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Kumral E, Dorukoğlu M, Uzunoğlu C, Çetin FE. The clinical and cognitive spectrum of locked-in syndrome: 1-year follow-up of 100 patients. Acta Neurol Belg 2022; 122:113-121. [PMID: 33987814 DOI: 10.1007/s13760-021-01675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
In patients with locked-in syndrome (LIS), it is not known exactly to what extent cognitive functions are preserved and it is not known exactly how much it has improved. We aimed to examine the clinical and cognitive features of LIS 1 year after stroke. One hundred patients with locked-in syndrome (LIS) were recruited between January 2008 and May 2019 among 8200 patients with ischemic stroke. Patients were classified into two groups as single pontine infarcts (n = 72), and pontine plus multiple ischemic lesions (PMIL) (n = 28). Since the patients had limited motor and verbal response, the cognitive status of the patients in the early and late stages was evaluated with the Short Neuropsychological Questionnaire for Disabled Patients (SNQDP) test. At the onset of stroke, orientation to time and place was normal in 43% of patients with a single infarct compared with 18% of those with PMIL (OR 3.48; 95% CI 1.10-10.18; P = 0.015). There was no sustained visual fixation or tracking in 53% of patients with a single pontine infarct and 82% of those with PMIL (OR 4.12; 95% CI 1.41-12.02; P = 0.005). After 1-year follow-up, there was significant difference between patients with a single infarct and those with PMIL regarding to perception and execution, especially complex command follow (P = 0.042), attention span and concentration (P = 0.30), intelligible verbalization (P = 0.022). There was relatively high incidence (24%) of patients with a "good outcome" (mRS = 3) in those with single infarct. Given as in our study that many patients can show significant improvement in LIS, we recommend aggressive supportive measures, intense physical, speech and cognitive therapy to facilitate interaction with others and the environment.
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Affiliation(s)
- Emre Kumral
- Stroke Unit, Department of Neurology, School of Medicine, Ege University, Bornova, Izmir, Türkiye.
| | - Mesut Dorukoğlu
- Stroke Unit, Department of Neurology, School of Medicine, Ege University, Bornova, Izmir, Türkiye
| | - Cansu Uzunoğlu
- Anesthesia and Reanimation Department, School of Medicine, İzmir, Türkiye
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Ponti A, Berardi A, Galeoto G, Marchegiani L, Spandonaro C, Marquez MA. Quality of life, concern of falling and satisfaction of the sit-ski aid in sit-skiers with spinal cord injury: observational study. Spinal Cord Ser Cases 2020; 6:8. [PMID: 32034122 PMCID: PMC7007432 DOI: 10.1038/s41394-020-0257-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE To describe (1) user satisfaction, (2) the Quality of Life (QoL) and (3) fear of falling in individuals with tetraplegia or paraplegia who used a mono-ski for sit-skiing. SETTING Spinal units and Sport associations. METHODS An observational study of people with spinal cord injury (SCI) who used a sit-ski. Participants were recruited in various SCI rehabilitation centers and sport associations. Participants completed three assessment tools: the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0); the World Health Organization Quality of Life (WHOQoL-BREF); the Spinal Cord Injury Fall Concern Scale (SCI-FCS). Results were evaluated with chi-squared test and Kolmogorov-Smirnov's test and the significance was set for p values < 0.05. RESULTS Fifteen participants were included. Results showed positive and statistically significant values for all the items of the SCI-FCS related to fear of falling, and for most of the items of the WHOQoL-BREF related to QoL and the QUEST 2.0 related to satisfaction with the device. CONCLUSIONS This study highlights that sit skiing is correlated with high levels of satisfaction with the mono-ski, increases in QoL, and low levels of fear of falling. In adding these findings to the existent literature, it can be stated with more certainty that sit-skiing is a sport that can be recommended in rehabilitation and sports therapy programs.
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Affiliation(s)
| | | | - Giovanni Galeoto
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy.
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Kashif M, Jones S, Darain H, Iram H, Raqib A, Butt AA. Factors influencing the community integration of patients following traumatic spinal cord injury: a systematic review. J PAK MED ASSOC 2019; 69:1337-1343. [PMID: 31511721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. . METHODS Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period. RESULTS A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals. CONCLUSIONS The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.
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Affiliation(s)
- Muhammad Kashif
- Riphah College of Rehabilitation Sciences, Riphah International University
| | - Shirley Jones
- Department of Allied Health, Anglia Ruskin University, Cambridge UK
| | - Haider Darain
- Institute of Physical Medicine & Rehabilitation, Khyber Medical University Peshawar
| | - Humaira Iram
- Riphah College of Rehabilitation Sciences, Riphah International University
| | - Abdul Raqib
- DHQ Teaching Hospital Dera Ismail Khan (KPK), Pakistan
| | - Asif Ali Butt
- Riphah College of Rehabilitation Sciences, Riphah International University
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Khalili Ardali M, Rana A, Purmohammad M, Birbaumer N, Chaudhary U. Semantic and BCI-performance in completely paralyzed patients: Possibility of language attrition in completely locked in syndrome. Brain Lang 2019; 194:93-97. [PMID: 31151035 DOI: 10.1016/j.bandl.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/14/2019] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
Patients with completely locked-in syndrome (CLIS) are incapable of any voluntary muscle movement and do not have any means of communication. Recently functional near infrared spectroscopy (fNIRS) based brain computer interface (BCI) has been successfully used to enable communication with these patients. The developed fNIRS-BCI system relies on the intactness of language comprehension in these patients in all dimensions of language. Interwoven language and motor cortex in brain, and lack of muscular activity in long run, can cause language attrition due to complete immobility in CLIS patients. In this study we have investigated effects of semantic content of sentences presented to a CLIS patient on the performance of the BCI system during a YES/NO paradigm. Comparison of communication success rate in BCI classification between different semantic categories indicate that semantic content of sentences presented to a CLIS patient can affect the BCI performance. Affected concepts are mostly associated with executive words. These findings can be beneficial towards development of more reliable communication device for patients in CLIS. In addition, these results may assist in elucidating the cognitive changes in completely paralyzed patients with the passage of time since the onset of total immovability.
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Affiliation(s)
- Majid Khalili Ardali
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Department of Cognitive Linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Aygul Rana
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany
| | - Mehdi Purmohammad
- Department of Cognitive Linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland.
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Berlowitz DJ, Schembri R, Graco M, Ross JM, Ayas N, Gordon I, Lee B, Graham A, Cross SV, McClelland M, Kennedy P, Thumbikat P, Bennett C, Townson A, Geraghty TJ, Pieri-Davies S, Singhal R, Marshall K, Short D, Nunn A, Mortimer D, Brown D, Pierce RJ, Cistulli PA. Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial. Thorax 2019; 74:282-290. [PMID: 30538163 PMCID: PMC6467247 DOI: 10.1136/thoraxjnl-2018-212319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/03/2022]
Abstract
RATIONALE Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER ACTRN12605000799651.
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Affiliation(s)
- David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Jacqueline M Ross
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Najib Ayas
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Gordon
- Statistical Consulting Centre, School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Bonne Lee
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Allison Graham
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Susan V Cross
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Martin McClelland
- Princess Royal Spinal Cord Injuries Centre, Northern General Hospital, Sheffield, UK
| | - Paul Kennedy
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Pradeep Thumbikat
- Princess Royal Spinal Cord Injuries Centre, Northern General Hospital, Sheffield, UK
| | | | - Andrea Townson
- Department of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy J Geraghty
- Queensland Spinal Cord Injuries Service and The Hopkins Centre, Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Woolloongabba, Queensland, Australia
| | - Sue Pieri-Davies
- North West Regional Spinal Injuries Centre, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Raj Singhal
- Burwood Spinal Unit, Burwood Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Karen Marshall
- Burwood Spinal Unit, Burwood Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Deborah Short
- The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Doug Brown
- Spinal Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Robert J Pierce
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Medical School, University of Sydney, Melbourne, New South Wales, Australia
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Harris CA, Shauver MJ, Nasser JS, Chung KC. The golden year: How functional recovery sets the stage for tendon transfer surgery among patients with tetraplegia-a qualitative analysis. Surgery 2019; 165:365-372. [PMID: 30172564 PMCID: PMC10684031 DOI: 10.1016/j.surg.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tendon transfer surgery can effectively improve hand function for patients with tetraplegia but remains poorly utilized. Little is known regarding how patients' rehabilitation experiences influence their perception of function, identity, and coping to shape their reconstructive context. METHODS We performed a cross-sectional qualitative analysis of 19 participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured interviews were conducted using an interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory. RESULTS The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association grades A-D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing rehabilitation's necessity, functional gains, and constructive patient-therapist relationships promoted engagement in therapy. Poor insurance coverage and financial constraints decreased rehabilitation access. Function affected identity through the degree to which it tied participants to a "patient" role. Early in recovery, patients' function, roles, and attitudes were fluid but solidified over time; how satisfied patients were with these final positions influenced how they coped. CONCLUSION The balance of patients' positive and negative coping has been found to influence patients' progression to surgery. This study describes how function and identity contribute to coping. Participants' function and identity evolved during a finite period we call "the golden year," before reaching a fixed point around which they built their lives. The norms patients establish during this time may affect receptiveness to surgery.
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Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
| | - Melissa J Shauver
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jacob S Nasser
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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Ellison B. The Patient as Professor: How My Life as a Person with Quadriplegia Shaped My Thinking as an Ethicist. Perspect Biol Med 2019; 62:342-351. [PMID: 31281126 DOI: 10.1353/pbm.2019.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Limburg SD, Pols J, Limburg M. [Is there quality of life with locked-in syndrome?]. Ned Tijdschr Geneeskd 2018; 161:D2048. [PMID: 29328011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 57-year-old man developed a locked-in state due to a brain stem stroke. He communicated through eye movements. The team suggested treatment should be discontinued, as there was no perspective of improvement. The family was very upset because they experienced sufficient quality of life. We investigated what 'quality of life' means. The literature shows that severely ill and completely care-dependent patients may experience high quality of life; this is called the disability paradox. Patients and families evaluate quality of life by looking for positive things to live for. Some quality-of-life tests, however, understand quality of life as 'functionality'. Healthy people evaluate the situation of people living with handicaps more negatively than the handicapped themselves do. Practitioners may overlook the instability of patients' evaluations: responses and situations may shift. Quality of life as an outcome in clinical trials may be different for individual patients. These insights may improve communication.
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Affiliation(s)
- S D Limburg
- Academisch Medisch Centrum-Universiteit van Amsterdam, afd. Huisartsgeneeskunde, sectie Medische Ethiek, Amsterdam
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Harris CA, Muller JM, Shauver MJ, Chung KC. Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia. J Hand Surg Am 2017; 42:495-505.e11. [PMID: 28669418 PMCID: PMC5753404 DOI: 10.1016/j.jhsa.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that upper extremity reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. METHODS Nineteen patients with C4-8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semistructured interviews were conducted and transcripts evaluated using grounded theory methodology. RESULTS Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: (1) functional dissatisfaction, (2) awareness of UER, and (3) acceptance of surgery. Patients' ability to meet these criteria was determined by 3 checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. CONCLUSIONS We built a conceptual model that outlines how patients' personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. CLINICAL RELEVANCE To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.
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Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - John-Michael Muller
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Melissa J Shauver
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI.
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Marcondes BF, Sreepathi S, Markowski J, Nguyen D, Stock SR, Carvalho S, Tate D, Zafonte R, Morse LR, Fregni F. Pain severity and mobility one year after spinal cord injury: a multicenter, cross-sectional study. Eur J Phys Rehabil Med 2016; 52:630-636. [PMID: 26616359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Following a spinal cord injury, patients are often burdened by chronic pain. Preliminary research points to activation of the motor cortex through increased mobility as a potential means of alleviating postinjury chronic pain. AIM The aim of this study was to assess the relationship between pain severity and mobility among patients who have sustained a traumatic spinal cord injury while controlling for clinically-relevant covariates. DESIGN A multi-center, cross-sectional study. SETTING The SCIMS is composed of 14 centers, all located in the United States and funded by the National Institute on Disability and Rehabilitation Research (NIDRR). POPULATION The study cohort included 1980 patients who completed the one-year SCIMS follow-up assessment between October 2000- December 2013. METHODS A multi-center, cross-sectional study was performed to assess the impact of mobility on self-reported pain using information from 1980 subjects who sustained a traumatic spinal cord injury and completed a year-one follow-up interview between October 2000 and December 2013. Patient information was acquired using the Spinal Cord Injury National Database, compiled by the affiliated Spinal Cord Injury Model Systems. Analyses included a multivariable linear regression of patients' self-reported pain scores on mobility, quantified using the CHART-SF mobility total score, and other clinically relevant covariates. RESULTS After controlling for potential confounders, a significant quadratic relationship between mobility and patients' self-reported pain was observed (P=0.016). Furthermore, female gender, "unemployed" occupational status, paraplegia, and the presence of depressive symptoms were associated with significantly higher pain scores (P<0.02 for all variables). Statistically significant quadratic associations between pain scores and age at injury, life satisfaction total score, and the CHART-SF occupational total subscale were also observed (P≤0.03 for all variables). CONCLUSIONS Among patients with moderate to high levels of mobility, pain scores decreased with increasing mobility. CLINICAL REHABILITATION IMPACT Enhancing a patient's physical activity by increasing his or her mobility may reduce neuropathic pain if begun shortly after a spinal cord injury.
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Affiliation(s)
- Bianca F Marcondes
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA -
| | - Shruti Sreepathi
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | - Justin Markowski
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | - Dung Nguyen
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | - Shannon R Stock
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | - Sandra Carvalho
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA -
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Denise Tate
- University of Michigan Spinal Cord Injury Model System, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ross Zafonte
- Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslie R Morse
- Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA -
- Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Middleton JW, Tran Y, Lo C, Craig A. Reexamining the Validity and Dimensionality of the Moorong Self-Efficacy Scale: Improving Its Clinical Utility. Arch Phys Med Rehabil 2016; 97:2130-2136. [PMID: 27422349 DOI: 10.1016/j.apmr.2016.05.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To improve the clinical utility of the Moorong Self-Efficacy Scale (MSES) by reexamining its factor structure and comparing its performance against a measure of general self-efficacy in persons with spinal cord injury (SCI). DESIGN Cross-sectional survey design. SETTING Community. PARTICIPANTS Adults with SCI (N=161; 118 men and 43 women) recruited from Australia (n=82) and the United States (n=79), including 86 with paraplegia and 75 with tetraplegia. INTERVENTIONS None. MAIN OUTCOME MEASURES Confirmatory factor analysis deriving fit indices on reported 1-, 2-, and 3-factor structures for the MSES. Exploratory factor analysis of MSES using principal component analysis with promax oblique rotation and structure validation, with correlations and multiple regression using cross-sectional data from the Sherer General Self-Efficacy Scale and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS The MSES was confirmed to have a 3-factor structure, explaining 61% of variance. Two of the factors, labeled social function self-efficacy and personal function self-efficacy, were SCI condition-specific, whereas the other factor (accounting for 9.7% of variance) represented general self-efficacy, correlating most strongly with the Sherer General Self-Efficacy Scale. Correlations and multiple regression analyses between MSES factors, Sherer General Self-Efficacy Scale total score, SF-36 Physical and Mental Component Summary scores, and SF-36 domain scores support validity of this MSES factor structure. No significant cross-cultural differences existed between Australia and the United States in total MSES or factor scores. CONCLUSIONS The findings support a 3-factor structure encompassing general and SCI domain-specific self-efficacy beliefs and better position the MSES to assist SCI rehabilitation assessment, planning, and research.
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Affiliation(s)
- James W Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards; and Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
| | - Yvonne Tran
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards; and Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Charles Lo
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards; and Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Ashley Craig
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards; and Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
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Chooljian DM, Hallenbeck J, Ezeji-Okoye SC, Sebesta R, Iqbal H, Kuschner WG. Emotional Support for Health Care Professionals: A Therapeutic Role for the Hospital Ethics Committee. J Soc Work End Life Palliat Care 2016; 12:277-288. [PMID: 27462956 DOI: 10.1080/15524256.2016.1200519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in the case presented.
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Affiliation(s)
- David M Chooljian
- a Pulmonary Section, Medical Service, Veterans Affairs Loma Linda VA Healthcare System; and Division of Pulmonary and Critical Care Medicine, Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
| | - James Hallenbeck
- b Extended Care (Nursing Home Care, Home Care, Hospice and Palliative Care), Veterans Affairs Palo Alto Health Care System; and Division of General Medical Disciplines, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Stephen C Ezeji-Okoye
- c Director's Office Veterans Affairs Palo Alto Healthcare System; and Division of General Medical Disciplines, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Robert Sebesta
- d Social Work Service , Central Texas Veterans Health Care System , Temple , Texas , USA
| | - Hasan Iqbal
- e Pulmonary Section, Medical Service , Veterans Affairs Palo Alto Health Care System , Palo Alto , California , USA
| | - Ware G Kuschner
- f Pulmonary Section, Medical Service, Veterans Affairs Palo Alto Health Care System; and Division of Pulmonary and Critical Care Medicine, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
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Maiser S, Kabir A, Sabsevitz D, Peltier W. Locked-In Syndrome: Case Report and Discussion of Decisional Capacity. J Pain Symptom Manage 2016; 51:789-793. [PMID: 26674610 DOI: 10.1016/j.jpainsymman.2015.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 12/14/2022]
Abstract
Locked-in syndrome (LIS) is a rare neurologic disorder rendering an individual quadriplegic and anarthric with preserved self-awareness and normal if not near-normal cognition. A lesion to the ventral pons causes the classic form of LIS, and patients can typically interact with their environment with eye/eyelid movements. LIS patients may live for years with preserved quality of life (QoL) and cognitive function, but with severe disability. However, medical providers and family often underestimate the patient's QoL, and choose less aggressive care. Prompt assessment of decisionality in LIS patients is challenging, but it must be done to allow these patients to participate in their care. We present the case of a 54-year-old man with LIS. The medical team recommended comfort measures, but the family advocated involving the patient in goals of care discussions. The patient was determined to be decisional during the acute hospitalization, and he elected for life-prolonging care. This case emphasizes the importance of unbiased shared decision making, but also the importance of utilizing a practical framework to assess the decision-making capacity in these patients. We provide a suggested approach to determining decision-making capacity in similar cases or conditions.
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Affiliation(s)
- Samuel Maiser
- Palliative Care Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Departments of Neurology and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | - Ashish Kabir
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David Sabsevitz
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wendy Peltier
- Palliative Care Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Abstract
Ms B's in United Kingdom and Ms P's in Finland choices in life when dealing with acute ventilator-assisted tetraplegia were analyzed by means of Viktor E. Frankl's existential analysis/logotherapy. The freedom of will to existential meaning and to worth in one's suffering realizes in the attitudinal change the person chooses or is forced to adopt when subject to severe circumstances. Life becomes existentially meaningful relative to inescapable suffering by the completion of three values: creative, experiential, and attitudinal values. If the search for meaning on these paths is frustrated or obstructed, a person's will to meaning transforms into existential frustration along with an existential vacuum and feelings of despair emerge and harm the person's will to survive. However, a person's frustrated meaning in life, when subject to unavoidable severe conditions, can be averted and redirected by applying the basic tenets in an existential analytic/logotherapeutic approach to the extreme situation.
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Abstract
One of the central claims of the neurodiversity movement is that society should accommodate the needs of autistics, rather than try to treat autism. People have variously tried to reject this accommodation thesis as applicable to all autistics. One instance is Pier Jaarsma and Stellan Welin, who argue that the thesis should apply to some but not all autistics. They do so via separating autistics into high- and low-functioning, on the basis of IQ and social effectiveness or functionings. I reject their grounds for separating autistics. IQ is an irrelevant basis for separating autistics. Charitably rendering it as referring to more general capacities still leaves us mistaken about the roles they play in supporting the accommodation thesis. The appeal to social effectiveness or functionings relies on standards that are inapplicable to autistics, and which risks being deaf to the point of their claims. I then consider if their remaining argument concerning autistic culture may succeed independently of the line they draw. I argue that construing autistics' claims as beginning from culture mistakes their status, and may even detract from their aims. Via my discussion of Jaarsma and Welin, I hope to point to why the more general strategy of separating autistics, in response to the accommodation thesis, does not fully succeed. Finally, I sketch some directions for future discussions, arguing that we should instead shift our attention to consider another set of questions concerning the costs and extent of change required to accommodate all autistics.
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Käthner I, Kübler A, Halder S. Comparison of eye tracking, electrooculography and an auditory brain-computer interface for binary communication: a case study with a participant in the locked-in state. J Neuroeng Rehabil 2015; 12:76. [PMID: 26338101 PMCID: PMC4560087 DOI: 10.1186/s12984-015-0071-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we evaluated electrooculography (EOG), an eye tracker and an auditory brain-computer interface (BCI) as access methods to augmentative and alternative communication (AAC). The participant of the study has been in the locked-in state (LIS) for 6 years due to amyotrophic lateral sclerosis. He was able to communicate with slow residual eye movements, but had no means of partner independent communication. We discuss the usability of all tested access methods and the prospects of using BCIs as an assistive technology. METHODS Within four days, we tested whether EOG, eye tracking and a BCI would allow the participant in LIS to make simple selections. We optimized the parameters in an iterative procedure for all systems. RESULTS The participant was able to gain control over all three systems. Nonetheless, due to the level of proficiency previously achieved with his low-tech AAC method, he did not consider using any of the tested systems as an additional communication channel. However, he would consider using the BCI once control over his eye muscles would no longer be possible. He rated the ease of use of the BCI as the highest among the tested systems, because no precise eye movements were required; but also as the most tiring, due to the high level of attention needed to operate the BCI. CONCLUSIONS In this case study, the partner based communication was possible due to the good care provided and the proficiency achieved by the interlocutors. To ease the transition from a low-tech AAC method to a BCI once control over all muscles is lost, it must be simple to operate. For persons, who rely on AAC and are affected by a progressive neuromuscular disease, we argue that a complementary approach, combining BCIs and standard assistive technology, can prove valuable to achieve partner independent communication and ease the transition to a purely BCI based approach. Finally, we provide further evidence for the importance of a user-centered approach in the design of new assistive devices.
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Affiliation(s)
- Ivo Käthner
- Institute of Psychology, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany.
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany.
| | - Sebastian Halder
- Institute of Psychology, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany.
- Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.
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Scherer R, Faller J, Friedrich EVC, Opisso E, Costa U, Kübler A, Müller-Putz GR. Individually adapted imagery improves brain-computer interface performance in end-users with disability. PLoS One 2015; 10:e0123727. [PMID: 25992718 PMCID: PMC4436356 DOI: 10.1371/journal.pone.0123727] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 03/06/2015] [Indexed: 11/19/2022] Open
Abstract
Brain-computer interfaces (BCIs) translate oscillatory electroencephalogram (EEG) patterns into action. Different mental activities modulate spontaneous EEG rhythms in various ways. Non-stationarity and inherent variability of EEG signals, however, make reliable recognition of modulated EEG patterns challenging. Able-bodied individuals who use a BCI for the first time achieve - on average - binary classification performance of about 75%. Performance in users with central nervous system (CNS) tissue damage is typically lower. User training generally enhances reliability of EEG pattern generation and thus also robustness of pattern recognition. In this study, we investigated the impact of mental tasks on binary classification performance in BCI users with central nervous system (CNS) tissue damage such as persons with stroke or spinal cord injury (SCI). Motor imagery (MI), that is the kinesthetic imagination of movement (e.g. squeezing a rubber ball with the right hand), is the "gold standard" and mainly used to modulate EEG patterns. Based on our recent results in able-bodied users, we hypothesized that pair-wise combination of "brain-teaser" (e.g. mental subtraction and mental word association) and "dynamic imagery" (e.g. hand and feet MI) tasks significantly increases classification performance of induced EEG patterns in the selected end-user group. Within-day (How stable is the classification within a day?) and between-day (How well does a model trained on day one perform on unseen data of day two?) analysis of variability of mental task pair classification in nine individuals confirmed the hypothesis. We found that the use of the classical MI task pair hand vs. feed leads to significantly lower classification accuracy - in average up to 15% less - in most users with stroke or SCI. User-specific selection of task pairs was again essential to enhance performance. We expect that the gained evidence will significantly contribute to make imagery-based BCI technology become accessible to a larger population of users including individuals with special needs due to CNS damage.
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Affiliation(s)
- Reinhold Scherer
- Institute for Knowledge Discovery, Graz University of Technology, 8010 Graz, Austria
- BioTechMed-Graz, Austria
- Clinic Judendorf-Straßengel, 8111 Gratwein-Straßengel, Austria
- * E-mail:
| | - Josef Faller
- Institute for Knowledge Discovery, Graz University of Technology, 8010 Graz, Austria
- BioTechMed-Graz, Austria
| | - Elisabeth V. C. Friedrich
- Institute for Knowledge Discovery, Graz University of Technology, 8010 Graz, Austria
- BioTechMed-Graz, Austria
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Eloy Opisso
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain
| | - Ursula Costa
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg, 97070 Würzburg, Germany
| | - Gernot R. Müller-Putz
- Institute for Knowledge Discovery, Graz University of Technology, 8010 Graz, Austria
- BioTechMed-Graz, Austria
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Abstract
Sexuality and intimacy are important components of health and well-being. Issues surrounding sexuality and intimacy are equally important for men and women living with physical disabilities, including spinal cord injury (SCI). Yet, women's sexuality after SCI remains largely unexamined. This article presents the findings from an in-depth qualitative investigation of the sexual and reproductive health experiences of 20 women with SCI in or around Detroit, MI. Findings echo existing literature documenting the sexual consequences of life after SCI and suggest new areas of inquiry important for better addressing sexual concerns across the lifespan. Specifically, findings suggest a need to consider the variable effects of SCI on sexual intimacy in relation to a person's developmental trajectory, the appropriate timing of sexual education, the need to expand conceptualizations of sexual intimacy, and the ways SCI may affect sexuality in later life.
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Affiliation(s)
- Heather A Fritz
- Heather A. Fritz, PhD, OTR/L, is Postdoctoral Fellow, Institute of Gerontology, Wayne State University, Detroit, MI;
| | - Heather Dillaway
- Heather Dillaway, PhD, is Associate Dean of Master's Programs, The Graduate School, and Associate Professor, Department of Sociology, Wayne State University, Detroit, MI
| | - Cathy L Lysack
- Cathy L. Lysack, PhD, OT(C), is Acting Dean, Eugene Applebaum College of Pharmacy and Health Sciences; Professor, Occupational Therapy Program, Department of Health Care Sciences; and Professor and Deputy Director, Institute of Gerontology, Wayne State University, Detroit, MI
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Matossian V, Gehlhaar R. Human Instruments: Accessible Musical Instruments for People with Varied Physical Ability. Stud Health Technol Inform 2015; 219:202-207. [PMID: 26799908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There are few ways in which persons, who do not have the use of their hands or arms, are able make music or control complex computer systems. Music as an expressive output is key to the full development of the human mind. Human Instruments is dedicated to the development and production of accessible musical instruments playable at a professional level, as well as computer control interfaces. We are currently user-testing three new, uniquely accessible devices, for their effectiveness in expressive music creation. Preliminary results are compelling.
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Brukamp K. [Motor-independent communication by severely physically challenged patients: neuroscientific research results and patient autonomy]. Nervenarzt 2013; 84:1190-1195. [PMID: 24081276 DOI: 10.1007/s00115-013-3813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Motor-independent communication is a novel diagnostic and therapeutic method that is currently in development in order to enable communication with severely physically challenged patients. Some patients with locked-in syndromes or with chronic disorders of consciousness are capable of modulating their brain activities to such a degree that the latter can be analyzed regarding communicative intentions with neuroscientific technologies, such as functional magnetic resonance imaging. Further scientific development and an increasing clinical use of motor-independent communication will aid in meeting essential quality standards for this method. In particular, the requirements need to be clarified under which the method may be utilized to support the patients' autonomy by enabling them to make their own decisions about therapeutic interventions. Communication mediated by technology promises to significantly improve the quality of life for severely physically challenged patients.
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Affiliation(s)
- K Brukamp
- Arbeitsbereich Geschichte der Medizin, Universitätsmedizin Rostock, Universität Rostock, Doberaner Str. 140, Raum 302/03, 18057, Rostock, Deutschland
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Dyer C. Paralysed man will ask judges to let a doctor end his life. BMJ 2013; 346:f2537. [PMID: 23604086 DOI: 10.1136/bmj.f2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Santos P, Plaza A, Vendrell M. [Conversion disorder after post-dural puncture headache and epidural patch with dextran]. Rev Esp Anestesiol Reanim 2012; 59:519-520. [PMID: 22727655 DOI: 10.1016/j.redar.2012.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 04/04/2012] [Indexed: 06/01/2023]
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Abstract
CONTEXT/OBJECTIVES To describe the relationships between secondary health conditions and health preference in a cohort of adults with chronic spinal cord injury (SCI). STUDY DESIGN Cross-sectional telephone survey. SETTING Community. PARTICIPANTS Community-dwelling adult men and women (N = 357) with chronic traumatic and non-traumatic SCI (C1-L3 AIS A-D) who were at least 1 year post-injury/onset. INTERVENTIONS Not applicable. OUTCOME MEASURES Health Utilities Index-Mark III (HUI-Mark III) and SCI Secondary Conditions Scale-Modified (SCS-M). RESULTS SCS-M responses for different secondary health conditions were used to create "low impact = absent/mild" and "high impact = moderate/significant" secondary health condition groups. Analysis of covariance was used to examine differences in HUI-Mark III scores for different secondary health conditions while controlling for impairment. The mean HUI-Mark III was 0.24 (0.27, range, -0.28 to 1.00). HUI-Mark III scores were lower (P < 0.001) in high impact groups for spasms, bladder and bowel dysfunction, urinary tract infections, autonomic dysreflexia, circulatory problems, respiratory problems, chronic pain, joint pain, psychological distress, and depression compared with the low impact groups. As well, HUI-Mark III scores were lower (P < 0.05) in high impact groups for pressure sores, unintentional injuries, contractures, heterotopic bone ossification, sexual dysfunction, postural hypotension, cardiac problems, and neurological deterioration than low-impact groups. CONCLUSION High-impact secondary health conditions are negatively associated with health preference in persons with SCI. Although further work is required, the HUI-Mark III data may be a useful tool for calculating quality-adjusted life years, and advocating for additional resources where secondary health conditions have substantial adverse impact on health.
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Affiliation(s)
- Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Oliva D, Campodonico F, Lang R. Persons with multiple disabilities exercise adaptive response schemes with the help of technology-based programs: three single-case studies. Res Dev Disabil 2012; 33:849-857. [PMID: 22240142 DOI: 10.1016/j.ridd.2011.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 05/31/2023]
Abstract
The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b) left- and right-arm movements for a woman who tended to hold both arms/hands tight against her body (Study II), and (c) touching object cues on a computer screen for a girl who rarely used her residual vision for orienting/guiding her hand responses. The technology involved microswitches/sensors to detect the response schemes and a computer/control system to record their occurrences and activate preferred stimuli contingent on them. Results showed large increases in the response schemes targeted for each of the three participants during the intervention phases of the studies. The importance of using technology-based programs as tools for enabling persons with profound and multiple disabilities to practice relevant responses independently was discussed.
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Abstract
OBJECTIVES A stroke that affects the medulla oblongata and/or pons can result in tetra pareses and paralysis of the lower cranial nerves while other parts of the brain remain intact, thus locking the person in. The incidence and prevalence is not known. The aim of this article is to communicate the need for and benefits of a comprehensive rehabilitation and a standardized way of approaching the locked-in person. MATERIAL AND METHODS To illustrate the rehabilitation process, we present four cases to highlight the needs of the person and what is required of the team. RESULTS Communication at arrival: three persons communicated through eye movement, one by weak voice. At follow-up (1-6 years later): computer assisted communication was used by two persons, a letter board by one and 'ordinary communication' by one. CONCLUSIONS There is a need for follow-up not only to re-assess skills and needs partly owing to new technologies but also to see whether the person needs more assistance to adapt to the alternative means of communication or whether the carers of the person need extra information about communication. We conclude that the low incidence of the syndrome necessitates a skilled team in which different professionals can together assess the person. This probably requires some centralization.
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Affiliation(s)
- A Schjolberg
- Sunnaas Rehabilitation Hospital and Faculty of Medicine, University of Oslo, Norway
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Gaillard A, Gaillard R, Mouaffak F, Radtchenko A, Lôo H. Traitement par électroconvulsivothérapie d’une tétraplégie par conversion hystérique : à propos d’un cas. Encephale 2012; 38:104-9. [PMID: 22381730 DOI: 10.1016/j.encep.2011.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 03/23/2011] [Indexed: 11/17/2022]
Affiliation(s)
- A Gaillard
- Service hospitalo-universitaire de santé mentale et de thérapeutique, faculté de médecine Paris-Descartes, université Paris-Descartes, hôpital Sainte-Anne, 7, rue Cabanis, 75674 Paris cedex 14, France.
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Dyer C. Court should not allow lethal injection for patient with locked-in syndrome, lawyer says. BMJ 2012; 344:e648. [PMID: 22279096 DOI: 10.1136/bmj.e648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stronks M, Buck N, Müller V. [Rehabilitation nursing. "... nothing is as it was once"]. Krankenpfl Soins Infirm 2012; 105:24-26. [PMID: 22468493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wecht JM, Rosado-Rivera D, Jegede A, Cirnigliaro CM, Jensen MA, Kirshblum S, Bauman WA. Systemic and cerebral hemodynamics during cognitive testing. Clin Auton Res 2011; 22:25-33. [PMID: 21792728 DOI: 10.1007/s10286-011-0139-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 06/22/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cognitive deficits are reported in 10-60% of individuals with SCI, the primary etiology of these deficits is believed to be concomitant traumatic brain injury (TBI). We recently documented diminished memory and marginally deficient attention and processing speed in individuals with SCI discordant for hypotension but matched for TBI. METHODS Twenty-nine individuals participated: 16 non-SCI controls, 6 paraplegic (T2-T10) and 7 tetraplegic (C4-C8). The Stroop test was used to measure cognitive function and transcranial Doppler ultrasound was used to measure cerebral blood flow (CBF) while resting (5 min) and continuously during cognitive testing. Mean arterial pressure (MAP) was calculated from three brachial blood pressures and cerebral vascular resistance index was calculated as: CVRi = MAP/CBF. RESULTS The paraplegia group (54 ± 6) was marginally older than the non-SCI (42 ± 15; p = 0.06) and tetraplegic (42 ± 11; p = 0.09) groups. Compared to non-SCI group, normalized t-score on the Stroop Color (SC) task was significantly lower in the paraplegic group (p < 0.05). In the tetraplegic group, MAP was significantly lower (p < 0.05) than the non-SCI and paraplegic groups, and related to SC t-score (r (2) = 0.873; p < 0.01). In the paraplegic group, CBF was reduced (p < 0.05) and CVRi increased (p < 0.05) compared to the non-SCI group, and CVRi was increased compared to the tetraplegic group (p < 0.05). A significant inverse relationship was noted between change in CVRi and SC t-score in the non-SCI group. CONCLUSION Asymptomatic hypotension relates to cognitive performance in persons with tetraplegia; therefore, BP normalization should be considered. The inappropriate cerebral vascular response to cognitive testing and poor test performance should be investigated in persons with paraplegia.
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Affiliation(s)
- Jill M Wecht
- Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, USA.
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Chen CL, Lin KC, Chen CH, Chen CC, Liu WY, Chung CY, Chen CY, Wu CY. Factors associated with motor speech control in children with spastic cerebral palsy. Chang Gung Med J 2010; 33:415-423. [PMID: 20804671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Speech production is often impaired in children with cerebral palsy (CP). This study investigated the factors associated with motor speech control in children with spastic cerebral palsy. METHODS Thirty-three children with spastic CP who were able to speak were identified for this study. They were classified into two groups: group A (spastic diplegia or hemiplegia, n = 17) and group B (spastic quadriplegia, n = 16). Each child received various assessments, namely cognition, language, modified Verbal Motor Production Assessment for Children (VMPAC), speech intelligibility, CP subtype, and Gross Motor Function Classification System (GMFCS). RESULTS Group A showed better cognition and language function, higher modified VMPAC scores and better GMFCS levels than group B (p < 0.05). However, the two groups did not significantly differ in speech intelligibility. Linear regression indicated that all modified VMPAC scores were negatively related to CP subtype (adjusted r2 = 0.51~0.63, p < 0.001). The average modified VMPAC scores had a positive relationship with global language scores (adjusted r2 = 0.63, p < 0.001), and the modified VMPAC scores of the sequence subtests were positively related to the full intelligence quotients (adjusted r2 = 0.55, p < 0.001). CONCLUSION The findings of this study suggest that motor impairment severity, cognition and language functions are associated with the motor speech control among children with CP.
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Affiliation(s)
- Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Cologan V, Schabus M, Ledoux D, Moonen G, Maquet P, Laureys S. Sleep in disorders of consciousness. Sleep Med Rev 2010; 14:97-105. [PMID: 19524464 PMCID: PMC2855378 DOI: 10.1016/j.smrv.2009.04.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 11/30/2022]
Abstract
From a behavioral as well as neurobiological point of view, sleep and consciousness are intimately connected. A better understanding of sleep cycles and sleep architecture of patients suffering from disorders of consciousness (DOC) might therefore improve the clinical care for these patients as well as our understanding of the neural correlations of consciousness. Defining sleep in severely brain-injured patients is however problematic as both their electrophysiological and sleep patterns differ in many ways from healthy individuals. This paper discusses the concepts involved in the study of sleep of patients suffering from DOC and critically assesses the applicability of standard sleep criteria in these patients. The available literature on comatose and vegetative states as well as that on locked-in and related states following traumatic or non-traumatic severe brain injury will be reviewed. A wide spectrum of sleep disturbances ranging from almost normal patterns to severe loss and architecture disorganization are reported in cases of DOC and some patterns correlate with diagnosis and prognosis. At the present time the interactions of sleep and consciousness in brain-injured patients are a little studied subject but, the authors suggest, a potentially very interesting field of research.
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Affiliation(s)
- Victor Cologan
- Coma Science Group, Cyclotron Research Center, University of Liège, Belgium.
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Abstract
The human brain is subjective and reflects the life of a being-in-the-world-with-others whose identity reflects that complex engaged reality. Human subjectivity is shaped and in-formed (formed by inner processes) that are adapted to the human life-world and embody meaning and the relatedness of a human being. Questions of identity relate to this complex and dynamic reality to reflect the fact that biology, human ecology, culture, and one's historic-political situation are inscribed in one's neural network and have configured its architecture so that it is a unique and irreplaceable phenomenon. So much is a human individual a relational being whose own understanding and ownership of his or her life is both situated and distinctive that neurophilosophical conceptions of identity and human activity that neglect these features of our being are quite inadequate to ground a robust neuroethics.
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Affiliation(s)
- Stephen Lyng
- Department of Sociology, Carthage College, 2001 Alford Park Drive, Kenosha, WI 53140, USA.
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Carifio M, Kaestner T. Center caters to children's needs. Provider 2009; 35:53-58. [PMID: 19795679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Michael Carifio
- Children's Comprehensive Care Center, Pompano Beach, FL, USA
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Affiliation(s)
- S Van McCrary
- Clinical Ethics Consultation Service, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
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Fager S, Beukelman D, Karantounis R, Jakobs T. Use of safe-laser access technology to increase head movement in persons with severe motor impairment: A series of case reports. Augment Altern Commun 2009; 22:222-9. [PMID: 17114165 DOI: 10.1080/07434610600650318] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The purpose of this article is to describe the impact of an intervention involving safe-laser pointing technology on six persons with locked-in syndrome. When these individuals were invited to participate in this project (4 weeks to 18 years post onset), none were able to speak and none were able to access an augmentative and alternative communication (AAC) device. All communicated using eye movements (e.g., looking up or down), eye blinks, dependent scanning strategies with eye movement signals, or eye linking. Following intervention with the Safe-Laser Access System, three of the six participants developed head movement sufficient to control AAC technology. Two participants continue to develop head control; however, their progress has been slowed by repeated illnesses. One participant has discontinued his involvement with the project because of medical and psychological concerns. These six participants represent consecutive referrals to the project.
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Affiliation(s)
- Susan Fager
- Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital, Lincoln, NE 68506, USA.
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Gorski JA, Slifer KJ, Townsend V, Kelly-Suttka J, Amari A. Behavioural treatment of non-compliance in adolescents with newly acquired spinal cord injuries. ACTA ACUST UNITED AC 2009; 8:187-98. [PMID: 16087553 DOI: 10.1080/13638490400021438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury. METHOD A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy. RESULTS Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started. CONCLUSIONS The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.
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Abstract
PURPOSE Physical activity in people with traumatic spinal cord injury (SCI) is of importance not only for maintaining health but also for increasing the possibilities of living an independent life. Physical inactivity leads to poorer muscular and cardiovascular conditioning and sub-optimal levels of functioning. To help people with SCI to achieve optimum physical activity, it is important to understand what promotes the incorporation of regular physical activity into daily life. The aim of this study was thus to identify factors that may promote participation in physical activity among people with spinal cord injuries. METHOD Qualitative multiple case studies. Sixteen participants with SCI were interviewed. RESULT Four main themes of promoting factors could be identified. They were: using cognitive and behavioural strategies; finding supporting environmental solutions; exploring motivation post injury; and capturing new frames of reference. CONCLUSION By utilising the motivational power of role models, together with the other motivational factors identified in this study, such as identifying relevant individual motives post injury and capturing new frames of reference, the process towards physical active life may be facilitated.
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Peeters M, Verhoeven L, de Moor J, van Balkom H, van Leeuwe J. Home literacy predictors of early reading development in children with cerebral palsy. Res Dev Disabil 2009; 30:445-461. [PMID: 18541405 DOI: 10.1016/j.ridd.2008.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 04/17/2008] [Indexed: 05/26/2023]
Abstract
The goal of the present 1-year long longitudinal study was to determine which home literacy variables were effective in stimulating early reading skills of children with cerebral palsy (CP) directly or indirectly via the reading precursors. Parents of 35 children with CP completed questionnaires regarding aspects of the home literacy environment (HLE). The reading precursors: Vocabulary, Syntactic skills and phonological awareness, i.e., Rhyme and Phonemic awareness, were assessed at the end of Kindergarten and the end of Grade 1, while the early reading skills Letter knowledge and Word recognition were assessed only at the end of Grade 1. Three HLE variables were found to be related to reading precursors and early reading skills: Parent literacy mediation, Word orientation and Story orientation activities during shared book reading. Path analyses showed that these three HLE variables were not directly related to early reading skills in Grade 1, but indirectly via the reading precursors, in particular phonological awareness.
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Affiliation(s)
- Marieke Peeters
- Department of Special Education, Behavioural Science Institute, Radboud University Nijmegen, The Netherlands.
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Lancioni GE, O'Reilly MF, Singh NN, Sigafoos J, Oliva D, Severini L. Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology. J Intellect Disabil Res 2008; 52:327-336. [PMID: 18339095 DOI: 10.1111/j.1365-2788.2007.01024.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention. METHODS Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three. RESULTS The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available. CONCLUSIONS Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Bari, Bari, Italy.
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Schnakers C, Majerus S, Goldman S, Boly M, Van Eeckhout P, Gay S, Pellas F, Bartsch V, Peigneux P, Moonen G, Laureys S. Cognitive function in the locked-in syndrome. J Neurol 2008; 255:323-30. [PMID: 18350365 DOI: 10.1007/s00415-008-0544-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 12/21/2006] [Accepted: 01/05/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The lockedin syndrome (LIS) originates from a ventro-pontine lesion resulting in a complete quadraplegia and anarthria. Classically, communication remains possible by means of spared vertical eye movements and/or blinking. To allow assessing cognitive functions in LIS patients, we propose here a neuropsychological testing based on eye-coded communication. METHODS Ten chronic LIS survivors were assessed 1 to 6 years after their brain insult. One patient was evaluated subacutely (at 2 months) and retested at 6 and 16 months. Neuropsychological testing encompassed short- and long-term memory, attention, executive functioning, phonological and semantic processing and verbal intelligence. RESULTS None of the patients showed alterations in verbal intelligence. Impairments in one or several tests were found in five patients. In three of these patients, neuropsychological deficits could be related to additional cortical or thalamic structural brain lesions. In the other 2 patients, weakness or signs of fatigue only were observed in one or two cognitive tasks. Repeated measures in a subacute patient with pure brainstem lesion indicate the recovery of good levels of cognition 6 months after injury. CONCLUSION Results indicate that LIS patients can recover intact cognitive levels in cases of pure brainstem lesions, and that additional brain injuries are most likely responsible for associated cognitive deficits in the LIS. Furthermore, a systematic neuropsychological assessment in LIS patients would allow detecting their cognitive deficits,which will contribute to improve their quality of life and of communication with family and medical caretakers.
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Abstract
Looking back is often painful. Although in the first instance I might approach a research project with enthusiasm and confidence, in retrospect the sins of omission can become very obvious. In reviewing five research projects employing qualitative ethnographic methods, I explored the underacknowledged role of the visible body in these projects. Although the task of retrospection is blessed with the accumulated wisdom of others, I emphasize the importance of ongoing self-scrutiny and critical analysis of methodological dogmas for researchers and their practices.
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Affiliation(s)
- Wendy Seymour
- School of Social Work and Social Policy, Hawke Research Institute for Sustainable Societies, University of South Australia, Magill, Australia
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Robey KL. Identity related to living situation in six individuals with congenital quadriplegia. Disabil Rehabil 2007; 30:107-13. [PMID: 17852238 DOI: 10.1080/09638280701214206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was a preliminary examination of structural aspects of identity, particularly identity associated with living situation, in individuals who have quadriplegia due to cerebral palsy. METHOD A hierarchical classes algorithm (HICLAS) was used to construct idiographic 'identity structure' models for three individuals who are living in an inpatient hospital setting and for three individuals living in community-based group residences. RESULTS Indices derived from the models indicate that the identity 'myself as one who has a disability' was structurally superordinate (i.e., resided at a high hierarchical level) for all six participants, suggesting a high level of importance of this identity in participants' sense of self. The models also indicate that while identity associated with one's particular living situation was superordinate for persons living in the hospital, it was not for persons living in community residences. CONCLUSIONS While conclusions based on this small sample are necessarily limited, the data suggest that identity associated with living situation might differ in structural centrality, and presumably subjective importance, for persons living in inpatient versus community-based settings.
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Affiliation(s)
- Kenneth L Robey
- Matheny Institute for Research in Developmental Disabilities, Matheny Medical and Educational Center, Peapack 07977, USA.
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Kemp BJ, Spungen AM, Adkins RH, Krause JS, Bauman WA. The relationships among serum lipid levels, adiposity, and depressive symptomatology in persons aging with spinal cord injury. J Spinal Cord Med 2007; 23:216-20. [PMID: 17536289 DOI: 10.1080/10790268.2000.11753528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) appears to occur prematurely in persons with spinal cord injury (SCI). Stress may play a significant role in the development of CVD. Depression is the most common form of stress complicating the care of persons with SCI. METHODS In 188 persons with SCI, 46% with tetraplegia and 54% with paraplegia, the relationship between depression and the serum lipid profile was studied. Depression was measured by the Older Adult Health and Mood Questionnaire (OAHMQ) for persons with disability. Total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol and triglycerides were measured; body mass index (BMI) was computed and percent body fat was determined by dual-energy x-ray absorptiometry (DXA). RESULTS Depression and level of SCI were found to have significant interactive effects on serum lipid levels. Serum total and LDL cholesterol, as well as triglycerides, were all higher among persons with paraplegia who were depressed compared to those who were not depressed. This was not found in persons with tetraplegia. Inverse relationships were evident between serum triglycerides and HDL cholesterol levels. Persons with paraplegia who were depressed had significantly more adiposity than those not depressed. BMI correlated directly with serum triglycerides and indirectly with serum HDL cholesterol. CONCLUSION Depression appears to be a strong determinant of adverse lipid profiles in patients with paraplegia. association between depression and adiposity in these patients compounds the risk for cardiovascular disease.
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Affiliation(s)
- B J Kemp
- Rehabilitation Research and Training Center on Aging with Spinal Cord Injury, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
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Abstract
OBJECTIVE To assess the effects of spinal cord injury (SCI) on perceived health-related quality of life (QOL). BACKGROUND SCI is physically disabling, socially handicapping, and romantically limiting. Nevertheless, little is known about post-SCI neurocognitive and psychosocial life. Better understanding of the cognitive and emotional worlds of SCI patients is essential to better address and meet their needs and expectations. METHODS Twenty subjects with high-cord (T6 and above) complete (American Spinal Injury Association [ASIA] A) SCI (High SCI) were compared with 10 subjects with low-cord (T7 and below) ASIA A SCI (Low SCI) and with 11 Able-Bodied control subjects. Satisfaction with Life and Short Form-36 instruments were used to assess physical and emotional aspects of QOL. Analyses of variance were used to assess potential differences across groups. RESULTS Overall, satisfaction with life was the same among the groups. Expectedly, High SCI and Low SCI subjects reported lower physical functioning than Able-Bodied subjects (p < 0.0001). But, oddly, there were no differences in perceived physical role, physical health, or social functioning. Furthermore, High SCI subjects reported better perceived mental health than Able-Bodied control subjects (p = 0.004) and a trend over Low SCI subjects (p = 0.06), better perceived emotional role in society (p = 0.02), and greater vitality (p = 0.01) than Low SCI subjects and Able-Bodied subjects. CONCLUSIONS Despite severe physical impairment and disability and frequent medical complications, subjects with complete spinal cord injury at high anatomic levels report better than average quality of life, being overall content. Reasons for these findings are unclear. Psychological adaptive reactions are likely, but the possible role of physiologic and neurocognitive changes needs further exploration.
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