The prevalence of non-accidental trauma among children with polytrauma: A nationwide level-I trauma centre study

ObjectiveWe aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC).Summary of backgroundData 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear.MethodsThis is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel.ResultsThe study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02).ConclusionsNAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.     

Lasting improvements in left spatial neglect following a protocol combining neck-muscle vibration and voluntary arm movements: a case-study

Purpose: Beyond promising experimental results of sensory passive stimulations in spatial cognition disorders, some questions still remain regarding interests of these stimulations during the daily activities in neglect. The aim of this case-study was to evaluate the effects of a protocol combining left neck-muscle vibration with daily simple movements, like arm pointing movements, on perceptivo-locomotor deficits in a left spatial neglect patient.

Materials and methods: Two neuropsychological tests, one subjective straight-ahead pointing (SSA) test and one wheelchair navigation test were carried out before the combination protocol, immediately after, 1?h later, and 24?h later.

Results: The results showed a reduction of neglect spatial bias following the protocol lasted at least 24?h in all the tests (except for the SSA test due to the unavailability of the pointing device).

Conclusions: The range of improvements in the symptoms of spatial neglect suggests that this therapeutic intervention based on the combining neck-muscle vibration to voluntary arm movements could be a useful treatment for this condition. One of future investigation axes should be the development of a vibratory tool in order to facilitate the combining this proprioceptive stimulation to daily activities.

• Implications for rehabilitation

• Spatial neglect is a perplexing neuropsychological syndrome, affecting different domains of spatial cognition and impacting also the functional domain.

• The treatments based on neck-muscle vibration are simple to use, non-invasive and requires none active participation of patient.

• A therapeutic intervention based on the combining left neck-muscle vibration and voluntary arm movements in a left-spatial-neglect show a lasting reduction of symptoms especially in daily activities.

• The combination of treatments based on the Bottom–Up approach opens innovative perspectives in rehabilitation.

     

Child Neglect: Assessment and Intervention

Neglect is often a neglected form of child maltreatment even though it is the most common and deadliest form of child maltreatment. Pediatric nurse practitioners (PNPs) will most likely encounter neglected children in their practice. It is crucial that PNPs recognize child neglect in a timely manner and intervene appropriately. This continuing education article will help PNPs understand and respond to child neglect. Neglect will be defined and risk factors will be discussed. Children who are neglected can experience serious and lifelong consequences. The medical assessment and plan of care for children with concerns of suspected neglect will be discussed.     

Mental number space in three dimensions

A large number of experimental findings from neuroscience and experimental psychology demonstrated interactions between spatial cognition and numerical cognition. In particular, many researchers posited a horizontal mental number line, where small numbers are thought of as being to the left of larger numbers. This review synthesizes work on the mental association between space and number, indicating the existence of multiple spatial mappings: recent research has found associations between number and vertical space, as well as associations between number and near/far space. We discuss number space in three dimensions with an eye on potential origins of the different number mappings, and how these number mappings fit in with our current knowledge of brain organization and brain-culture interactions. We derive novel predictions and show how this research fits into a general view of cognition as embodied, grounded and situated.     

Early parenting: The roles of maltreatment,trauma symptoms,and future expectations

The psychosocial determinants of early parenting are still not well understood. The current study used data on 115 girls in the Capella Project, who were followed longitudinally for the first 18 years of life. Potential predictors of early parenting assessed were child maltreatment, trauma symptoms, and girls' expectations for their socioeconomic outcomes. Cox regression survival analyses were conducted to predict time to the birth of first child. Significant unique predictors of early parenting included neglect, anxiety, low depression, and low expectations of going to college. Practice and research implications of these findings include the importance of neglect for risk of early parenting, the importance of ongoing trauma symptoms in youth, and the potentially protective influence of expectations of going to college.     

Severity of neglect predicts accuracy of imitation in patients with right hemisphere lesions

Goldenberg [Goldenberg, G. (1996). Defective imitation of gestures in patients with damage in the left or right hemisphere. Journal of Neurology, Neurosurgery, and Psychiatry, 61, 176–180] proposed that the vulnerability of the imitation of meaningless gestures to right or left brain damage depends on the body parts that are involved in the gestures. Whereas imitation of hand postures was disturbed only in patients with left brain damage, imitation of finger postures was affected to similar degrees in left and right brain damage. Subsequent studies confirmed the selective vulnerability of hand postures to LBD but failed to replicate the severe disturbance of finger postures in RBD. In contrast to Goldenberg's studies, these studies excluded RBD patients with neglect. The present investigation aimed to explore the relationship between spatial neglect and imitation of finger postures in RBD patients.Presence and severity of spatial neglect and accuracy of imitation of hand and finger postures were tested in 50 RBD patients. Disturbance of imitation was much more severe for finger than hand postures and was tightly correlated with severity of neglect. The number of errors was higher for fingers which from the patient's perspective were located on the left side of the examiner's demonstrating hand but this spatial bias was not sufficient to explain all errors. Possible causes for non-lateralized errors could be a general narrowing of the focus of attention and reduced capacity for processing of visual information which have been postulated to be regular companions of the lateral displacement of attention in spatial neglect.     

European map of prevalence rates of elder abuse and its impact for future research

This article aims to map existing prevalence research on abuse and neglect of older people and to provide a critical overview of existing methodologies, which have been adopted to survey the prevalence rates of abuse against elders. This article is part of the prevalence study of Abuse and Violence against Older Women (AVOW) study, which was conducted in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal). The article provides an overview of the state of the art of prevalence data, survey designs and methods, instruments and results in Europe. Therefore, this draws on an extensive literature search and qualitative content analysis, which was conducted as an early part of the AVOW study. Results indicate that some EU countries have a rich history of prevalence research, whereas other countries have just begun to tackle this aspect of research on of elder abuse. One of the lacunae concerns reliable numbers on the prevalence rates of elder abuse. Research about where, when and how often elder abuse occurs, is inadequate and inconsistent. Data in some cases are based on professionals’ reports rather than on information from older people themselves. Surveying elders about such a sensitive topic, however, implies the need for an adequate research instrument (questionnaire) and research design, and an adapted data collection method. In conclusion, substantial attention is paid to outlining possible guidelines for future research.     

Body schema and body image—Pros and cons

There seems to be no dimension of bodily awareness that cannot be disrupted. To account for such variety, there is a growing consensus that there are at least two distinct types of body representation that can be impaired, the body schema and the body image. However, the definition of these notions is often unclear. The notion of body image has attracted most controversy because of its lack of unifying positive definition. The notion of body schema, onto which there seems to be a more widespread agreement, also covers a variety of sensorimotor representations. Here, I provide a conceptual analysis of the body schema contrasting it with the body image(s) as well as assess whether (i) the body schema can be specifically impaired, while other types of body representation are preserved; and (ii) the body schema obeys principles that are different from those that apply to other types of body representation.     

A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect

Extrapersonal neglect is one clinical manifestation that can occur following stroke. Existing neglect assessment procedures have been criticised for lengthy administration and do not assess how extrapersonal space is affected. This study investigated the psychometric properties of a new, time-efficient screening tool for extrapersonal neglect. Full ethical approval was granted and consent obtained from 50 participants with first-time stroke. Participants were screened for extrapersonal neglect on two consecutive days by two raters using the Dublin Extrapersonal Neglect Assessment (DENA) to test inter-rater reliability. Construct validity of the DENA was investigated by comparing the DENA to the Catherine Bergego Scale (CBS). Additional analyses were calculated between the DENA and the extrapersonal items of the CBS (CBS-E). The kappa statistic, intraclass correlation coefficients (ICCs) and Bland Altman analyses were calculated to determine excellent inter-rater reliability (ICC 0.971, κ?=?.876) and significant correlation between the DENA and the CBS and CBS-E (ICC 0.870, 0.934, κ?=?.793, .833, respectively). Bland Altman analyses demonstrated acceptable levels of agreement between the DENA raters, and the DENA and CBS, with no systematic differences evident. The DENA provides clinicians with a quick and psychometrically sound screening tool for extrapersonal neglect to ensure this impairment is addressed in stroke rehabilitation.     

Modelling attuned relationships in art psychotherapy with children who have had poor early experiences

This paper aims to critically explore the current research coming under the umbrella of attachment theory and the implications this may have for the practice of art psychotherapy with children whose experience of early care has been inadequate. The author sets out a model of three ways areas of work within the therapeutic relationship where the therapist is modelling the experience of an attuned relationship regulation, affect processing and developing narrative. We discuss the development of an individual's capacity to regulate, to process affect and to develop a narrative within a secure and attuned relationship during infancy, along with the ways in which art psychotherapy is uniquely positioned to make up for deficits in these areas. The model is shown to provide a meaningful framework for thinking about the therapeutic process. Vignettes are used to give an insight into work within each of these three areas from the author's clinical practice.