stroke has a substantial impact on the accomplishment of daily activities and social roles life habits that are essential to wellbeing and personal development even when impairment and disability are mild 10 Objective of the study This study examined partially met and unmet rehabilitation needs expressed and normative for people with stroke aged 65 and over with respect to their personal factors capabilities and life habits and environmental factors with a view to maintaining optimal social participation Better knowledge and understanding of rehabilitation needs and services for this population should contribute to changes in clinical and organizational practices Methods Design The study conducted in 2005 followed a crosssectional design using the focus group technique 78 individual interviews and a qualitative analysis strategy 79 80 Sample and eligibility criteria To enhance the transferability 80 81 of results this study was conducted in three regions of the province of Quebec Montreal metropolitan area 1 873813 people 36713 per km 2 15 over 65 years old Eastern Townships rural area 300 383 people 295 per km 2 144 over 65 years old and ChaudièreAppalaches rural area 396171 people 263 per km 2 138 over 65 years old In Canada 30000000 people there are over 50000 strokes each year including 16000 deaths Four target populations were identified 1 older people with stroke hereinafter called patients 2 family caregivers 3 health professionals and 4 health care managers involved in the rehabilitation of older adults Caregivers and stroke survivors were independent of each others The patients and family caregivers were recruited through support groups for people who had suffered a stroke such as stroke clubs or community home services centres Specific criteria theoretical sampling were defined such as various levels of disabilities gender and different For the eligibility criteria the patients had to a have had at least one stroke with the most recent occurring after the age of 65 and the previous at least two years earlier b be living at home and c be able to verbally express their needs Three quarters of people who had a stroke are aged over 65 years and in Canada specific health care programs are offered to this clientele justifying the age criterion We excluded people affected by other limitative neurological sensory musculoskeletal or chronic diseases to avoid confusion between the needs related to these diseases and Focus group technique and individual interviews Focus groups were organized in each region with patients family caregivers health professionals and health care managers for a total of 12 groups 4 populations 3 regions The meetings lasted approximately two hours each and were recorded on audiotape A moderator an assistant moderator and an observer researcher were present at each group meeting The same research team attended the meetings in all three regions Focus group interview guides refined after the pilot study are presented in Talbot et als paper 76 To ensure the group meetings ran smoothly and generated the best content 45 participants were sought for each group of patients and caregivers and 78 participants were expected for each group of health professionals and health care managers 78 In addition to capture a wider variety of experience related to the needs expressed 4 individual interviews with patients and caregivers were conducted since some participants were not able to participate in the focus group meetings for various reasons reduced mobility uncomfortable in a group situation caregiver unavailable Data analysis strategy and conceptual framework The focus group participants profile was described in terms of age gender and other relevant characteristics depending on the group The audiotape of the content of each group n 12 and during interviews n 4 was transcribed then coded recoded and classified NVivo software v2 was used to manage the data The analysis process was systematic and rigorous and respected scientific criteria for qualitative research 79 80 An initial classification of the data was based on the Disability Creation Process presented earlier All the transcriptions were recoded by the groups researchers to validate the process of coding ie the accuracy of the theoretical classification and the emerging classification themes Disagreements were discussed 30 of the codification and decisions reached by consensus to finally converge on emerging themes that made sense and which accurately reflected the content of the discussions Data were analyzed considering two aspects 1 For each type of group we calculated iterations for each theoretical theme the number of times a participant discussed a specific Results Participants profile In all three regions 17 persons with stroke and living at home took part in individual interviews n 3 and focussed discussion groups n 14 Table 1 Their age varied between 65 and 85 years Most had had their stroke over two years previously and were living alone or with their spouse Patients profile meets the specific criteria various levels of disability representation because less than one third were receiving home care assistance from the public health care system while over half were being cared for informally by their next of kind Also three patients with more severe limitations were met at home The patients educational level varied Table 1 Description of characteristics of people with stroke Patients N 17 Eastern Townships n 8 1 Montreal n 3 ChaudièresAppalaches n 6 Age 6575 years 4 1 5 7685 years 4 2 1 Gender M 5 0 5 Living environment urban 3 3 3 Time elapsed since stroke 1 to 3 years 4 1 4 48 years 4 1 2 9 years and 0 1 0 Education level Elementary 6 1 2 Secondary 2 1 3 Postsecondary 0 1 1 Registered for public home care services 2 1 2 Receive assistance from relatives or friends 5 3 3 Note 1 In this region 3 patients were interviewed individually Twelve close caregivers aged between 41 and 69 participated in focussed discussion groups n 11 and one individual interview n 1 Table 2 In general the caregivers interviewed were assisting people who were more severely disabled than the patients recruited to participate in the focus groups for persons with stroke They were either the spouse or the daughter of the person for whom they had been caring for at least one year from two to twenty hours per week in various ways Most of the caregivers were retired Table 2 Description of characteristics of close caregivers Caregivers N 12 Eastern Townships n 6 1 Montreal n 3 ChaudièresAppalaches n 3 Age 4159 years 4 1 0 6069 years 2 2 3 Gender F 5 3 1 Living environment urban 2 3 2 Current occupation Works outside the home 2 2 1 Retired 4 1 2 Relationship with patient 3 Spouse 5 2 Daughter 1 1 0 Experience as a caregiver 1 to 4 years 3 2 2 over 4 years 3 1 1 Weekly assistance 012 hours 3 2 2 1320 hours 3 1 0 over 20 hours 0 0 1 Type of assistance given ADL 5 3 2 IADL 6 3 3 Psychological support 4 3 2 Otherstimulation 3 3 0 In this group of respondents only one caregiver was interviewed individually Twentyfive health professionals participated in the discussion groups Table 3 They had more than nine years of clinical experience They were working in six different areas of intervention and represented nine professional disciplines Table 3 Description of characteristics of health professionals Health professionals N 25 Eastern Townships n 9 Montreal n 8 ChaudièresAppalaches n 8 Gender F 5 7 8 Living environment urban 7 8 8 Field of practice Inpatient rehabilitation unit 0 5 5 Acute care hospital 2 3 1 Local community service centre 4 1 1 Day centre 2 0 0 Day hospital 1 1 2 Community organization 1 1 0 Professional discipline Dietetics 0 1 0 Specialized education 1 0 1 Occupational therapy 1 1 2 Nursing sciences 0 1 2 Social intervention 2 1 1 Neuropsychology 1 0 0 Speech therapy 1 1 0 PhysiotherapyPhysical 3 2 2 Rehabilitation therapy Psychology 0 1 0 Experience with stroke clientele Less than 2 years 0 0 2 24 years 1 1 0 58 years 1 1 2 9 years or more 7 6 4 Finally 18 health care managers took part in the discussion groups Table 4 They came from seven different practice areas twothirds had clinical experience with stroke patients Eight of them had over 10 years management experience see Table 4 Table 4 Description of characteristics of health care managers Health care managers N 18 Eastern Townships n 7 Montreal n 8 ChaudièresAppalaches n 3 Gender F 5 7 8 Living environmenturban 6 8 3 Field of practice Inpatient rehabilitation unit 1 5 2 Acute care hospital 1 2 0 Local community service centre 1 1 1 Day centre 1 0 0 Day hospital 1 1 1 Community organization 1 0 0 Rehabilitation centre 1 0 0 Clientele targeted by work General 3 3 3 Over 65 years 2 3 0 Neurology 2 2 0 Field of study Management 3 4 1 Health 6 7 3 Number of years management experience Less than 5 years 2 3 2 510 years 1 1 1 More than 10 years 4 4 0 Needs related to personal factors capabilities Nine categories of capabilities were documented out of a possibility of 10 listed in the DCP model 18 In fact only the breathing capabilities category was not discussed by participants The themes that emerged for each category are presented in Table 5 The capabilities that drew the most interest in terms of partially met or unmet needs were those related to behaviour language motor activities and sexual relations The caregivers were especially sensitive to behavioural changes in the patient which was also the case for the health professionals though to a lesser extent The health care managers were particularly sensitive to the needs related to language capabilities while the patients themselves seemed more affected by partial or unmet needs relating to motor activities such as walking and gripping ability as well as more intimate activities such as sexual relations However Table 5 shows four categories of capabilities that were not identified as partial or unmet needs by the patients and three that were not identified as such by the health care managers Table 5 Partially met and unmet needs with respect to personal capabilities Capabilities No of iterations reported by Themes Caregivers Health Professionals Healthcare Managers Patients Intellectual capabilities 1 2 0 2 Stimulation neuropsychology speech therapy occupational therapy Language capabilities 5 5 8 0 Aphasia Learning to point Aphasia Relearning words with pictures Aphasia Relearning to write Aphasia Communicating on the computer Behaviour capabilities 33 8 1 7 Valuing security acceptance being loved keeping up to date Followup for depression psychology Followup for periods of mourning agressivity revolt frustration discouragement anxiety hope Changes of role and timetable sitting dependence on family for ADL outings organized differently driving car Sense and perception capabilities 6 1 1 0 Unilateralneglect reeducation reading eating dressing Hypersensitivity on affected side Spasticity Pain Motor activity capabilities 3 1 5 10 Learning to walk again loss of balance climbing stairs Physical exercises stiffness and followup Reeducation of upper limb and followup Digestion capabilities 3 3 2 0 Dysphagia reeducating family food and swallowing Discussion occupational therapist speech therapist dietician Excretion capabilities 3 0 0 0 Enuresis acceptance and dignity Support at day centre Reproduction capabilities 2 3 0 10 Expressing sexuality Availability of information little discussed by health professionals Protection and resistance capabilities 0 1 1 1 Pain Tiredness car driving and walking long distances Needs related to environmental factors Table 6 presents the themes emerging for each environmental factor of the DCP model according to the order shown in Figure 1 Four politicoeconomic factors were documented out of a possible seven sociohealth system medical care rehabilitation social assistance education system other types of instruction public infrastructure and community organizations Needs related to the political system and governmental structure the judicial system or the economic system were not reported by any of the participants One of the two sociocultural factors of the model was explored Social rules were not addressed by the participants Finally some physical elements were discussed Table 6 Partially met and unmet needs with respect to environmental factors Environmental Factors No of iterations reported by Themes Caregivers Health Professionals Healthcare Managers Patients Political economic factors Medical care sociohealth system 33 30 24 32 Information on existing services Access to services delays and disparities Followup and transfer of files between establishments Respite services for caregivers lodging sitting Longterm followup by CLSC 1 Information on medication Followup on taking medication Rehabilitation sociohealth system 64 63 17 39 Rehabilitation Multidisciplinary care for patients speech therapist neuropsychologist psychologist nutritionist Evaluation of care dependent on budget and services offered rather than on patients needs Personalized approach length of stay competency of staff with respect to aphasia knowledge of patients file feeding alternative therapy intensity of interventions services limited in some disciplines speech therapy attitude of staff with respect to overprotection staff rotation versus counselling Adjustment Access to services delays assistive technology adaptation of home and vehicle Disparities between services offered in different CLSC territories Obtaining AT and support for care process AT for the bathroom clamp electric bed portable hoists AT feeding grab bars emergency call button Home adaptation support for care process door frames bathroom access ramps lift on rails stairs exiting the home Vehicle adaptation Followup on attribution of AT and home adaptation Support and means to find resources in the community social worker doctor Psychosocial support offered to the family at start and end of stay Meeting with family at start and end of stay Social assistance sociohealth system 15 12 10 4 Information on existing services Discussion group and support for caregivers Discussion group for patients Sitting or respite services Day centre Temporary lodgings Support service for meeting with volunteers Voluntary support and partnership life project Who does what meetings voluntary work services care Other types of instruction education system 14 23 10 19 Direct instruction to caregiversfamily by health professionals bathroom hygiene with AT practising walking preventing falls medication aphasia exercises state of health nutrition feeding and nourishment basic care such as using the toilet Integration of caregiversfamily in vivo during care interventions gym therapy services plan day hospital Prevention of falls information meeting video Momentum for communicating information to patient and caregiver Education on consequences and impacts at home preparing for return home Education on mourning process Equip caregivers with tools to find services for the patients answers to their questions and support resources Public infrastructures 4 2 3 10 Adaptedaccessible transportation or paratransit Community organizations 1 9 2 2 Information on existing services directories Community services for stroke survivors Transport by community organizations Promotion and education by certain community organizations relating to consequences of stroke values attitudes Sociocultural factors Social Network 6 6 1 7 Family availability and relationships Friends social climate Physical factors Architecture National and regional development 2 0 0 7 Circulation space in public places walking frame wheelchair sidewalks ramps stairs Parking spaces Rest areas public benches Use of doors Technology 0 2 2 6 Access to mobility aids for shopping wheelchair walking frame tripod cane Access to special needs equipment pool treadmill rails 1 center of local community services Sociohealth system At the medical care level all the groups agreed on needs relating to financial and human resources scarcity of resources and most participants talked of difficulty accessing the services delays and disparities and obtaining followup Partially met or unmet needs were reported at several levels of rehabilitation For ease of understanding in Table 6 all the interventions aimed at improving a persons potential were classified under rehabilitation while those concerning adjustment to the human and physical environment were classified under adjustment Adjustment becomes necessary when an individuals rehabilitation has reached a plateau at that stage the individuals disabilities must be compensated by the human or physical environment 82 The themes arising from the discussions indicate that rehabilitation is not often personalized to the needs of the patient and that for reasons of budget and availability of resources the emphasis is put more on evaluating patients than on rehabilitation activities Lack of resources in psychology speech therapy and neuropsychology was also reported On the issue of adjustment the caregivers and health professionals exposed a number of problems relating to services for adapting the patients home or vehicle and with respect to obtaining technical assistance In addition to the disparities and delays in the various services there are also persistent social assistance emerges as an unmet need that is criticized by many Access to support groups for caregivers sitting and respite services and temporary lodging remain unmet needs expressed by many participants Regarding the education system with respect to other types of instruction not related to academics there is a pressing need to educate caregivers and to give the instruction at the right time The need for education was discussed in all the groups and to a greater degree among the health professionals Insofar as public infrastructure is concerned only the need for accessibleadapted transportation or paratransit was described as being partially met or unmet The issue of community resources was hardly raised at all this appeared to be a little known subject by all the groups of participants Finally with respect Sociocultural factors Just one sociocultural factor was discussed the social network This aspect remains an unmet need that was identified unanimously by the caregivers health professionals and patients alike The main points raised concerned relations with family friends and organizations promoting awareness in the community Physical factors At the development level of the DCP models physical factors partial and unmet needs were addressed if succinctly in terms of architecture national and regional development and technology related to medical devices or assistive technology used by people with stroke Needs related to life habits Table 7 presents all the themes that emerged per life habit according to the Disability Creation Process 18 Eleven life habit areas were documented out of a possible twelve only Education was not discussed One life habit was the subject of heated discussions in all the groups interpersonal relationships The managers and patients in particular reported various problems persisting in relationships with friends family members partners other patients and in the community The issue of carrying out personal care at home also emerged as an unmet need and was discussed by all four groups more especially by the health professionals The main difficulties lie in dressing use of the toilet and personal hygiene Travelling short and long distances Table 7 Partially met and unmet needs with respect to life habits Life habits No of iterations reported by Themes Caregivers Health Professionals Health Care Managers Patients Nutrition 3 4 0 8 Preparing food Independent feeding Feeding oneself Using kitchen utensils with one hand Mealsonwheels service Diet to be followed Difficulty swallowing Fitness 1 5 3 9 Enrolling in a group activity requiring use of upper limb Exercise program offered on discharge Changing bad habits smoking alcohol eating exercise Personal care 4 8 3 2 Dressing Use of toilet Personal hygiene Housing 1 0 0 1 Supervision at home and safe movement Mobility 8 0 0 8 Walking long distances Driving a car losing a license Trips outside the home with community organization volunteers restricted to bank doctor Adaptedaccessible transportation outings doctor Taxi expensive Communication 5 6 0 0 Stimulation for communication reading speaking Responsibility 0 1 0 1 Change in roles managing budget paying bills doing personal care going to the bank Interpersonal relationships 4 6 10 9 Visit from friends or family movement more difficult Family relations arguments humiliation Intimate and sexual relations difficult in lodgings Relationship with partner prevention separation divorce Resources for meeting people socially Relationships with other patients Community life 0 1 1 3 Going to church spiritual life Shopping difficult if have to walk and carry bags Adapted leisure activities Using banking services Employment and other habits 0 1 2 0 Social integration through leisure adapted or regular work or volunteer work find partners outside the health network Recreation 2 8 1 3 Availability of volunteers for adaptedaccessible transportation Openair activities in wheelchair and adapted vehicle Community leisure activities organized through day centre Seeing new areas Going on travels Using restaurants Discussion The results show that partially met and unmet needs exist with respect to nine types of personal capabilities nine environmental factors and the majority of life habits 11 out of 12 In light of these results what conclusions can we draw from the analysis of the expressed and normative needs of each of the four groups of experts consulted Furthermore how can the results obtained improve what we currently know about the rehabilitation needs of people with stroke Finally what were the advantages and limitations of using the DCP model for this study Expressed normative and comparative needs Half of the expressed needs corresponded to patients demands and were inherent to activities carrying social importance such as feeling well walking having sexual relations cooking keeping fit visiting friends driving or using public transport Few had restarted social activities outside the home Patients interviewed individually expressed the same opinions as those participating in the focus groups They would like more access to resources to reduce the burden on caregivers and to be more independent but they did not mention what kind of resources except for adaptedaccessible transportation or paratransit It is also possible that the stroke survivors did not The other half of the expressed needs corresponded to requests from caregivers They said they would like more means with which to facilitate patients integration at home and in the community They find it hard to cope with the behavioural problems of stroke sufferers and like the health professionals they deplore certain shortcomings in the adjustment and rehabilitation services Table 6 n 64 iterations and the critical need for social assistance and education This is probably linked to the fact that the persons they were taking care of had more serious disabilities than the patients participating in the focus groups and interviews The caregivers like the health professionals talked more about what should be done and were more specific in how they perceived rehabilitation and social support services than the patients and health care managers Normative needs were for the most part reported by the health professionals whose goal is to provide optimal rehabilitation services according to standard practices in the field but who also raised concerns relating to intervention type time restrictions the institutional environment and the type of disability They said they have very little time in which to provide the direct and indirect services necessary to ensure complete rehabilitation and to follow up on patients after hospital discharge they therefore rely on other resources for making the adjustments needed in the home environment Table 6 n 63 iterations The health professionals talked of their frustration in dedicating a large amount of time to evaluating patients and identifying rehabilitation goals but not being able to achieve all those goals It would therefore seem that health professionals have to make intervention choices more often according to the limitations of the institutional environment in which they work even if clinical data for their stroke patients show that some of those patients should be given more time and resources The health professionals said they concentrate their energies on the needs of people with severe disabilities Patients with only slight Comparative needs were mostly reported by the health care managers they believe it is important that responsibility for patients be properly assured by the teams of professionals in charge of them This is an attempt to standardise provision According to the managers the patients needs are inextricably linked with those of their families and in this sense the managers heavily emphasized the need to offer more instruction to caregivers and to make more support resources available to them and to the patients when they return home In one of the three groups of managers the discussion revolved mainly around the 6 medical care They suspect that there is a trend among health professionals to want to delegate responsibility for patient care The managers reported needs centred on means ie available resources financial human physical and the demand for services for stroke patients and their caregivers Table 6 rehabilitation The managers were of course aware of the service shortages in certain disciplines eg speech therapy and for the pressing need to find solutions for the wellbeing of patients but they did not have a lot to say on the subject of making the interventions more personalized to meet the needs of patients and caregivers Like the patients the health care managers talked more in terms of availability of resources and in a more global sense New awareness of rehabilitation needs and contribution of needs classification By comparing the viewpoints of the various people involved we can see a division between the two groups of patientshealth care managers and health professionalscaregivers Neither the patients nor the health care managers have to give direct assistance Patients receiving services or support are more concerned with having lost former significant occupations eg in Table 7 Preparing food walking long distance driving a car which is backed by the study of Brandiet et al 60 As for the managers they are primarily concerned with the productivity of their departments they must oversee the smooth functioning and organization of a service where patients caregivers and health professionals meet and they can not deal with the individual needs of each in any detail What the patients and the managers have in common is their concern for the how things stand at a given moment to be able to draw a profile of the situation It is a completely different scenario for the health care professionals and the caregivers who have to deal with behaviour that varies from 5 Followup for periods of mourning agressivity revolt frustration discouragement anxiety hope In this respect the needs perceived by health care professionals and caregivers are more centred on how the individual functions in his or her environment and on the intervention methods needed to optimize that persons rehabilitation and adjustment Even though the individualized approach is seen as the key to successful rehabilitation it is not often used according to the health care professionals the caregivers and the patients Many times the caregivers reported the lack of personalization in interventions and education They were in no way criticizing the skills of New awareness of rehabilitation needs and contribution of DCP model The partially met and unmet needs expressed normative arising in the various capabilities remain similar to those that have been documented normative needs with regard to cognitive problems intellectual and language capabilities 14 47 48 49 50 51 perceptual problems sense and perception protection and resistance 47 48 49 50 51 72 affective problems behaviour 60 61 62 72 and motor problems motor activity 14 44 45 72 The needs reported relating to behavioural skills corroborate existing literature with respect to a noticeable decline in functional and psychosocial activities during the first four years after the inpatient rehabilitation period and the fact that a number of rehabilitation interventions have not been completed when the patient is discharged 11 59 71 75 The patients and caregivers therefore expressed similar needs to those raised by the health care professionals With respect to digestion excretion and sexual relations reproduction capabilities as far as we are aware there are no points of comparison with literature on this subject The partially met and unmet needs that emerged with respect to environmental factors go beyond those that are already known and published in scientific journals The importance of meeting needs such as preparing for going back home care to be given education information and referral to community support resources 5 38 43 55 60 64 65 66 67 72 83 are all issues raised in our study and which are reported under themes linked to the sociohealth system and education system under the DCP model In this respect the results obtained from our 12 focus groups corroborate the literature many patients continue to face problems of social participation and many of these intensive postrehabilitation needs have not been met The originality of the results of this study lies in the factors explaining the unmet rehabilitation needs Furthermore the partially met and unmet needs relating to environmental factors also show that they are far from optimal with respect to assuring the Finally partially met and unmet needs expressed in relation to life habits are concordant with previous studies but they are more specific than the problems identified of a functional nature stroke and mobility 10 60 61 and psychosocial nature 22 40 43 49 52 53 54 55 56 57 58 59 72 Our study identifies needs associated with eating habits personal care housing travel communication consumption of goods and services as well as fitness of body and mind taking responsibilities relationships with others primary occupation and leisure activities The subthemes that emerged suggest ways towards concrete solutions for the various levels of decisionmakers In short the DCP model will have made it possible to highlight the partially met and unmet needs relating to environmental factors that were not mentioned in literature This finding is hardly surprising for most of the studies already conducted did not concentrate on elderly peoples adjustment to their home environments whether in the home or in the community Strengths and limitations of the study and future research This study presents a number of strong points with respect to trustworthiness of qualitative research Certain strategies suggested by Krefting 80 ensure rigor without sacrificing the relevance of the qualitative research First to ensure the credibility truth value of results it was developed by researchers in different disciplines involved in the rehabilitation of older adults and considers the views of everyone involved in the process from the patient to the health care manager Furthermore the density of descriptions obtained in the various groups helps us get a clear understanding of the expressed and normative needs put forward To ensure the transferability applicability of the results the diversity of the sample sought when recruiting by reasoned choice as well as the description The limitations of this study are associated with the research design descriptive transversal The results only take account of the sociopolitical sociocultural and physical environments of three regions of Quebec Due to the size of the groups the transferability of the data can not be completely assured at least for persons with stroke Indeed given the various possible profiles of stroke patients it is plausible that some needs were not addressed in our study because we did not have a sufficiently wide representation of patients There is a certain selection bias inherent to participation in the focus groups or interviews Other studies are necessary to continue validation of the needs according to the Disability Creation Process framework The expected results of a farreaching longitudinal study led by our group will enable us to document more precisely the various degrees and types of disabilities of people with stroke how they carry out their life habits and the obstacles they come up against in their environment Conclusion Better knowledge of the needs of people with stroke in accomplishing the activities and social roles they value is essential for improving rehabilitation services because social participation is recognized as being the ultimate goal of rehabilitation The presence of handicap situations in areas such as interpersonal relationships mobility and leisure can isolate the person and foster the development of secondary disabilities if appropriate interventions are not offered A better knowledge of rehabilitation needs and changes in them after discharge from formal services will improve coordination of these services and develop other services to address needs that are not currently being Declarations Acknowledgements In addition to the authors of this paper the BRAD group is composed of Sylvie Belleville Gina Bravo Louise Demers Philippe Landreville Louisette Mercier Nicole Paquet Hélène Payette Constant Rainville Bernadette Ska and René Verreault The BRAD group collaborated for the overall research protocol which includes five other objectives and methods related to the rehabilitation needs of stroke clientele This study was carried out with the financial support of the Canadian Health Research Institute CHRI and the Réseau québécois de recherche sur le vieillissement du Fonds de la recherche en santé du Québec FRSQ Dr Claude Vincent holds a FRSQ Authors original submitted files for images Below are the links to the authors original submitted files for images 12877_2006_84_MOESM1_ESMjpeg Authors original file for figure 1 Competing interests The authors declare that they have no competing interests Authors contributions CV conceived the design of the study participated in the data analysis and outlined and drafted the manuscript ID managed the database performed the data analysis and commented the manuscript LR conceived design the study participated in the data analysis and commented the manuscript JR conceived design the study participated in the data analysis and commented the manuscript ChV formed the focus groups and conducted the interviews performed the data analysis and commented the manuscript JD was the principal investigator submitted the research protocol for its financing conceived the design of the study and the coordination of all the research 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O O O O O B O O B I O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

rehabilitation
older adults
four populations


Rank Overall 15209 51 Red Scare 2017 95 Rating s 35 Comment s GeekBuddy Analysis 4 10 Players Community no votes 20 30 Min Playing Time Age 10 Community no votes Weight 233 5 Complexity Rating Designer Benjamin Kanelos Artist Ian OToole Publisher Pandasaurus Games See Full Credits My rating Overview Ratings Forums Images Videos Files Stats Expansions Versions My Games Market Ad Get Red Scare on Amazoncom from 1192 Eligible for Super Saver Shipping Sponsor Amazoncom See All Description Classification Type Uncategorized Category Deduction Negotiation Political SpiesSecret Agents Mechanisms Partnerships Variable Player Powers Family Country USA Advertisement The threat of Communist infiltration is at an alltime high and red panic is everywhere Its on you trusted patriots of the FBI to scour the files of any and all that may be promoting the Soviet agenda and threatening these sacred shores The nation trusts you to detect then publicly accuse and deport these traitors But watch out because double agents are everywhere Even your closest colleagues are not to be trusted Perhaps even you have something to hide Red Scare is a hidden rolesocial deduction game with a delightful wrinkle the only way to discover the truth about your friends is with a pair of secret decoder glasses The game features no player elimination so everyone is in on it until the end Official Links Propose Official Link Additional Suggestions Language Dependence no votes Community Stats Own 266 Wishlist 176 For Trade 26 Want In Trade 16 Has Parts 0 Wants Parts 0 See All Stats BGG Item ID 224212 Buy a Copy Stores Ebay listings GeekMarket Recent Sell a Copy Price History Advertisement Videos Hot Review No video found Hot How To Play No video found Latest Video No video found InDepth Reviews Hot Reviews No reviews found Recent Reviews No reviews found Forums Threads No discussions found Threads No discussions found See All 999999 Files Top Files Recent Files See All 999999 Community Wiki This page does not exist You can edit this page to create it More of This Game 0 Expansions 1 Versions 0 Accessories 0 Contains 0 Contained in 0 Reimplemented By 0 Reimplements 0 Video Game Adaptations 0 Integrates With Community Tags News Links 1 Web Links 1 BGG News 6 BGG Blog Posts 4 Podcasts GeekLists with This Game

O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O B I O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

red scare
benjamin kanelos
pandasaurus games


8 IMPORTANT FIORA BUG Fiôrà EUNE submitted 3 months ago in httpsyoutube4q2y9Qn6fmk Fiora Bug Second Video httpsimgurcomIHYB5zz So lately Q prioritizes Minions INSTEAD of Vitals and Champions which caused me to lose a lot of kills I experienced this Bug a lot since Patch 818 I do think this bug is Gamebreaking if you are playing Fiora I know there are alot Fiora bugs like Double Vitals but really cant pick Fiora in ranked anymore since i cant rely on Q to proc Vitals EDIT Please click on the Second Video as its a actually a gif and wont Autoplay on boards 7 comments Sort comments by Best New Switch to Chronological View Post Login to comment 6 FreeOfChargeHoe EUW 3 months ago but really can039t pick Fiora in ranked anymore I think that majority of top mains are grateful for this Login to comment Permalink 1 StDouchebag NA 3 months ago So correct me if Im wrong but Im pretty sure that if you click on the minion while youre using your q it will attack the minion or whatever you click on as you q so its possible that you clicked a minion accidentally as you qd I only say this cuz I have her m7 and Ive never experienced that happening to me unless I misclicked and hit a minion myself Login to comment Permalink 1 Fiôrà EUNE 3 months ago StDouchebag NA 3 months ago So correct me if Im wrong but Im pretty sure that if you click on the minion while youre using your q it will attack the minion or whatever you click on as you q so its possible that you clicked a minion accidentally as you qd I only say this cuz I have her m7 and Ive never experienced that happening to me unless I misclicked and hit a minion myself Hii sorry but im sure it definitely does not work like that Also its going to be fixed next patch was told by a Rioter Legit On reddit cant quite remember his name though Login to comment Permalink 1 Noor Sakata EUW 3 months ago I had a Fiora bug lately happening to me a lot it shows 2 passive vitals on enemies sometimes one of them is fake and the other is the right one and now gotta play the guessing game I lost Login to comment Permalink 1 Fiôrà EUNE 3 months ago Noor Sakata EUW 3 months ago I had a Fiora bug lately happening to me a lot it shows 2 passive vitals on enemies sometimes one of them is fake and the other is the right one and now gotta play the guessing game I lost Yeah that bug has been around Since Reworked Fiora Launch 2015 I can say its quite frustrating and causes me to lose as well Login to comment Permalink 1 ONLY PLAY TO WIN EUNE 3 months ago Looks like barely out of range for me but I cant tell for sure as I havent played Fiora in a long time Login to comment Permalink 1 XxDRAGONsAK47xX NA 3 months ago Ive seen that happen playing against Fioras before I literally won lane in ranked once because she lost the 1v1 because her q prioritized minion Login to comment Permalink Create a Discussion Boards Home UNIVERSAL RULES Boards User Guide Boards Discord Discuss the Boards Red Tracker Dev Corner The Game Gameplay Gameplay Player Behavior Story Art Sound Recruitment Clash Creative Corner Concepts Creations Streams Videos Community General Discussion Memes Games Esports Roleplay Event Finder Mechs vs Minions Support Report A Bug Client Discussion Service Status Guidelines Culture This is the place to report bugs that you find within League of Legends Something that occurs within the Client patching related issues or anything that involves gameplay stuns not working unintended interactions between abilities vision issues etc should be posted here Please do NOT post about disconnects or lag Instead redirect those problems to Etiquette Basically follow these steps when reporting an issue and keep the content focused on active bugs in League of Legends Game or Client We want to learn about all the bugs you guys discover but we also want to organize them track them and make sure we have the information we need to fix them Before you post please consider what kind of a bug youre posting and categorize it appropriately using the suggested tags below Gameplay Champions items and game systems etc Client The air client patcher etc Crash Bugsplats Thanks in advance for your awesome bug reports Eeaugh Bugs are gross Ugh

O O B I O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O