Training muscle activation patterns of the lower paretic extremity using directional exertion improves mobility in persons with hemiparesis: a pilot study

Background

Controlled static exertion performed in the sagittal plane on a transducer attached to the foot requires coordinated moments of force of the lower extremity. Some exertions and plantarflexion recruit muscular activation patterns similar to synergies previously identified during gait. It is currently unknown if persons with hemiparesis following stroke demonstrate similar muscular patterns, and if force feedback training utilizing static exertion results in improved mobility in this population.

Methods

Electromyographic (EMG) activity of eight muscles of the lower limb were recorded using surface electrodes in healthy participants (n = 10) and in persons with hemiparesis (n = 8) during an exertion exercise (task) performed in eight directions in the sagittal plane of the foot and a plantarflexion exercise performed at 20 and 40% maximum voluntary effort (MVE). Muscle activation patterns identified during these exertion exercises were compared between groups and to synergies reported in the literature during healthy gait using cosine similarities (CS). Functional mobility was assessed in four participants with hemiparesis using GAITRite® and the Timed Up and Go (TUG) test at each session before, during and after static force feedback training. Tau statistics were used to evaluate the effect on mobility before and after training. Measures of MVE and the accuracy of directional exertion were compared before and after training using ANOVAs. Spearman Rho correlations were also calculated between changes in these parameters and changes in mobility before and after the training.

Results

Muscle activation patterns during directional exertion and plantarflexion were similar for both groups of participants (CS varying from 0.845 to 0.977). Muscular patterns for some of the directional and plantarflexion were also similar to synergies recruited during gait (CS varying from 0.847 to 0.951). Directional exertion training in hemiparetic subjects resulted in improvement in MVE (p < 0.040) and task performance accuracy (p < 0.001). Hemiparetic subjects also demonstrated significant improvements in gait velocity (p < 0.032) and in the TUG test (p < 0.022) following training. Improvements in certain directional efforts were correlated with changes in gait velocity (p = 0.001).

Conclusion

Static force feedback training following stroke improves strength and coordination of the lower extremity while recruiting synergies reported during gait and is associated with improved mobility.

Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report

BACKGROUND

Irritable bowel syndrome (IBS) appears to have a bidirectional interaction with both depressive and anxiety-related complaints. However, it remains unclear how exactly the psychological complaints, at the individual level, are related to somatic symptoms on a daily basis. This single case study investigates how somatic and psychological variables are temporally related in a patient with irritable bowel syndrome.

CASE REPORT

The patient was a woman in her mid-twenties with an IBS diagnosis. She reported frequent soft bowel movements (5-6 times per day), as well as flatulence and abdominal pain. She resembled a typical IBS patient; however, a marked feature of the patient was her high motivation for psychosomatic treatment as well as her willingness to try new strategies regarding the management of her symptoms. As an innovative approach this single case study used a longitudinal, observational, time series design. The patient answered questions regarding somatic and psychological variables daily over a period of twelve weeks with an online diary. The diary data was analysed using an autoregressive (VAR) modeling approach. Time series analyses showed that in most variables, strong same-day correlations between somatic (abdominal pain, daily impairment) and psychological time series (including coping strategies) were present. The day-lagged relationships indicated that higher values in abdominal pain on one day were predictive of higher values in the psychological variables on the following day (e.g. nervousness, tension, catastrophizing, hopelessness). The use of positive thinking as a coping strategy was helpful in reducing the pain on the following days.

CONCLUSION

In the presented case we found a high correlation between variables, with somatic symptoms temporally preceding psychological variables. In addition, for this patient, the use of positive thoughts as a coping strategy was helpful in reducing pain.

Using virtual reality to target positive autobiographical memory in individuals with moderate-to-moderately severe depressive symptoms: A single case experimental design

So far, several aspects of autobiographical memory (AM) have been found to be impaired in depression. Among others, depressed patients show the tendency to recall more negative than positive events (i.e., negative bias) and usually retrieve memories that lack of specificity and details (i.e., overgeneral memories). Based on this, we designed an AM task enhanced by the use of virtual reality (VR) to specifically train the recall of positive memories. Using a single-case, multiple baseline experimental design, we explored the effects of a brief intervention consisting of two sessions of this training in a sample of 18 individuals with moderate-to-moderately severe depressive symptoms. According to the results, changes occurred at the short term only. In particular, almost all participants reported a significant improvement in at least one outcome measure 0-3 days after the intervention. However, these clinical gains were not maintained in the mid-term (from day 4 to 10). The present findings do not support the efficacy of our VR-based AM recall treatment as a standalone intervention. Nevertheless, it might represent a suitable procedure to obtain immediate and/or short-term improvements. It might also serve as a valid component to be integrated in broader protocols for patients with moderate-to-moderately severe depressive symptoms.

An Interpretative Phenomenological Analysis of a Religious Conversion

Religious conversion is an important phenomenon in contemporary religious climate, but existing psychology research work is mostly based on quantitative methods. In an attempt to contribute to this field, the present study proposes a qualitative exploration of religious conversion. The in-depth interview of a French woman is examined in order to investigate her experience of religious conversion, 40 years prior. The interview was analysed using interpretative phenomenological analysis, with the purpose of revealing how the participant experienced the process of religious conversion, what was its impact on her life, identity and personality and how she coped with this impact. The four emerging themes were: conflicted relationship with Judaism, the pursuit of a spiritual quest, changes after conversion and life after conversion. These themes painted the image of a powerful spiritual transformation, a profound and dynamic lifelong process, integrating concepts and practices, life changes and developments. The findings are explained with the help of available literature.

Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety

BACKGROUND

Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem.

AIMS

The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA.

METHODS AND PROCEDURES

A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the client's text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the client's anxious and challenging behaviour. The social validity was evaluated by means of questionnaires.

OUTCOMES AND RESULTS

There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA.

CONCLUSION AND IMPLICATION

Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.