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At least 793 records · Page 44Linked to original sources
PubMed1997

Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial.

BACKGROUND AND PURPOSE: After stroke, the ability to balance in sitting is critical to independence. Although impairments in sitting balance are common, little is known about the effectiveness of rehabilitation strategies designed to improve it. The purpose of this randomized placebo-controlled study was to evaluate the effect of a 2-week task-related training program aimed at increasing distance reached and the contribution of the affected lower leg to support and balance. METHODS: Twenty subjects at least 1 year after stroke were randomized into an experimental or control group. The experimental group participated in a standardized training program involving practice of reaching beyond arm's length. The control group received sham training involving completion of cognitive-manipulative tasks within arm's length. Performance of reaching in sitting was measured before and after training using electromyography, videotaping, and two force plates. Variables tested were movement time, distance reached, vertical ground reaction forces through the feet, and muscle activity. Subjects were also tested on sit-to-stand, walking, and cognitive tasks. Nineteen subjects completed the study. RESULTS: After training, experimental subjects were able to reach faster and further, increase load through the affected foot, and increase activation of affected leg muscles compared with the control group (P < .01). The experimental group also improved in sit-to-stand. The control group did not improve in reaching or sit-to-stand. Neither group improved in walking. CONCLUSIONS: This study provides strong evidence of the efficacy of task-related motor training in improving the ability to balance during seated reaching activities after stroke.

Aged↗
PubMed2002

Reducing diagnostic errors in medicine: what's the goal?

This review considers the feasibility of reducing or eliminating the three major categories of diagnostic errors in medicine: "No-fault errors" occur when the disease is silent, presents atypically, or mimics something more common. These errors will inevitably decline as medical science advances, new syndromes are identified, and diseases can be detected more accurately or at earlier stages. These errors can never be eradicated, unfortunately, because new diseases emerge, tests are never perfect, patients are sometimes noncompliant, and physicians will inevitably, at times, choose the most likely diagnosis over the correct one, illustrating the concept of necessary fallibility and the probabilistic nature of choosing a diagnosis. "System errors" play a role when diagnosis is delayed or missed because of latent imperfections in the health care system. These errors can be reduced by system improvements, but can never be eliminated because these improvements lag behind and degrade over time, and each new fix creates the opportunity for novel errors. Tradeoffs also guarantee system errors will persist, when resources are just shifted. "Cognitive errors" reflect misdiagnosis from faulty data collection or interpretation, flawed reasoning, or incomplete knowledge. The limitations of human processing and the inherent biases in using heuristics guarantee that these errors will persist. Opportunities exist, however, for improving the cognitive aspect of diagnosis by adopting system-level changes (e.g., second opinions, decision-support systems, enhanced access to specialists) and by training designed to improve cognition or cognitive awareness. Diagnostic error can be substantially reduced, but never eradicated.

Cognition↗
PubMed2003

Cognitive and behavioral change in health care professionals after training in the treatment of injection drug users.

A training program was implemented for 56 health care professionals who work with injection drug users (IDUs) in Spain. The aims were to change health care professionals' concepts of drug treatment for IDUs and increase the knowledge required to implement effective drug treatment programs and train professionals who would in turn train other professionals, thus creating a network. Follow-up was carried out at 8 months. All of the professionals had little prior experience in designing and implementing risk reduction programs. At the end of the training program, all thought that they had increased their knowledge; had gained the skills required to design, implement, and evaluate harm reduction programs for IDUs; and felt qualified to train colleagues from other treatment centers. After 1 year, they had trained 676 health care professionals. The program is appropriate with regard to the aims sought and the target population for which it was designed. The effectiveness of a network-building strategy was also validated.

Adult↗
PubMed2002

The impact of error training and individual differences on training outcomes: an attribute-treatment interaction perspective.

The authors examined the effectiveness of error training for trainees with different levels of cognitive ability, openness to experience, or conscientiousness. Participants (N = 181) were randomly assigned to control, error-encouragement, or error-avoidance conditions and trained to perform a decision-making simulation. Declarative knowledge, task performance, and self-efficacy were measured posttraining. Findings suggest the effectiveness of error training is dependent on the cognitive ability or dispositional traits of trainees. High cognitive ability or more open individuals benefit more from error-encouragement training than low cognitive ability or less open individuals. Conscientiousness has a negative effect on self-efficacy when trainees are encouraged to make errors.

Adult↗
PubMedDate not supplied

Aging and everyday memory: the beneficial effect of memory training.

The authors investigated elderly people's ability to benefit from specific memory training. Empirical evidence of cognitive aging shows a deterioration in working memory ability but also suggests that elderly people maintain the ability to acquire new information and strategies. The aim of the present study was to investigate the effects of two different mnemonic strategies (Loci mnemonic vs. Strategic training) in young and older adults and to evaluate the ability of the older groups to improve performance. Participants received extensive practice in the use of a specific strategy. Three groups of participants (20 adult, 20 younger elderly, and 20 older elderly) were tested in the laboratory, as well as in ecological conditions using a battery of cognitive tests. Questionnaires were also administrated to explore cognitive, metacognitive and emotive motivational aspects of working memory performance. The results show the efficacy of both trainings in improving performances in different tasks, particularly the ecological. The elderly benefit from strategies as much as younger people; nevertheless, the memory performances of the latter are higher. Differences between the two trainings are found only in the task evaluating ability to re-use learnt strategies in other unfamiliar situations. Improvement in performance was more pronounced for the strategic training.

Adult↗
PubMed1993

[Adolescents with autism syndrome and autistic manifestations in vocational education centers].

Young people with autistic syndrome or autistic traits have for some years also been included in vocational training centre programmes. The present study had been aimed at analyzing the experience gained during vocational rehabilitation service provision and at fathoming conditions for a successful training course and placement process. 10 centres reported their experience from vocational training of 29 autistic young people, with the following noted in conclusion: The vocational training centres primarily accept young people with qualified educational levels and moderate behavioural peculiarities. The training as a rule is completed successfully. During programme participation, however, considerable problems arise in acquiring social and communication skills as well as in cognitive respects. Notwithstanding successful training completion, only some 25% could be placed in appropriate employment in the general labour market. Communication problems, impact of vocational training centre infrastructure, supportive and follow-up services, preparation and follow-along of staff, as well as alternatives to current vocational education practices are discussed.

Adolescent↗
PubMed2004

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.

Adult↗
PubMed1989

Effects of coping skills training on generalized self-efficacy and locus of control.

A number of studies have shown that mastery experiences strengthen self-efficacy expectancies that are specific to the mastery situation. In this study I assessed the effects of cognitive-behavioral coping skills training on generalized expectancies concerning self-efficacy and locus of control in test-anxious college students. Compared with a waiting-list control group, the trained subjects exhibited significant decreases on trait and state measures of test anxiety and a higher level of academic performance on classroom tests, as well as changes in specific self-efficacy expectancies relating to test-anxiety management and academic performance. Consistent with generalization predictions derived from self-efficacy theory, the coping skills group also exhibited decreases in general trait anxiety and increased scores on a trait measure of generalized self-efficacy. Locus of control was unaffected by the program, and changes in general self-efficacy were unrelated to changes in locus of control, suggesting the possibility that different parameters of experience are related to changes in the two types of generalized expectancies.

Achievement↗
PubMed1999

5HT antagonists attenuate MK801-impaired radial arm maze performance in rats.

Glutamatergic hypofunction occurs in Alzheimer's disease (AD). MK801, a noncompetitive blocker of glutamate N-methyl-D-aspartate receptors, was used to disrupt the cognitive performance of rats trained on a delayed nonmatching to sample radial maze task. Drugs which act by blocking serotonin (5-HT) receptors were evaluated for their ability to reduce the cognitive impairment produced by MK801. Specifically, WAY-100635, a selective 5-HT1A receptor antagonist, buspirone, a 5-HT1A partial agonist, ritanserin, a 5-HT2 antagonist, and ondansetron, a 5-HT3 antagonist, were assessed. In addition, the muscarinic agonist arecoline was evaluated for its potential cognitive benefit in this model. It was found that WAY-100635 significantly reduced the cognitive impairment induced by MK801. Treatment with single doses of ritanserin, ondansetron, or arecoline in combination with MK801 did not result in a cognitive impairment, indicating that these drugs attenuated the MK801 impairment. The combination of buspirone and MK801 resulted in an inability of the animals to complete the task. These results suggest that interactions between 5-HT and glutamate may mediate the beneficial effects of reducing cognitive impairment and that 5-HT antagonists, especially selective 5-HT1A antagonists, may be useful in treating AD. Further, it is indicated that the MK801 model of cognitive impairment may add to the armamentarium of tools available to predict treatment efficacy in AD.

Alzheimer Disease↗
PubMed1995

Effects of lesion of the inferior olivary complex in learning of the equilibrium behavior in the young rat during ontogenesis. I. Total lesion of the inferior olive by 3-acetylpyridine.

Young DA/HAN strain rats were submitted to an equilibrium test consisting in maintaining equilibrium upon a rotorod rotating at 10 or 20 rpm. They were either intact or lesioned, the lesion consisting in destruction of the inferior olivary complex (IOC) by 50-95 mg/kg i.p. administration of 3-acetylpyridine (3-AP) at day 15, followed, 2 to 4 h later, by i.p. injection of niacinamide (300 mg/kg). All the 3-AP-treated animals included in this study were completely lesioned, the extent of the lesion being estimated by both the response of the rats to harmaline and histological controls at the end of the experiments. The IOC lesioned rats were either naive (tested at one given day) or trained every day (10 trials per day); among the latters, some were trained before and after the lesion, the others being trained either before or only after. Control rats were submitted to the same training schedule. Both quantitative (time during which the animals maintained the equilibrium upon the rotating rod) and behavioral data (strategy used by the animals to maintain equilibrium) were obtained. The results demonstrate that, compared to those of controls rats, the quantitative and behavioral scores of the IOC lesioned animals were altered. Comparison of naive and trained animals shows that the impairment of the equilibrium behavior is not only due to the ataxia provoked by the IOC lesion but is also due to cognitive deficits. However, prelesion training facilitates the acquisition of a more efficient postlesion equilibrium behavior. From these results, it can be concluded that the olivo-cerebellar pathway is involved in the adaptation of motor behavior to the environmental conditions.

Aging↗
PubMed2004

[Non pharmacological treatment of migraine].

Actual recommendations for treatment of migraine consist both of pharmacological and non-pharmacological treatment. The latter enables the patient higher responsibility and self-efficacy in coping with migraine. Therefore, the active involvement in the treatment of the patients is obligatory in all psychological pain therapy methods. Focus of therapy are emotional, cognitive, behavioural and social factors of migraine illness, with the aim to modify unfavourable habits and migraine attack-inducing factors. As non-pharmacological methods counselling, relaxation training, biofeedback and cognitive-behavioural treatments are employed. The long-term effects are comparable with those of pharmacological treatment, combination of pharmacological and non-pharmacological treatment lead to even higher efficacy and is often indicated. In case of headache in children, behavioural therapy should be the method of first choice. In the text, empirically proven methods of psychological pain therapy in migraine will be explained.

Biofeedback, Psychology↗
PubMed1999

Cognitive interventions among older adults.

This chapter reviews psychoeducational and/or psychosocial interventions designed to improve cognitive function in adults without cognitive impairment. Included are sections on (a) meta-analyses and other reviews; (b) cognitive aging and cognitive improvement; (c) memory training; (d) depression and memory improvement; (e) self-efficacy and aging memory; (f) maintenance of gains and subject retention; (g) comprehensive memory improvement program; and (h) future research. Several aspects of memory training now known to influence outcomes, i.e., memory performance, need to be considered in future studies. First, follow-up instruction (booster sessions) facilitates the use of these newly learned memory strategies in elders' everyday lives. Second, elders' memory self-efficacy (beliefs and confidence) impacts performance. Third, the inclusion of subjective measures in memory training is recommended. Fourth, greater emphasis needs to be placed on the modification of participants' attitudes toward aging-related memory loss. Fifth, designs must emphasize the long-term outcomes of the memory training. Sixth, establishing a relationship between a memory intervention and functional ability (IADLs) is the next step in assisting older adults to remain independent. If early failure in cognitive ability can be improved through intervention, perhaps early decline in functional independence and the need for formal services, e.g., nursing home placement, can be delayed.

Aged↗
PubMedDate not supplied

[Impact of a new cognitive remediation strategy on interpersonal problem solving skills and social autonomy in schizophrenia].

INTRODUCTION: Despite recent developments, the impact of pharmacotherapy on social autonomy and interpersonal problem solving skills in patients with schizophrenia remains limited, with consequences in terms of socio-professional functioning. Indeed, independently of the positive, negative and/or disorganization symptoms, functional deficits in patients with schizophrenia rely mainly on various cognitive impairments. OBJECTIVES: To determine the impact of a new Cognitive Remediation Strategy on interpersonal problem solving skills, social autonomy and symptoms in patients with schizophrenia. METHODS: Thirty patients with schizophrenia were enrolled in a program consisting of 14 training sessions of 4 cognitive functions (attention/concentration, topological memory, logical reasoning, executive functions) using the REHACOM software. Measurements of attention (Continuous Performance Test, CPT), memory (Rivermead Behavioural Memory Test, RBMT) and executive functions (Wisconsin Card Sorting Test, WCST) as well as interpersonal problem solving skills (Assessment of Interpersonal Problem-Solving Skills, AIPSS) and social autonomy (Social Autonomy Scale, EAS) and finally schizophrenia symptoms (Positive And Negative Syndrom Scale, PANSS) were undertaken at the beginning and the end of the 14 remediation meetings. RESULTS: Cognitive functions, interpersonal problems solving skills, social autonomy and symptoms were significantly improved by the Cognitive Remediation Strategy. CONCLUSION: Our results confirm the therapeutic impact of a Cognitive Remediation Strategy among 30 schizophrenic patients stabilised on clinical, therapeutic and functional levels. The question of the long-term maintenance of such improvements still requires further investigation.

Adolescent↗
PubMed1999

Cognitive-behavioral coping-skills therapy for alcohol dependence. Current status and future directions.

Cognitive-behavioral coping-skills training (CBST) is an alcoholism treatment approach aimed at improving the patients' cognitive and behavioral skills for changing their drinking behavior. CBST encompasses a variety of approaches that despite their core similarities differ in duration, modality, content, and treatment setting. Numerous studies and reviews have ranked CBST among the most effective approaches for treating alcoholic patients. Nevertheless, a recent analysis of nine studies failed to identify specific CBST components that could account for the treatment's effectiveness. Furthermore, a similar analysis of 26 studies suggested that CBST's superior effectiveness was limited to specific treatment contexts (i.e., when delivered as part of a comprehensive treatment program) and to specific patient subgroups (e.g., patients with less severe alcohol dependence). Several measures may help broaden CBST's focus and effectiveness, such as incorporating components of other treatment approaches.

Adaptation, Psychological↗
PubMed1982

Cognitive and cognitive-behavioral methods for pain control: a selective review.

The literature on cognitive and cognitive-behavioral methods for pain control is selectively reviewed, with particular focus on controlled studies. Such methods include the provision of preparatory information, cognitive coping skills or strategies, the provision of preparatory information plus some form of coping skills instructions or training, prepared childbirth techniques, multifaceted cognitive-behavioral treatment regimens, and stress-inoculation training. Overall, the scientific evidence for the efficacy of cognitive and cognitive-behavioral methods for clinical pain attenuation is somewhat meager, although some encouraging but still tentative results have been obtained. There has been much work on the psychological elements involved in such strategies in the laboratory but there is still little sound information on their use for clinical pain. Several issues emerging from the literature review are discussed, with the need for further controlled evaluations being obvious.

Behavior Therapy↗
PubMed2006

Strength training in older adults: an empowering intervention.

PURPOSE: This study evaluated the benefits of adding a psychological empowerment intervention (PEI) to traditional strength training (TST) on social cognitive variables in community-dwelling older adults. METHODS: Thirty-eight participants were randomly assigned to either a PEI or a TST intervention for 6 wk. Before random assignment and following training, participants completed measures of self-efficacy for upper and lower body strength as well as the desire to be able to lift specific amounts of weight. Both treatments involved two sessions per week of center-based training and one session per week of home-based training. The PEI condition also included a group-mediated intervention that was designed to increase self-efficacy for physical strength and the desire for upper and lower body strength. RESULTS: General linear models on difference scores revealed that the two groups experienced differential gains in the desire for upper body strength (P = 0.023, effect size (ES) = 0.79) and were marginally different in gains for upper body strength self-efficacy (P = 0.065, ES = 0.63). On a four-point scale, the adjusted mean (+/-SE) differences for the PEI group on the desire for upper body strength was 0.71 (+/-0.12) as compared to 0.27 (+/-0.13) for the TST group, whereas the PEI group's improvement in self-efficacy for upper body strength was 25.70 (+/-3.02) as compared to 17.18 (+/-3.19) for the TST group. CONCLUSIONS: Empowerment-based exercise programs may be particularly motivating for older adults by creating a more meaningful physical activity experience for them.

Aged↗