Integrative Psychotherapy in Addictive Disorders.

In most countries, addictive disorders have increased considerably in the recent years, becoming a main problem of public health for governments. One approach toward the rehabilitation of people with addictive disorders is in Chile's Therapeutic Communities. In such communities, recovering addicts actively collaborate in the rehabilitation of people in treatment. The characteristics of the rehabilitation process are presented from the perspective of the supraparadigmatic integrative model proposed by R. Opazo (1997). The application of an integrative clinical evaluation record (Ficha de Evaluacion Clinica Integral) helps one to understand, through the different subsystems of the model, the presenting problems of persons entering rehabilitation, the etiological role of each subsystem, and the modification that takes place during treatment. Biological predisposing factors such as extraversion and neurological immaturity are resistant to treatment modification; however, alterations acquired during the addictive process, in all the subsystems of the model, are modifiable after 9 months of integrative psychotherapy. On the basis of the authors' observations and on the supraparadigmatic integrative model, an etiological approach of addictive disorders is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond one-bun, two-shoe: recent advances in the psychological rehabilitation of memory disorders after acquired brain injury

Memory disorders are one of the most frequent types of cognitive impairment encountered in neurological populations. The more severe degrees of such impairment case major disability and handicap, and have a profound impact on a person's capacity to engage in independent living. To date, commonly used remediation strategies range from drills and practice, including computer-based tasks, to mnemonic techniques and memory notebooks. In general, these therapies have met with varying degrees of success. The last decade has seen exciting developments in remediation techniques for memory disorders, a number of which are based on implicit learning skills, as well as programmes tailored to an individual's unique pattern of deficits. The present paper provides an overview of this literature and discusses issues relating to their application in rehabilitation programmes.     

Rehabilitation after traumatic brain injury in adults

PURPOSE: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.     

Treating conversion disorders: Is a pediatric rehabilitation hospital the place?

A conversion disorder is a psychiatric disorder with a physical manifestation. Symptoms affect voluntary motor or sensory function and are suggestive of a neurological or other medical condition, but are inconsistent with known neurological or musculoskeletal presentations. Conversion disorders are more common in adolescents than either children or adults. Historically, they have been treated in mental health settings. However, recent work has suggested that rehabilitation units may provide a more effective treatment milieu. This article includes a case study documenting the efficacy of treatment for an adolescent with a functional gait disturbance. Focus of the discussion is on the needs of the patient, requirements of the rehabilitation psychologist, and conflictual relationships between the provider of care and third-party payer for treatment interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of a 56-stimulus train for the rapid acquisition of auditory brainstem responses

PURPOSE: The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). METHOD: Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n = 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process. RESULTS: The patients talked more about attaining their pre-stroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status. CONCLUSIONS: The patient does not participate in the goal-setting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.     

Evidence for persistence of human parvovirus B19 DNA in bone marrow

Neurological rehabilitation involves the systematic presentation of environmental stimuli and challenges that enable the patient to learn strategies for minimizing their disabilities. Rehabilitation therapy of transplant recipients may be an important factor in enhancing the efficacy of the transplanted organ or tissue to promote functional recovery. Laboratory research and clinical trials on neural transplantation, as an experimental treatment for neurological disorders (e.g., Parkinson's disease, Huntington's disease, and cerebral ischemia), have focused primarily on devising effective surgical implantation strategies with little attention devoted to the interaction between environmental factors and restorative neurosurgery. Exercise training as part of neurological rehabilitation may be an important factor for neural transplantation therapy for Parkinson's disease. Rehabilitation providers are particularly well placed to provide the environment and the support to optimize the behavioral functioning of neural transplant patients in learning to use the new grafted tissue.     

Clinical audit; who is auditing who?

Clinical audit is the principal means by which current clinical practice is improved. Doctors in training must gain positive experience of audit as juniors, so as to establish the importance of audit for future practice. Good audit requires involvement of doctors in training, a high level of participation and a leading role to be taken by the professional bodies. To examine the degree to which such criteria are met currently, the quality and prevalence of clinical audit, the participation of junior doctors in audit, and the preparedness of medical professional bodies' to guide audit were assessed. One hundred and twenty-six junior and senior house officers in three Edinburgh hospitals were administered questionnaires in person, whilst eight Royal Colleges, the British medical Association and the General Medical Council were assessed by the quality of their written guidelines for audit. The data showed that only thirteen out of twenty four specialties, which employed half the juniors, utilised clinical audit. Half of these audit programs were structured to lead to improved patient care. Surprisingly, only three out of ten professional bodies were able to provide good quality audit information. In conclusion, clinical audit is not universal practice and many existing audit programs are inappropriately structured. Commonly, doctors at all levels seemed unaware of the goals of clinical audit. In addition, the majority of professional bodies provide poor information, thereby impeding successful audit by doctors in training. Clinical audit will not succeed until such deficiencies are rectified.     

Self-care independence in children with neurological disorders: An interactional model of adaptive demands and executive dysfunction.

Objective: To describe a neuropsychological assessment model that proposes executive functioning as a key moderator in the development of self-care independence. Setting: Inpatient and outpatient rehabilitation facilities. Participants: Transition-age youths with congenital and acquired neurological disorders. Intervention: Transition to the adaptive roles and expectations of adulthood can be challenging for adolescents with neurological disorders and other chronic medical conditions. These individuals frequently encounter functional problems related to additional time requirements, new life skill demands, and increased need for organization and planning. In addition, the neuropsychological consequences of these disorders often include deficits in motor speed and coordination as well as executive control (including planning, organization, and working memory). Consideration of the integrity of executive function skills and the presence of atypical adaptive demands is crucial during planning for transition of individuals into self-care independence and development of an approach to assessment and intervention. Conclusions: Rehabilitation psychologists have the potential to improve the quality of life of adolescents with neurological disorders as they transition into adulthood by considering the "executive burden" posed to the individuals by various combinations of executive dysfunction and atypical adaptive demands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of the neurobehavioral cognitive status examination with geriatric rehabilitation patients.

Objective: To provide normative data for 3 commonly encountered rehabilitation diagnostic groups and examine demographic influences on the Neurobehavioral Cognitive Status Examination (NCSE, now called Cognistat). Design: Normative data are presented along with correlational associations to demographic variables. Analysis of variance was used to examine test scores between the 3 diagnostic groups. Particoants: Eighty-six urban geriatric rehabilitation patients (34 recent total joint replacements, 22 with general medical conditions, and 30 with diagnosed neurological disorders). Results: Scores on many of the NCSE scales are associated with level of education. Five subtests evidenced performance differences between the joint replacement and neurologic groups. Conclusions: The NCSE has utility in detecting cognitive dysfunction with geriatric rehabilitation patients, although caution is suggested in NCSE interpretation in a lesser educated, older population because of educational effects on test performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gene transfer into haemopoietic cells

The therapeutic potential achievable by efficient transfer and expression of genes into haemopoietic stem cells (HSC) is enormous. In addition to inherited disorders such as haemoglobinopathies and lysosomal storage disorders, this technology can be applied to acquired disorders such as myelosuppression induced by anticancer chemotherapy or infection with human immunodeficiency virus (HIV). To date retroviral vectors are the most attractive modality for gene transfer into HSC. Unfortunately, the expectations of gene therapy are more advanced than the methodology needed to fulfil the goals. In this chapter, the current concepts and limitations in the genetic manipulation of haemopoietic cells are presented. Overcoming these limitations requires not only improvement in isolation and expansion of HSC that contribute to long-term repopulation, but also development of better retroviral transfer systems. Current restrictions occur at various levels in the viral transfer process, including efficient cell entry, regulated expression levels, and sustained expression. The analysis of retroviral mutants has proven to be a successful approach to developing effective retroviral vectors for HSC gene therapy.     

Distinguishing psychological disorders from neurological disorders: Taking Axis III seriously.

Inasmuch as current efforts in clinical neuropsychology call attention to the difficulty in differentiating psychological from neurological disorders, it is unclear to what extent professional psychologists without expertise in this subspecialty have knowledge of this diagnostic issue. This article asserts the need for psychologists to have requisite knowledge of neurological disorders that can initially present with psychological symptoms. Recent developments in professional psychology's advancement into hospital settings have prompted examination of such competency issues, and the abilities of psychologists to accurately differentiate neurological from psychological disorders are discussed. Examples of neurological conditions that commonly exhibit psychological symptoms are highlighted, and reference to the elderly is made to exemplify the need for accurate diagnostic sophistication. Relevant research is reviewed, and suggestions for training are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The identification of neurologically relevant items in the MMPI-2

The assessment of personality and (mal) adjustment after brain damage is regarded as an important aspect of rehabilitation. However, the administration of widely used self-report questionnaires, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), is restricted because of the danger of overscoring psychopathology and personality disorders. This is due to the inclusion of items reflecting manifestations of neurological dysfunction. Earlier investigations revealed variable neurologically relevant items (NRIs), within and between discrete cerebral aetiologies for the MMPI as well as the first part of the MMPI-2. In this study, 10 neuropsychologists, 10 neurologists, 10 psychiatrists, and 10 physiatrists identified NRIs in the complete MMPI-2. An item was considered to be an NRI based on professional expertise as well as type of brain damage. Based on a substantial inter-rater agreement index, four sets of clinical relevant NRIs were selected: one for brain damage in general and three partially overlapping sets for stroke, traumatic brain damage, and whiplash. Thus, the findings of this study unveil items which may indicate bona fide symptoms or manifestations related to neurological damage or dysfunction, rather than just reflecting psychopathology or personality disorders. It is advocated to develop an interpretative approach to correct for the impact of these NRIs on MMPI-2 scores.     

Why do we need more information about the risk factors of the musculoskeletal pain disorders in childhood and adolescence?

Musculoskeletal pain disorders such as low back pain, neck pain and shoulder pain are a major and ever increasing public health problem among the working population in industrialized countries with social insurance. Especially the economic impact of these diseases on society has been rising, but the disorders do also produce a lot of pain and suffering to the people. It is an important challenge to the health care systems to prevent and treat these disorders, but at the moment poor understanding of the risk factors of these diseases has failed in giving any effective tools to control the musculoskeletal pain disorder epidemic. Most of the epidemiological studies made are cross-sectional and they do not extend to childhood and adolescence, when the organs are developing, achieving their loading strength and possibly being traumatized and starting their degenerative process. The longitudinal Northern Finland 1966 birth cohort study offers a unique opportunity to find early risk factors for musculoskeletal pain syndromes.     

Critical thinking within the RACGP Training Program and the college examination

Current developments with the formalisation of the Program's curriculum provide the opportunity for the College to clarify its position on this important educational area. While not all GPs want to be involved in research, increasing demands for accountability for expenditure of insurer's (ie the government's) funds are inevitable. Skills related to audit of actual practice process and outcomes are likely to be required in the near future. The option of developing an audit project segment for the College examination should be considered. Critical appraisal skills could be assessed in the context of the development of standards for the audit. Similarly the efficacy of the Training Program in the development of accurate self-assessment skills in trainees should be researched. If found lacking, steps should be put in place to ensure that these educational processes become effective.     

The rehabilitation ethic and ethics.

A set of evolving ethical models is presented to illuminate key issues and provide decision-making guidance to rehabilitation staff regarding admission and termination of rehabilitation treatment. Roles, goals, and guiding principles are outlined for the paternalistic, contractual, and educational models and a deliberative model is offered as an alternative for use in preventing and resolving ethical dilemmas. This model redefines the rehabilitation process in terms of patients and providers acting in community. Recent observations have reemphasized the importance of empathy and communal interests in facilitating human development. Emphasizing these principles, which are fundamental to therapeutic relationships, may prove instrumental in resolving ethical dilemmas that arise in rehabilitation. Recommendations for training in therapeutic principles and ethical models throughout the psychologist's career are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology: Exploring issues.

Rehabilitation Psychology has several goals. One of its primary functions is to disseminate information that promotes the effective use of knowledge. While really new and current developments in rehabilitation interventions having psychological components may be known to the reader long before discussion of them appears in Rehabilitation Psychology, few "new findings" are dealt with to everyone's complete satisfaction. Many opinions exist about the efficacy of most innovative strategies; these conflicting views often are diverse, if not controversial. Therefore, it is helpful to provide professionals a forum in which they can discuss a problem and offer different viewpoints and perspectives that promote its resolution. I hope to make the journal such a forum within which these varying viewpoints can be heard. As Editor, I view Rehabilitation Psychology as being the single most significant organ through which the field can acquire additional clarity and identity. I view the role of Editor as being similar to that of a gatekeeper. The role entails major responsibility for ensuring that clinicians and academicians have an opportunity to present their findings and their opinions about critical issues facing the field. It is a role I hope to fulfill with competence and sensitivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical neurology of aging.

Reviews the book, Clinical neurology of aging, edited by Martin L. Albert (1984). This book covers the "neurology" of aging in the broadest sense of the term. The 27 chapters, written by recognized authorities in their specialties, deal with the organic bases of aging (neuroanatomy, neuropathology, neurochemistry, and neuroimmunology); the clinical neurological evaluation and the application of neurodiagnostic techniques (electroencephalography, computerized axial tomography, evoked potentials, cerebral blood flow); the neuropsychological, sensory, and motor changes associated with aging; psychiatric syndromes; rehabilitation procedures; and the most common neurological disorders encountered in the elderly patient. Both the practicing clinician and the researcher in the field of rehabilitation will find this volume to be a valuable reference. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Programming for occupational outcomes following traumatic brain injury".

Responds to an article Programming for occupational outcomes following traumatic brain injury by William J. Haffey and Frank D. Lewis (see record 1990-02644-001). The dramatic upsurge in attention paid in the past 10 years to the rehabilitation of persons with traumatic brain injury (TBI) has resulted in an accelerating proliferation of treatment programs purporting to apply specialized techniques that will "remediate" the cognitive and behavioral deficits of this population, with implicit or explicit promises of functional gain. Specifically, given the epidemiologic realities of the TBI population, returning to work is a major goal of the rehabilitation process. With the movement of TBI rehabilitation programs out of academic medical centers and into the private sector, increasing numbers of zealous professionals are ready to apply a variety of treatment approaches, thousands of families are eager to find the "best" program, and more and more nervous insurers are both mandated and requested to pay for expensive treatments that hold out the promise of return to work. Unfortunately, the field of TBI rehabilitation has been more eager to provide services than critically evaluate the effectiveness of those services. The first major contribution of the Haffey and Lewis article is to call attention both to the paucity of posttreatment vocational outcome studies, and to emphasize the need to evaluate the success of various models of vocational rehabilitation. The second major contribution of the Haffey and Lewis article is their offering of a concrete example of one approach to systematic programming for vocational outcomes. Our experience is that vocational potential—and therefore reasonable goals—only emerge as the product of a process that involves testing the client's capacities not just cognitively and behaviorally, but also his or her capacity to conform to a series of messages and procedures that will determine the viability of any given vocational plan. Readers should take from the concrete programming suggestions in this article the laudable objective of making vocational goals, obstacles, and critical events specific and public, but beware of mechanically applying the approach without appreciating the complex subtleties in enabling a brain-injured person to become a productive worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)