A meta-synthesis of qualitative research on perceptions of people with long-term neurological conditions about group-based memory rehabilitation

The effectiveness of memory rehabilitation based on randomised controlled trials and meta-analyses has been inconclusive, but patient reports based on qualitative studies have been largely positive. We conducted a meta-synthesis of qualitative studies of group-based memory rehabilitation programmes for people with neurological conditions. Based on systematic searches of electronic databases and reference lists, five papers (87 participants) were selected. Quality appraisal of papers was conducted by two independent reviewers using the Critical Appraisal Skills Programme tool. Data synthesis was guided by the meta-ethnography approach. Five higher order themes were elicited. These suggested that memory rehabilitation was associated with insight and acceptance of participants' neurological condition and resultant cognitive deficits. The therapeutic effects of the groups, with social support and leisure activities, helped with participants' confidence. There were improvements in memory related to better self-awareness and learning to use new skills and strategies to compensate for memory deficits. These improvements also related to other psychological effects, in terms of positively affected mood, confidence and fatigue. Ultimately, these changes had a positive impact on daily life, with changes seen in the personal, inter-personal and professional spheres. Therefore, this synthesis of qualitative studies suggests that memory rehabilitation offers positive outcomes for people with long-term neurological conditions.     

Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants’ reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants’ quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.     

Parents with learning disabilities: a study of gender and cultural perspectives in East London

The rights of people with learning disabilities to marry and have a family is at the heart of the Government's new strategy (Valuing People), yet there are few integrated and co‐ordinated services to meet their needs. All too often, learning disability is the sole reason why children are removed from their biological parents. Whilst there is a small but growing literature on the quality and extent of the social supports available, little attention has been paid to culture and gender. This study analyses data on parents who came into contact with the specialist community learning disability health team in East London over a 5‐year period in respect of culture, gender and outcomes.     

A Kinect-based system for physical rehabilitation: a pilot study for young adults with motor disabilities

This study assessed the possibility of rehabilitating two young adults with motor impairments using a Kinect-based system in a public school setting. This study was carried out according to an ABAB sequence in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their motivation for physical rehabilitation, thus improving exercise performance during the intervention phases. Practical and developmental implications of the findings are discussed.     

Chronic fatigue syndrome: A qualitative investigation of patients'' beliefs about the illness

The chronic fatigue syndrome is a disabling chronic condition of uncertain cause. Previous studies have found that patients seen in hospital clinics with the syndrome often strongly believe that their illness is physical in nature and minimize the role of psychological and social factors. There is also evidence that patients cope by avoiding activity. However, almost all of these studies have assessed illness beliefs only by questionnaire. The aim of this study was to explore the nature and origin of illness beliefs in more detail using in-depth interviews and a qualitative analysis of patient responses. Sixty-six consecutive referrals meeting Oxford criteria for chronic fatigue syndrome were recruited. Analysis of responses indicated that, whereas the most commonly described explanation for the illness was a physical one, more than half the patients also believed “stress” had played a role. Patients believed that they could partially control the symptoms by reducing activity but felt helpless to influence the physical disease process and hence the course of the illness. Patients reported that they had arrived at these beliefs about the illness after prolonged reflection on their own experience combined with the reading of media reports, self-help books, and patient group literature. The views of health professionals played a relatively small role. There is potentially a considerable opportunity to help patients arrive at a wider and more enabling explanation of their illness when they first present to primary care.     

The role of hippocampus in memory: A hypothesis

The role of the hippocampus in memory storage in the mammalian brain is examined. The intrinsic anatomical organization of the hippocampus is such that a multidimensional mapping of other brain regions is represented. Emerging knowledge of the cortico-limbic-subcortical anatomy suggests that the hippocampal representations preserve the topological features of the targets and possess reciprocal connectivity. Long-Term Potentiation (LTP) is a prominent physiological characteristic of hippocampal synapses and is a promising candidate mnemonic device. The hypothesis is advanced that the pattern, or index, of specific neocortical (and other) areas activated by an experiential event is represented, or indexed, in the hippocampus by means of LTP. This hypothesis, termed the Memory Indexing Theory, suggests that experiential events are initially stored in an index of neocortical locations maintained in hippocampus. Subsequently, other regions, notably neocortex itself, permanently encode these experiential events and the interrelationships between them.     

心理卫生工作者参与新冠肺炎疫情现场心理危机干预意愿的质性研究

目的探讨心理卫生工作者参与新冠肺炎疫情现场心理危机干预的意愿,了解其真实感受,提高心理卫生工作者进行疫情心理干预的积极性。方法运用质性研究中现象学分析法,根据半结构式访谈提纲对绵阳市某三级甲等医院的10名心理卫生工作者进行面对面的深度访谈,运用Colaizzi分析法对资料进行整理分析。结果心理卫生工作者参与新冠肺炎疫情现场心理危机干预意愿的主题包括愿意参加危机干预的因素和阻碍参加危机干预的因素。愿意参加疫情心理危机干预的因素可归纳为:具备自我心理调节能力和对他人进行心理干预的专业能力、心理危机干预是专业职责、希望有亲身经历现场危机干预的经验;阻碍因素包括缺少疫情相关的知识和能力、家庭原因及心理恐惧。结论心理卫生工作者参加疫情心理危机干预意愿较高,但需要有针对性地开展疫情防治知识及技能培训、心理督导及建立保障体系。     

The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review

Background A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross‐referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review. Results One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant – clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs). Conclusion Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non‐validated outcome measures for a short period of follow‐up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self‐injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive‐compulsive disorder. Most studies have highlighted the concern regarding adverse effects.     

Errorless learning improves memory performance in children with acquired brain injury: A controlled comparison of standard and self-generation techniques

The principle of errorless learning has proven efficacy in helping adults and older adults with acquired memory impairment learn novel information. However, surprisingly few studies have investigated its efficacy in children. The present study addresses this omission in the literature, investigating the effectiveness of two forms of errorless learning — the established method, in which the examiner provides responses during learning, and a self-generation method, in which learners produce their own responses — each relative to the standard baseline of trial-and-error learning, in young people with acquired brain injury (ABI, n?=?15) and non-injured controls (n?=?15). Participants learned different word lists in each condition and their memory was tested after distraction and, subsequently, after a 20-minute delay. Not surprisingly, controls performed better than the ABI group. However, while there was no effect of learning condition for controls, in the ABI group memory performance was significantly better under errorless conditions. In contrast to findings in the adult literature, there was no difference in the efficacy of the two errorless methods, suggesting that self-generation was no better than standard examiner-generation. This study extends upon previous research to provide the first demonstration of the effectiveness of errorless methods in a group of young people with ABI.     

Residential treatment following outpatient treatment for children with mild to borderline intellectual disabilities: A study of child and family characteristics

In this study, the question was explored whether children with a mild intellectual disability (MID) who were placed in residential treatment following outpatient treatment differ significantly on child and family characteristics from children with MID and not placed in residential treatment following outpatient treatment. The records of the children were examined with respect to various child and family characteristics. Retrospective case analyses were thus undertaken. The results showed those children placed in residential treatment to have experienced significantly more often a traumatic event than the other children. Those children placed in residential treatment had received significantly fewer months of outpatient treatment than those not placed in residential treatment. Finally, there were significantly more children placed in residential treatment having educationally incapable parents or parents with alcohol/drug problems and/or psychiatric problems than in the other group. The findings are discussed in light of a disturbed balance between the support needs and means of the family which can lead to placement of a child in a residential treatment. The possibilities of a multisystemic model for outpatient treatment are discussed.     

The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study

PURPOSE: Cognitive deficits are one of the major limiting factors in the everyday life functioning of patients with focal seizures. Although cognitive rehabilitation methods have been successfully applied to patients with other central nervous system (CNS) lesions, these methods have not yet been evaluated in cognitively impaired patients with epilepsy. The present study evaluated the effectiveness of two commonly used methods for attention deficits: (a) the Retraining Method, aimed at retraining impaired cognitive functions; and (b) the Compensation Method, aimed at teaching compensatory strategies while taking neuronal loss for granted. METHODS: Fifty adult outpatients with focal seizures and attention impairments receiving carbamazepine (CBZ) monotherapy were randomly assigned to the Retraining Method, the Compensation Method, or to a waiting-list control group. Established and self-reported neuropsychological outcomes and self-reported quality of life of these groups were evaluated at pretraining, posttraining, and at a 6-month follow-up measurement point and were completed by 44 patients. RESULTS: Neuropsychological outcomes related to training, self-reported neuropsychological outcomes, and quality of life at the 6-month follow-up measurement point improved both in the Retraining Method group (n = 19) and the Compensation Method group (n = 17) relative to the waiting-list control group (n = 8). The Compensation Method was more effective in improving self-reported neuropsychological outcomes and quality of life, especially for patients with less education. The patients with active epilepsy benefited more from both methods than did the seizure-free patients. CONCLUSIONS: These data show that cognitive rehabilitation programs are effective for patients with focal seizures and attention deficits and should, therefore, be incorporated into comprehensive care programs.     

Depression and anxiety in memory clinic attenders and their carers: implications for evaluating the effectiveness of cognitive rehabilitation interventions

BACKGROUND: The potential of cognitive rehabilitation (CR) for people who have a diagnosis of Alzheimer's disease (AD) is increasingly being recognised. It has been suggested, however, that interventions targeting memory functioning in AD have negative effects on the well-being of participants and carers in terms of mood and perceived strain. While some 'memory training' studies do report an increase in self-report scores on scales assessing these variables, it is not clear whether the changes are attributable to the intervention. There is some overlap between CR and 'memory training', but CR is a much more individualised approach, and therefore CR intervention studies often adopt within-subjects or single case experimental designs, for which relevant comparison data are required. METHOD: Participant and carer depression and anxiety, and carer strain, were assessed at initial attendance and again by postal survey 6 months later in a consecutive series of 94 Memory Clinic referrals who received standard treatment but no specialised CR interventions. RESULTS: At the group level, there were no statistically significant changes in scores at follow up, although the participants scoring above designated cut-points were not necessarily the same individuals at the two time points. CONCLUSIONS: The study provided useful comparison data for use in evaluating the effects of cognitive rehabilitation interventions on mood and carer strain, showing that in the absence of intervention scores remain generally stable over time. Significant changes observed in intervention studies should be viewed in this context.     

Longing for existential recognition: A qualitative study of everyday concerns for people with somatoform disorders

Objective

Patients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life.

Methods

A cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory.

Results

A major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) “existential misrecognition” covered the experience of being met with distrust and disrespect, 2) “uncertain existential recognition” covered experiences of unclear communication and a perception of not being totally recognized, and 3) “successful existential recognition” covered experiences of total respect and understanding. “Misrecognition” and “uncertain recognition” related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas “successful recognition” related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal.

Conclusion

Different modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.     

The behavioral neurobiology of learning and memory: A conceptual reorientation

Research on the neurobiology of learning and memory has been guided by two major theories: (i) memory as a psychological process and (ii) memory as a change in synaptic neural connectivity. It is not widely recognised that not only are these theories different but, moreover, they are fundamentally incompatible. Confusion concerning basic concepts in the learning and memory field in mammals has lead to the creation of an extensive but often inconclusive experimental literature. However, one important conclusion suggested by recent work in this field is that experience-dependent changes in neural connectivity occur in many different brain systems. Particular brain structures, such as the hippocampus, do not play any uniquely important role in experience-dependent behavior. Research in learning and memory can be best pursued on the basis of biological studies of animal behavior and a cellular approach to brain function.     

The effects of computer-based cognitive rehabilitation in patients with visuospatial neglect following stroke: a systematic review

Objectives: To identify studies concerning the effects of computer based cognitive rehabilitation (CBCR) on visuospatial neglect (VN) after stroke to summarize the current state of knowledge in this research field and make recommendations for future research.

Methods: Four electronic databases were systematically searched. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases. Data was extracted from included studies using predefined coding schemes and characteristics and results of individual studies were summarized qualitatively.

Selection criteria: Studies were included if at least 50% of the included patients had a stroke, if the studies explored the effects of CBCR as a primary intervention for rehabilitation of VN and if they included neuropsychological outcome measures for the presence of VN.

Results: Seven studies were included. Six of the seven studies suggested positive effects of CBCR on VN after stroke. However, the study that did not find these effects was also the study with the strongest methodological quality. All included studies consisted of small samples, varied greatly in design and had various methodological limitations.

Conclusion: Because the existing literature is very sparse and studies have various methodological limitations, it is currently not possible to either support or reject the effects of CBCR on VN after stroke. Future studies should aim to compare CBCR with active and passive control conditions and include larger samples in randomized and blinded designs.