Towards theory‐driven therapies for aphasic verb impairments: A review of current theory and practice

Background: This review is intended for both theoretically and clinically motivated audiences with an interest in aphasic verb impairments.

Aims: Building from previous reviews, our aim is to provide a concise summary of the relevant theoretical research and perspectives on verbs, and from this theoretical foundation to explore which aspects have been incorporated and tested in therapy studies.

Main Contribution: In the theoretical domain, the review first considers the patterns of verb and noun impairments in aphasic syndromes. Second, an overview of the linguistic differences between verbs and nouns is provided, differences that occur at various levels of linguistic analysis: phonological, morphological, semantic, and syntactic. This is followed by a detailed account of the psycholinguistic perspective on verb–noun differences. Specifically, this section examines the role of variables such as imageability and frequency, and the issue of depiction of actions in static picture versus dynamic video format. Evidence from neuroimaging studies as well as neurodegenerative conditions such as semantic dementia is also reviewed. Finally, the psycholinguistic account further discusses the question of whether verbs (and nouns) serve as primary ordering principles in the cognitive architecture of language processing or whether they should be more accurately viewed as points on an overarching psycholinguistic continuum. Also within the psycholinguistic discussion, event perception is described as a theoretical account with implications for verb processing. Despite the importance of verbs in their pivotal role in connected speech, there is a very limited body of literature on verb therapies and only a small number of the theoretical issues/perspectives have penetrated approaches to treating verb impairments. Ten published papers are described. Two of these directly compare verb and noun therapies, reflecting the many comparisons of noun vs verb impairments in the theoretical literature. The remaining eight consist of purely verb‐focused therapies, which also examined the effects of increased verb retrieval skills on related sentence production (reflecting the pivotal role of verbs in connected speech). These eight studies are subdivided between four that targeted verb retrieval only and four that also investigated aspects of verb argument structure and sentence production.

Conclusions: The general discussion notes possible new approaches to the treatment of verb deficits that arise from the many factors noted in the theoretical literature which are yet to be fully explored in therapy studies.     

Holding and creating: A grounded theory of art therapy with 0–5-year-olds

Abstract

This research utilised grounded theory methodology to explore the current clinical experiences of art therapists who work with young children, formulating an art therapy frame that currently does not exist. Following a series of focus groups with art therapists who have worked extensively with 0–5-year-olds, additional written and creative responses were collected and further clarified the emergent theoretical frame. This theoretical frame posits art therapy as a modality that offers both creativity and structure, a dialectic integration that responds to identified issues at the early stages of life while combating pressures to over-standardise treatment.     

Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome——A retrospective study

BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS. DESIGN: Retrospective case-analysis. SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21–85 years. METHODS: ①The condition of diabetes mellitus complicated by abnormal thyroid function was observed. ② The effect on predominant hand, and paraesthesia were observed. ③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria. ④ Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved. MAIN OUTCOME MEASURES: ①Condition of CTS complicated by metabolic disease; ②Effects on predominant hand and paraesthesia; ③Electrophysiological grading; ④Prognosis. RESULTS: Totally 161 patients participated in the final analysis. ①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism. ②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like numbness and paresthesias were the predominant symptoms, accounting for 89.1% (134/161), this discomfort was felt in all 5 digits of the hand in 47.6%, and lateral three and half digits in 21.4%. The noctural symptoms were present in 30.4% (49/161) patients. ③Electrophysiological typing: The most frequent abnormality was that of the prolonged mid-palm median and ulnar latency difference in 146(54.7%) hands; 103(38.6%) hands had prolonged median motor distal latency. Absent response from thenar muscle was present in 35 (13.1%) hands. Nerve conduction study showed bilateral CTS in 105 (65.2%) patients and unilateral CTS in 56 (34.8%) patients. Sixteen patients with bilateral CTS had symptoms in one hand only. Overall, 36.8% had mild, 49.2 % had moderate and 13.9 % had severe CTS, with median duration of symptoms of 6, 9 and 14 months, respectively. ④Delay in diagnosis: 37(22.9%) patients delayed in diagnosis from 1–4 months, 16(43.2%) were misdiagnosed as cervical spondylosis; 6(16.2%) were ignored due to their condition by busy work; 15(40.5%) were unware of their symptoms. ⑤Prognosis: Follow up data was available for only 72.7% (117/161) patients. Conservative management was conducted in 73.5% (86/117). Clinical symptoms were resolved or improved in 65.1% (56/86) patients with 17 mild CTS, 29 moderate CTS, and 10 severe CTS. 26.5% (31/117) patients underwent surgery for CTS release, and clinical symptoms were improved in 12(38.7%) with moderate CTS and 2 (6.5%) with severe CTS at 3 months of follow up. CONCLUSION: ①Sensory symptoms in CTS are more in severe and common in dominant hand. ②Conservative management showed resolution or improvement for mild and moderate CTS. Surgical intervention shows either resolution or improvement in clinical symptoms in moderate CTS. ③ The common reasons for delay in diagnosis were due to misdiagnosis as cervical spondylosis and lack of awareness of the condition. ④Assessment on severity of CTS by electrophysiological grade is of important significance for determining therapeutic mean.     

Resilience,Refugees and the Rights of Children — An Immorality Play

It is well established that violent media can increase levels of aggression. The aim of the present study was to examine whether cognitive distortions mediate the relationship between enjoyment of violent media and the frequency in which people are exposed to violent media, and whether this exposure to violent media mediates the relationship between cognitive distortions and levels of aggression. Eighty-six participants completed questionnaires assessing enjoyment of and frequent exposure to film and television violence, lyrical violence in music, and computer game violence. Participants were also assessed with respect to frequency of aggression and moral disengagement. Mediation analysis indicated partial mediation effects of moral disengagement regarding the relationship between enjoyment of violent media and the frequency of exposure to violent media; and full mediation effects of moral disengagement in the frequency of exposure to violent media–aggression relationship. The study emphasizes the role that cognitive distortions such as moral disengagement play in digesting violent media, making it more acceptable and therefore increasing the likelihood of higher levels of aggression.     

The social interview schedule (SIS) — content,structure and reliability

Summary The English original form of a standardized social interview was presented by Clare and Cairns (1978). The German version is described with regard to concept, structure, and methodology. The interview is designed to assess social maladjustment by measuring three conceptual categories (Objective Material Conditions, Social Management, and Satisfaction) in eight role areas. The instrument is especially suited for outcome assessment in various clinical and non-clinical populations and takes an average of about 30–45 min to complete. The 39 items are rated on 4-point scales either by the interviewer with the help of an extensive rating manual, or by the subject himself (all Satisfaction items). The results of a reliability study are presented using both the test-retest and the interrater method. In general, the results show that the instrument is satisfactorily reliable, but some possible weaknesses are discussed. Finally, the structure of the instrument is examined by an analysis of interrelationships between the items in a normal population sample. The results are discussed with regard to questions of score construction.     

Therapists’ honesty,humor styles,playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect

Objective: This study examined whether therapists’ honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. Method: In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. Results: Therapists’ Aggressive Humor Style (AHS) was a significant negative predictor of clients’ symptom change over time. The therapists’ honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. Conclusions: Therapists’ inferred traits of Honesty–Humility and AHS may influence the effectiveness of their treatments.     

Establishment of a multimodal protocol combining a motivational interview,subcutaneous injection of NicoSan® and hyper-hydration for the “stopsmoking therapy”: A multicentre real-life study’

ObjectivesThe StopSmoking Therapy, combins a motivational interview, a subcutaneous injection of NicoSan® and a hyperhydration protocol. The objectives were to evaluate the number of patients declaring cessation and factors related to relapse.MethodsIn the 18 months following protocol, 554 subjects who consented, responded to the study's questionnaire. Categorical variables are presented as the frequency and percentage, continuous variables are presented as the mean and standard deviation, responses of abstinent subjects and of those who had started smoking again are compared via the chi-square test for categorical variables, and the Student's t-test for continuous variables.ResultsIn our sample 92.8% of the subjects reported smoking for 10 years or more. A total of 475 subjects (85.7%) reported a complete cessation (31.2% for more than 6 months and 33.1% for more than a year). Among relapsing subjects, were significantly over-represented: youngest ages, lower motivation, more frequent close friends or family using tobacco, lower dependency scores. No subject reported any significant adverse effects.ConclusionThe multimodal protocol explored seems to have a favorable impact on smoking cessation, which could be enhanced by additional interventions dedicated to the youngest age groups, to people having smoking close friends and family, and should possibly add interventions based on cognitive behavioral therapy. A dedicated support by specialist tobacco addiction in the first weeks after treatment and/or the use of mobile support applications could also be useful. In order to asses efficacy, a prospective randomized double blind controlled versus placebo protocol could be considered.     

Maternal eating disorder history and toddlers’ neurodevelopmental outcomes: A brief report

ABSTRACT

This study explored the neurodevelopmental outcomes of toddlers whose mothers have eating disorder histories and the contribution of maternal eating and comorbid psychopathology to the children’s cognitive functioning. Twenty-nine mothers with prenatal eating disorders and their toddlers (18–42 months old) were compared to a case-control matched group of mothers with no eating psychopathology and their toddlers. Measures included current maternal eating and co-occurring psychopathology, and a developmental assessment of each child. The children of mothers with eating disorders showed delayed mental and psychomotor development. Severity of maternal eating disorder symptoms emerged as a significant predictor of child development, but other maternal psychopathology did not. Findings suggest that maternal eating disorder history may play a unique role in the development of neurodevelopmental functions in their children.     

Hiring and retaining direct-care staff: after fifty years of research,what do we know?

Recruiting and retaining direct-care staff has long been a challenge for administrators of programs that serve persons with disabilities. A literature review revealed that beginning in 1950, researchers set out to develop a paper-and-pencil test that would identify good employees. Regardless of how they defined good, employers were unable to identify tests that selected promising job applicants. Efforts to develop research-based selection tools decreased in the early 1970s with the transition from state institutions to community programs. However, the growth of community programs did not mitigate the turnover problem, and the need remains for a reliable hiring tool. Whereas recent researchers have identified practices that can reduce turnover, these practices should be more widely implemented and their efficacy examined.     

Is asthma a psychosomatic illness?—I.: A retrospective study of mental illness and social adjustment

A group of 53 asthmatics and 50 matched controls together with their first-degree relatives has been followed up retrospectively after an interval of 15 years. There was no evidence that the mental illness experienced by the asthma group differed significantly from that of controls during the follow up period eithet in period prevalence or diagnosis. The presence of mental illness amongst asthmatics was not related to the prognosis for asthma, nor to the age of onset, family history of asthma or other atopic conditions. The asthma group showed only slightly greater impairment in social adjustment than controls. These findings are discussed in the light of traditional views of asthma as a psychosomatic illness.     

Measuring outcomes in aphasia: Bridging the gap between theory and practice… or burning our bridges?

Abstract

Economic forces have increased demands for efficacy research in the speechlanguage rehabilitation of aphasia that is more relevant to aphasic individuals' ability to function as productive, or at least independent, members of society. Siegel (1993) views efficacy research as ‘a natural bridge between the requirements of careful research and the needs of clinical practice’; however, he acknowledges that the therapy needs of individual clients do not always mesh with the requirements for ‘reliable and replicable data collection’ (p. 37). How will outcome measures help to bridge these two goals of the discipline? It is a widely held belief that the renewed emphasis on measuring ‘functional communication’ will bring theory and practice together, by focusing research on intervention efforts directed at communicative skills required in daily life, and by involving clinicians in on-going, standardized evaluation of their own efforts. In the process the profession will be able to justify its efforts in both clinical and research domains. It is worthwhile examining the rocky shores upon which these claims are based, before diving headlong into the current of changing health-care policies.     

Kleeblattschädel skull: a review of its history, diagnosis, associations, and treatment

Introduction

Kleeblattschädel (cloverleaf) skull is a very uncommon form of pansynostosis. Some cases are associated with syndromes, but often, this skull deformity is seen in isolation. To date, a comprehensive review of this topic is not available in the medical literature.

Conclusions

Herein, we review the history, associations, diagnosis, treatment, and complications of Kleeblattschädel skull.     

Art therapy: Re-imagining a psychoanalytic perspective—A reply to David Maclagan

Abstract

This article looks at the introduction and development of art therapy in a girls comprehensive school. It describes the institution and the steps taken to establish a sound framework for therapeutic practice in a new setting. The case study that follows illustrates a sixth-formers complex needs as acted out in the day-to-day life of the school and beyond.     

Psychogenic non-epileptic seizures—Definition,etiology, treatment and prognostic issues: A critical review

In this review we systematically assess our currently available knowledge about psychogenic non-epileptic seizures (PNES) with an emphasis on the psychological mechanisms that underlie PNES, possibilities for psychological treatment as well as prognosis. Relevant studies were identified by searching the electronic databases. Case reports were not considered. 93 papers were identified; 65 of which were studies. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. A working definition for PNES is proposed. With respect to psychological etiology, a heterogeneous set of factors have been identified. Not all factors have a similar impact, though. On the basis of this review we propose a model with several factors that may interact in both the development and prolongation of PNES. These factors involve psychological etiology, vulnerability, shaping, as well as triggering and prolongation factors. A necessary first step of intervention in patients with PNES seems to be explaining the diagnosis with care. Although the evidence for the efficacy of additional treatment strategies is limited, variants of cognitive (behavioural) therapy showed to be the preferred type of treatment for most patients. The exact choice of treatment should be based on individual differences in the underlying factors. Outcome can be measured in terms of seizure occurrence (frequency, severity), but other measures might be of greater importance for the patient. Prognosis is unclear but studies consistently report that 1/3rd to 1/4th of the patients become chronic.     

The “Patient Presentation:” The Evolutions of a Practice,of Its Objectives,and of Its Effects on Training

ObjectivesThrough a review of the history of patient presentations and changes to this system, we will try to situate its function and challenges, particularly with regard to its effects on the training of professionals. The articulation of these effects with the necessary ethical questions raised by this practice will be highlighted.MethodThe review of the French-language literature on the practice of patient presentations makes it possible to note its permanence since the origins of psychiatry, its multiple challenges, the risks it has encountered over the course of its history, and the consequent changes that have resulted from it. A personal experience of patient presentations at the Centre Hospitalier Sainte-Anne over more than twenty years allows us to emphasize the essential elements of this exercise.ResultsPracticed mainly in recent years by psychoanalysts, the system of patient presentations has been considerably modified by taking into account the registers of language, speech, and the transference. The control or supervisory dimension also becomes a central function of this practice. This subversion makes it possible to significantly advance the controversies that run through its history. It also highlights its instructive effects, which, far from being limited to a pedagogical demonstration to inexperienced practitioners, involve practitioners in a place that allows them to question their position as well as their action, in their daily practice.DiscussionThe diversity of patient presentation systems, the variety of circumstances that led to their implementation in hospital services, the variable place they occupy in the organization of care, and the unequal interest that they can arouse on the part of healthcare teams justify identifying the essential benchmarks that make this practice so specific. The articulation of the three distinct places of the patient, the examiner, and the public – through the distinct knowledge attributed to each of these places – makes it possible to propose a reading of the structure of these presentations to examine their effects on the training of practitioners, as well as on clinical research.ConclusionIf clinical practice is developed and transmitted “at the patient's bedside” and in the dialogue between practitioners, then the presentation of the patient is one of the key places where clinical practice is developed. The ethical questions it raises thus constitute an opportunity for a renewal of the psychiatric clinic and its practice.