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PubMed2003

Choice of unconventional treatment by patients with cancer.

OBJECTIVES: Previous studies conducted on the use of unconventional treatment by patients with cancer have focused on unconventional treatment as a joint group of therapies. The objective of this study is to gather preliminary information about the use of different modes of unconventional cancer treatment by patients with cancer and to describe user profiles of standardized and individualized treatments. DESIGN: Data originate from an ongoing explorative 5-year study of 441 consecutively registered cancer patients who have consulted medical doctors and alternative therapists practicing unconventional treatment in Denmark. This paper is based on data from the first and second of six questionnaires. The unconventional treatments included in this study are categorized into two forms of treatment: standardized and individualized treatment. SUBJECTS: Four hundred and forty-one (441) Danish patients with cancer who use unconventional cancer treatment. OUTCOMES MEASURES: The analysis shows significant correlations between type of treatment and the following variables: gender, education, occupational status, type of cancer, purpose of seeking unconventional treatment, metastatic spread, opinion regarding appropriate unconventional treatment, and simultaneous use of unconventional treatment. RESULTS: The study shows that there are significant differences between patients with cancer choosing standardized and those choosing individualized unconventional treatment. The probability of choosing standardized unconventional treatment is greatest among male participants, patients having shorter school education, and for patients who have recovery as the goal of seeking unconventional treatment. The probability of choosing individualized unconventional treatment is greatest among women, for patients with longer school education, and for patients wanting relief from symptoms, information, and improvement of general condition as the purpose of seeking unconventional cancer treatment. Patients with breast and gynecologic cancer are more inclined to seek individualized treatment than patients with all other cancer diseases. CONCLUSIONS: The study points to the fact that it might be essential to differentiate between different forms of unconventional treatment to understand the use by patients with cancer and the outcomes of these treatments.

Adult↗

PubMed1987

Intellectual impairment in alcoholics: persistent issues.

Intellectual impairment in sober intermediate stage alcoholics has been well established. However, a number of persistent issues remain to be explored. Three of the most important concern 1) variability in cognitive-perceptual functioning in samples of alcoholics, 2) differential vulnerability of cognitive-perceptual functions to alcohol abuse and 3) the relationship of cognitive-perceptual impairment to treatment behaviour and benefit. Consideration of these issues resulted in the following conclusions. There is a substantial minority of alcoholics who do not manifest impairment on any given cognitive test. Variability of findings with different samples of alcoholics may be, in part, a function of family history of alcoholism and/or severity of alcoholism. Verbal and rote learning functions are less sensitive to alcohol abuse than non-verbal, or complex verbal, abstracting/problem-solving skills. Alcoholics' impersonal and interpersonal problem-solving abilities are both impaired but appear to be uncorrelated. Impairment in cognitive-perceptual functioning in alcoholics does predict therapists' ratings of treatment behaviour and benefit.

Alcoholism↗

PubMed1990

Visual inspection of single-subject data: an empirical analysis.

The ability of therapists and educators to reliably analyze data from single-subject designs using visual inspection of graphed data was investigated. Sixty-one examiners provided a rating of whether a significant change in performance occurred across the baseline and treatment phases of six graphs of hypothetical data. Results revealed considerable disagreement among the raters on four of them. Further analysis suggested that the visual characteristics of a change in variability or change in slope across the baseline and treatment phases were associated with the most disagreement. The advantages and limitations of visual analysis of graphed data were discussed and the argument made that additional information is needed on the process of visual inspection to ensure reliable interpretation of single-subject data.

Combined Modality Therapy↗

PubMed1986

Physical therapy in the multidisciplinary assessment and management of osteoarthritis.

As part of a multidisciplinary approach to the management of osteoarthritis, 77 patients with a mean age of 69 years were assessed by physical therapists. Goniometrics and strength evaluations of the shoulder, elbow, hip, and knee were performed at the initial and final assessment of this 12-week study. Biweekly gait evaluations consisted of timed free-speed walking over a 12-foot distance. Although the patients with osteoarthritis had joint pain with movement and limitations in joint range of motion and muscle strength, statistically significant improvements were obtained in a number of variables over the course of the study. The gait speed had a direct correlation with joint range of motion and muscle strength and an inverse correlation with pain.

Aged↗

PubMed1993

Parapraxes in song recall: a neglected variable.

In addition to expressing themselves with verbal and nonverbal communications, and by the countertransference reactions perceived by analysts, patients also reveal their inner world of images and feelings specifically with music evocations. This paper presents an initial attempt to identify and classify some of the parapraxes produced in the evocation of lyrics and music by polyglot members of treatment dyads in two empirical studies and in private practice. There may be many others, particularly related to the music per se. This paper has focused mainly on the lyrics, the equivalent of the manifest content of dreams, which nonmusician therapists can learn to handle well. Instead, in the case of the musical latent content, some knowledge of music is necessary. Supervisors' songs were considered beyond the scope of this paper and will be addressed separately. Parapraxes in song recall signal unconscious transference-countertransference states in process at the moment of evocation.

Countertransference↗

PubMed1999

Interactive risk factors for treatment adherence in a chronic psychotic disorders population.

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.

Adult↗

PubMed2003

[Intervention study using a fall prevention program to prevent functional decline of old-old elderly in a rural community].

The purpose of this study was to determine the effects of a fall prevention program for old-old elderly in a rural community in Japan. The subjects were 71 inhabitants aged 75 and over who used community health and welfare services such as day services and social activity classes. They were divided into two groups: 34 in the experimental group, and 37 controls. Physical therapists and care staff instructed the experimental group in fall prevention exercises once per two weeks from December 2000 to March 2001. The control group utilized the usual services without any special instructions. All subjects were evaluated by physical performance tests and a self-administered questionnaire before and after 4 months following the intervention. Collected data were analyzed by two-way ANOVA using intervention and time as independent variables, and physical performance tests as dependent variables. Twenty-three of the experimental group and 26 of the control group completed both baseline and follow-up surveys. There were no significant differences in physical ability between the two groups at the time of the baseline survey. The experimental group showed excellent compliance and participated in all sessions during the intervention period. Interaction effects on body mass index and Timed Up and Go Test were shown to be significant (F = 5.623, P < 0.01: F = 6.541, P < 0.05). There were no changes in terms of other physical and psychological factors. Our results showed specific exercises could improve some aspects of physical performance. Since the group exercise program can be effective for old-old elderly, it might contribute to decreasing falls and prolong independent living.

Accidental Falls↗

PubMedDate not supplied

Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics.

OBJECTIVE: This study investigated the stress experienced by parents in the neonatal intensive care unit (NICU), the infant and parent characteristics that resulted in different stress responses, and the characteristics that were predictive of stress. METHOD: The Parental Stress Scale: Neonatal Intensive Care Unit was used to measure the stress of 162 parents. A Parent/Infant Demographic sheet provided information for determining which characteristics resulted in different responses and which variables were stress predictors. RESULTS: The highest levels of stress experienced were in the relationship with baby-parental role area, and regarding how the baby looked and behaved. The infant characteristic of gestational age resulted in significantly different scores concerning the baby's appearance and behavior. Consistent predictors of stress were length of stay, extreme prematurity, and a cardiovascular diagnosis. CONCLUSION: Identifying the stressors parents experience can assist NICU therapists in intervention planning. Family-centered care that addresses stressors concerning their roles and their understanding of their infant should be emphasized.

Adolescent↗

PubMed1986

Objective assessment of postural balance through use of the variable resistance balance board.

The purpose of this study was to evaluate postural balance with a practical clinical assessment tool. I evaluated eight men and eight women in their 20s, using a variable resistance balance board, to determine the deviation of their average center of pressure in the anterior-posterior plane during stance. The resulting data were compared with the average center of pressure deviation of eight men in their 20s as measured by Murray et al with a force platform. The difference between the two men's groups was not statistically significant (p less than .05). These findings suggest that physical therapists may determine average center of pressure data and may assign progressive balance tasks that match any patient's level of center of pressure control.

Adult↗

PubMed1998

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients.

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.

Activities of Daily Living↗

PubMed1996

Transition from school to work of students with developmental disabilities and mental retardation: an Israeli perspective.

The present research was conducted in four special education schools for students with developmental disabilities and mental retardation in the Haifa area. The total number of subjects was 72. There were 45 (63%) males and 27 (37%) females. The mean age was 18.1 years (range: 16-19.5). The mean IQ (WISC) was 66.3 points (range: 40-85). The vocational placement at the end of 6 months after leaving school was recorded for each school graduate. A total of 53 teachers--school principles, counsellors, specialized teachers and speech and occupational therapists--filled out specially designed questionnaires covering three areas: (1) students' work programme experience; (2) teachers' ratings of final year students on: academic studies, social behaviour, independence and vocational skills as well as teachers' recommendations, given towards the end of the final year at the school, for the immediate plan of action for each of the graduating students; (3) teachers' ratings of parental involvement with the educational programme of each student. Background variables included IQ, age and gender. The major finding was that 6 months after graduation, one-third of special school graduates were not working, were not enrolled in any formal programme and were idle at home. The variables that were found to correlate with successful placement were students' prior work experience, teachers' ratings of students achievements and their recommendations for each student, and parental involvement.

Adolescent↗

PubMed1993

Concurrent validity of the ERGOS work simulator versus conventional functional capacity evaluation techniques in a workers' compensation population.

A prospective blinded cohort study was performed in an interdisciplinary vocational evaluation program to investigate the concurrent validity of the ERGOS work simulator in comparison to current methods of evaluation. Seventy men and eight women, aged 22 to 64 years, who attended for a 2-week physical capacity assessment participated in the study. Physical activity factors as defined by the Canadian Classification and Dictionary of Occupations and the American Dictionary of Occupational Titles were assessed for all subjects under three evaluation conditions: the ERGOS work simulator, an exercise-oriented physical evaluation by a rehabilitation therapist, and performance of project-format industrial tasks. In addition, 17 men and 7 women were assessed with VALPAR standardized work sample tests. The statistical significance of the relationships between results obtained by the various evaluation methods was examined. There was a strong correlation between the ERGOS dynamometry and the clinical assessment of strength for all standard movements tested (P < .001). The Methods Time Measurement rating by the ERGOS for dexterity variables, according to industrial engineering standards, tended to rate subjects as more restricted than did the clinical evaluators. There was a significant relationship (P < .001) between the "overall physical activity rating" from ERGOS dynamometry, clinical evaluation, and performance in an industrial workshop setting. There was also a significant relationship (P < .001) between the "overall physical activity rating" for endurance of a full workday produced by the 4-hour ERGOS evaluation and by the 2-week functional capacity evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

fMRI-compatible rehabilitation hand device.

BACKGROUND: Functional magnetic resonance imaging (fMRI) has been widely used in studying human brain functions and neurorehabilitation. In order to develop complex and well-controlled fMRI paradigms, interfaces that can precisely control and measure output force and kinematics of the movements in human subjects are needed. Optimized state-of-the-art fMRI methods, combined with magnetic resonance (MR) compatible robotic devices for rehabilitation, can assist therapists to quantify, monitor, and improve physical rehabilitation. To achieve this goal, robotic or mechatronic devices with actuators and sensors need to be introduced into an MR environment. The common standard mechanical parts can not be used in MR environment and MR compatibility has been a tough hurdle for device developers. METHODS: This paper presents the design, fabrication and preliminary testing of a novel, one degree of freedom, MR compatible, computer controlled, variable resistance hand device that may be used in brain MR imaging during hand grip rehabilitation. We named the device MR_CHIROD (Magnetic Resonance Compatible Smart Hand Interfaced Rehabilitation Device). A novel feature of the device is the use of Electro-Rheological Fluids (ERFs) to achieve tunable and controllable resistive force generation. ERFs are fluids that experience dramatic changes in rheological properties, such as viscosity or yield stress, in the presence of an electric field. The device consists of four major subsystems: a) an ERF based resistive element; b) a gearbox; c) two handles and d) two sensors, one optical encoder and one force sensor, to measure the patient induced motion and force. The smart hand device is designed to resist up to 50% of the maximum level of gripping force of a human hand and be controlled in real time. RESULTS: Laboratory tests of the device indicate that it was able to meet its design objective to resist up to approximately 50% of the maximum handgrip force. The detailed compatibility tests demonstrated that there is neither an effect from the MR environment on the ERF properties and performance of the sensors, nor significant degradation on MR images by the introduction of the MR_CHIROD in the MR scanner. CONCLUSION: The MR compatible hand device was built to aid in the study of brain function during generation of controllable and tunable force during handgrip exercising. The device was shown to be MR compatible. To the best of our knowledge, this is the first system that utilizes ERF in MR environment.

Journal Article↗

PubMed1977

The effect of unrecognized drug abuse on diagnosis and therapeutic outcome.

One-hundred and ninety-five consecutive psychiatric outpatients had urine sampled for the presence of opiates, cocaine, barbiturates, and amphetamines. All patients had demographic variables, diagnostic information, and treatment course analyzed in a blind fashion using preselected criteria. Patterns of abuse were defined for the 13.3% of the total sample who were covert abusers. An analysis of diagnostic accuracy for abusing and nonabusing populations indicated that covert abuse markedly distorted diagnosis and management. The study indicates that demographic variables and previous history were not reliable predicators of covert abuse. Drug abuse was a major factor in distorting the accuracy of diagnosis. Drug abusers were significantly less likely to improve with therapy than were nonabusers. Barbiturate abusers were most likely to suffer from adverse drug reactions. Urine screening for drugs was the single most valuable diagnostic tool and was felt to be indicated in all cases where diagnostic confusion was present. Therapists saw the covert abuser as sick out of proportion to their social behavior, were perplexed and frightened by these patients' dependency, and perceived them as too brittle for therapy. Therapists behaved very differently with these patients than with diagnostically matched controls. They misdiagnosed them four times more often, missed appointments with them seven times more often, and were ten times more likely to refer them to another therapist or agency. Therapist anxiety and "flight from therapy" with covertly abusing patients are discussed.

Adolescent↗

PubMed2002

Acute retropharyngeal and parapharyngeal abscesses in children.

OBJECTIVE: Acute retropharyngeal and parapharyngeal abscess is a rare but serious disease in children. We reviewed our experience highlighting some of the unusual features of our cases. METHODS: Medical records of children less than 12-years-old who were admitted to King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, over a 10- year period with final diagnosis of deep neck infection, were reviewed. RESULTS: Eight patient's records were reviewed. Seven were less than 3-years of age. The retropharyngeal abscess was suspected clinically in 3 cases only. The most common findings were fever, neck swelling and feeding problems. The duration of symptoms and signs were so variable. The most helpful diagnostic tests were direct visualization and computerized tomography scan of the cervical area. The combination of retropharyngeal and parapharyngeal abscess was encountered in 4 patients. Cefuroxime was the drug of choice in all patients. Five patients responded to conservative management with antibiotics alone. Two cases had unusual presentation, one with subacute neck swelling, and one with severe airway compromise one week after manipulation of the tonsils by traditional therapist. CONCLUSION: High index of suspicion is warranted in such rare and life threatening disease. Special attention should be directed to the parapharyngeal entity, which was not suspected clinically in any case. The use of traditional medicine could have serious consequences in some patients.

Abscess↗

PubMed1993

Burnout: a smouldering problem amongst South African speech-language pathologists and audiologists?

The present study aimed to investigate the frequency of burnout occurring within the profession of speech-language pathology and audiology and to examine possible work situation factors unique to the profession, that may be correlated with burnout. A cross-sectional postal survey research design was used, including a standardised measure of burnout as well as a questionnaire inquiring about demographic and work situation variables. Subjects were randomly drawn from names obtained from the South African Medical and Dental Council. Results were analysed statistically using Pearsons correlations, Multivariate Analysis as well as Bonferroni T-tests. The main finding that emerged was that, as a group speech-language pathologists (SPLP's) and audiologists in South Africa are experiencing moderate levels of emotional exhaustion, low levels of depersonalisation as well as high levels of personal accomplishment. Therapists working in hospitals, mainly treating peripheral hearing disorders, working either as audiologists only or speech-language therapists and audiologists, with heavy caseloads and extensive paperwork, and perceiving themselves to be under large amounts of work pressure, appear to be the most susceptible to burnout.

Audiology↗

PubMed1989

Relationship of client participation to psychotherapy.

Dimensions of client participation in psychotherapy were assessed to investigate whether participation is unidimensional or multidimensional, stable over therapy, and/or related to measures of psychotherapy outcome. Participation dimensions included compliance with scheduling (lateness, rescheduling, no-show) and with homework assignments (completion of a daily diary and relaxation home-practice), reported acceptance of the credibility of therapy rationale, satisfaction with global and specific aspects of therapy, expectation of personal improvement in anxiety symptomatology, self-rated engagement in therapy activities, and reported judgments about therapist characteristics and relationship qualities. Outcome measures included assessor ratings, daily client self-report of anxiety severity, and questionnaire measures. Subjects were 30 clients participating in a 12-session generalized anxiety disorder comparative treatment study in which they receive progressive relaxation training plus either cognitive therapy or nondirective therapy. Across clients in both treatment groups, behavioral compliance measures were poorly intercorrelated and unrelated to the other participation measures. Canonical correlation of participation variables with change on pre-post outcome measures showed a significant relationship between some participation variables representing satisfaction with specific aspects of therapy and the therapeutic relationship and improvement in daily level of subjective anxiety.

Anxiety Disorders↗

PubMedDate not supplied

The intertester and intratester reliability of hand volumetrics.

The purpose of this study was to examine the intertester and intratester reliability of hand volumetric measurements comparing two different protocols. The first protocol involved three clinicians at an outpatient facility interpreting the manufacturer's volumeter instructions. At the second university site, three testers utilized a modified version of the American Society of Hand Therapists' recommended protocol. Three measurements were taken of each of 30 nonedematous hands per site. Reliability was assessed using only the first measurement and using the mean of the three measurements. Results for both protocols revealed very high intertester reliability (ICC=0.99) whether using the first measurement or the mean of three measurements. Intratester reliability was also very high (ICC=0.99) using either protocol. Standard error of measurement values are included and additional variables, which may affect the reliability of hand volumetrics, are discussed. The authors conclude that there is high reliability with volumetric measurements.

Adult↗