The creation of the client reflexivity scale: A measure of minute fluctuations in self-awareness and exploration.

Objective: to design and pilot a reliable observer-based scale of client reflexivity that can be used on short segments of time (“coding intervals”) across therapy sessions. Reflexivity was defined as the level of a client's awareness and exploration of his or her interiority. Interiority was defined as thoughts, feelings, sensations, intentions, and desires. Method: The Client Reflexivity Scale (CRS) was designed through the coding of public access therapy videos featuring demonstrations of therapy. Along with the Experiencing Scale, the CRS was then piloted on one good outcome and one poor outcome session of cognitive-behavioural therapy for anxiety. Each session of therapy featured the same therapist but different clients. Two raters coded the sessions. Results: Weighted kappas for inter-rater reliability ranged from 0.74 to 0.81. The level of reflexivity was significantly higher in the good outcome session than the poor outcome session, though the trajectory of reflexivity for both sessions was the same. The CRS was also compared to the Experiencing Scale in order to determine similarities and differences between the scales. Conclusions: the CRS reliably measured reflexivity within the therapy sessions, and in the future can be layered with other process measures in order to map interactions across therapy sessions.     

镜像疗法对偏瘫患者上肢功能康复疗效的观察

目的 观察镜像疗法对卒中后偏瘫患者上肢功能康复的疗效。方法 选择30例入选卒中后8周内偏瘫患者随机分为两组：镜像疗法组和对照组,分别于治疗前及治疗后4周采用Fugl-Meyer运动评价（Fugl-Meyer motor assessment,FMA）（上肢部分）,上肢运动研究测试（the action research arm test,ARAT）、运动功能评估量表（motor assessment scale,MAS）对上肢运动功能进行评分,同时评定患者的视觉模拟评分（visual analogue scale/score,VAS）、痉挛程度以及改良Barthel指数,以观察镜像疗法对偏瘫患者上肢功能康复的疗效。结果 治疗4周后,两组上肢运动能力FMA评分、ARAT评分、MAS评分、改良Barthel指数均较治疗前提高（P＜0.01）;治疗组FMA评分、ARAT评分高于对照组（P＜0.05）,两组间MAS评分、改良Barthel指数提高,但差别无统计学意义（P＞0.05）。治疗组VAS评分较治疗前有下降（P＜0.05）,但对照组治疗前后,VAS评分差异无统计学意义（P＞0.05）,治疗后两组间的VAS差异有统计学意义（P＜0.05）。两组治疗前后及治疗后组间痉挛改善差异无统计学意义（P＞0.05）。结论 镜像疗法能提高偏瘫患者的上肢运动功能,且能减轻患者偏瘫上肢的疼痛,但对患者日常生活活动能力（activity of daily living scale,ADL）及患肢痉挛程度的改善无明显影响。     

镜像疗法对卒中偏瘫患者下肢运动疗效的Meta分析

目的 评价镜像疗法对卒中偏瘫患者下肢运动疗效。
方法 在APTA、PEDro、Embase、PubMed、CINAHL、Cochrane图书馆、中国生物医学文献、万方、维普及中
国知网系统检索2004年5月-2019年5月关于镜像疗法对改善卒中后下肢运动功能效果的随机对照试
验（randomized controlled trial，RCT）。根据纳入、排除标准进行筛选，提取资料，采用RevMan 5.3软
件对符合标准RCT研究中患者的下肢功能、平衡功能及步态指标进行Meta分析。
结果 共纳入14项RCT研究。Meta分析结果显示：相比对照治疗，镜像疗法可提高Fugl-Meyer下肢评
分[标准化均数差（standardized mean difference，SMD）3.20，95%CI 1.52～4.88，P＜0.001]，提高患者踝
关节活动度（SMD 1.20，95%CI 0.71～1.69，P <0.001），提高下肢Brunstrom分期[均数差（mean difference，
MD）0.55，95%CI 0.28～0.82，P <0.001]。尚无证据表明镜像疗法可改善下肢肌张力。镜像疗法可提高
10 m步行测试分数（SMD 0.08，95%CI 0.03～0.13，P＜0.001），但在提高功能性步行量表未显示明显
优势。镜像疗法可提高Berg平衡量表评分（SMD 0.98，95%CI 0.42～1.53，P＜0.001），但无法改善下肢
平衡的总体稳定指数。
结论 镜像疗法可在一定程度上改善卒中后患者下肢运动功能、步态，但平衡能力的改善仍需临床
研究证实。     

镜像疗法对卒中偏瘫患者下肢运动疗效的Meta分析

目的 评价镜像疗法对卒中偏瘫患者下肢运动疗效。 方法 在APTA、PEDro、Embase、PubMed、CINAHL、Cochrane图书馆、中国生物医学文献、万方、维普及中 国知网系统检索2004年5月-2019年5月关于镜像疗法对改善卒中后下肢运动功能效果的随机对照试 验（randomized controlled trial,RCT）。根据纳入、排除标准进行筛选,提取资料,采用RevMan 5.3软 件对符合标准RCT研究中患者的下肢功能、平衡功能及步态指标进行Meta分析。 结果 共纳入14项RCT研究。Meta分析结果显示：相比对照治疗,镜像疗法可提高Fugl-Meyer下肢评 分[标准化均数差（standardized mean difference,SMD）3.20,95%CI 1.52～4.88,P＜0.001],提高患者踝 关节活动度（SMD 1.20,95%CI 0.71～1.69,P <0.001）,提高下肢Brunstrom分期[均数差（mean difference, MD）0.55,95%CI 0.28～0.82,P <0.001]。尚无证据表明镜像疗法可改善下肢肌张力。镜像疗法可提高 10 m步行测试分数（SMD 0.08,95%CI 0.03～0.13,P＜0.001）,但在提高功能性步行量表未显示明显 优势。镜像疗法可提高Berg平衡量表评分（SMD 0.98,95%CI 0.42～1.53,P＜0.001）,但无法改善下肢 平衡的总体稳定指数。 结论 镜像疗法可在一定程度上改善卒中后患者下肢运动功能、步态,但平衡能力的改善仍需临床 研究证实。     

The Role and Value of a Paediatric Specialist Neurodevelopmental Diagnostic Service: Parental Perceptions

Background:  This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth.
Method:  Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance.
Results:  87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents' self-identified concerns about their child decreased.     

Engaging Latino Families in Therapy: Application of the Tree of Life Technique

With the continuous increase in the Latino population in the United States, it is important for mental health providers to provide culturally sensible therapeutic services to decrease the underutilization of mental health services by Latinos. The exploration of Latino families’ cultural values, beliefs, and acculturation strategies assists in increasing self-disclosure in therapy and culturally unique and sensible services. This article reviews some components of Latino culture and acculturation and explores the application of the tree of life activity in a family therapy setting found in wraparound services.     

The Efficacy of Lower Extremity Mirror Therapy for Improving Balance,Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis

Background

Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke.

Clinical and Magnetic Resonance Imaging Regression of Progressive Multifocal Leukoencephalopathy in an AIDS Patient After Intensive Antiretroviral Therapy

A 36-year-old homosexual man with 6 months of visual symptoms and headaches had right homonymous hemianopia, mild new learning impairment, and alexia with agraphia. The initial brain magnetic resonance imaging (MRI) scan was reported consistent with left occipital infarction. Subsequent MRI demonstrated abnormal demyelination in subcortical white matter and deep parieto-occipital white matter bilaterally, but primarily left. Human immunodeficiency virus testing and cerebrospinal fluid polymerase chain reaction for JC virus DNA were both positive, consistent with progressive multifocal leukoencephalopathy (PML) with AIDS. His clinical status steadily deteriorated, and MRI white matter abnormalities worsened despite high-dose antiretroviral therapy. After the antiretroviral regimen was intensified by the addition of a protease inhibitor, rapid clinical and radiographic improvement occurred with subsequent MRI studies revealing only residual left parieto-occipital encephalomalacia. PML in AIDS patients has been associated with a nearly uniformly poor prognosis until recent reports of improved outcomes after highly active antiretroviral therapy. This patient with PML and AIDS similarly showed a robust clinical and MRI response to intensive antiretroviral combination therapy, which has been maintained for more than 3 years.     

Effect of Task-Based Mirror Therapy on Motor Recovery of the Upper Extremity in Chronic Stroke Patients: A Pilot Study

Abstract

Background and Aims: Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired limb. Despite strong evidence for task-specific training in stroke, MT has been investigated using nontask movements. The aim of this pilot study was to assess the effectiveness of task-based MT on motor recovery of the upper extremity in chronic stroke patients. Method: In a pretest-posttest single-group design, a convenience sample of 13 chronic stroke patients at an occupational therapy department of a rehabilitation institute was assessed on a task-based MT intervention. Participants received a task-based MT program, performing various tasks by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection upper extremity (FMA-UE) and subpart upper arm (FMA-UA) and hand (FMA-WH), was used as an outcome measure. Results: Participants showed no significant improvement for FMA-UE and FMA-UA at postassessment. FMA-UE changed from 43% to 51%. Post FMA-UA score showed only 2% improvement. However, there was statistically significant improvement on mean scores of FMA-WH at postassessment (16.21 ± 3.06) as compared with the prescores (12.29 ± 3.1; P < .05). FMA-WH improved from 41% to 54%. Conclusions: The preliminary findings suggest that task-based MT is effective in improving wrist and hand motor recovery in chronic stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.     

Attentional processes in interactions between people with profound intellectual and multiple disabilities and direct support staff

Few studies have examined joint attention in interactions with persons with profound intellectual and multiple disabilities (PIMD), despite its important role in high-quality interaction. The purpose of this study is to describe the attention-directing behaviours of persons with PIMD and their direct support staff and the attention episodes resulting from their interactions, and to understand how these variables relate to each other. Video observations of 17 staff-client dyads were coded using partial interval recording. The results showed considerable variation across individuals and dyads. In general, persons with PIMD directed the attention of staff members infrequently. The staff members frequently directed their clients’ attention towards a topic of interest but did not often use the tactile modality. Within the staff-client dyad, there was not much joint attention; however, shared attention episodes occurred frequently. Shared attention and joint attention are strongly correlated. A negative correlation was found between clients not using attention-directing behaviours and staff members using tactile methods to direct the attention, and joint attention episodes. This study presents both directions for future research and practical implications.     

The neural correlates of mindfulness-induced depression reduction in adults with autism spectrum disorder: A pilot study

Adults with autism spectrum disorder (ASD) experience high rates of depression and anxiety, and some evidence suggests mindfulness-based stress reduction (MBSR) is effective in reducing these symptoms. However, the neural mechanisms of symptom alleviation, and benefit of MBSR beyond education/support groups are unknown. Maladaptive forms of self-reflection are linked to ASD, depression, and anxiety. In this pilot study, we hypothesized (a) MBSR would reduce depression and anxiety in adults with ASD and (b) a mechanism of symptom alleviation would be increased blood oxygen level-dependent signal in neural self-reflection hubs. Twenty-eight adults were randomly assigned to an 8-week MBSR group (n = 15) or a support group (n = 13) that met for the same amount of time with relaxation education materials. Based on previous self-reflection literature in ASD, regions of interest (ROIs) were middle cingulate cortex (MCC) and ventromedial prefrontal cortex (vmPFC). Only the MBSR group demonstrated significant reductions in depression, and neither group significantly changed in anxiety. Only the MBSR group increased activity of right MCC during self-reflection, and the increase correlated with depression alleviation. There were no changes in vmPFC for the MBSR group or either ROI for the support/education group. Seed-to-voxel connectivity analysis revealed that only the MBSR group increased functional connectivity between right MCC and pre/postcentral gyrus, suggesting MBSR may increase primary sensorimotor input to higher order cognitive brain regions. Taken together, MBSR may be effective for reducing depression in adults with ASD, and the neural mechanism may be increasing frontal circuit involvement during self-directed thought.     

Hereditary motor and sensory neuropathy--Lom (HMSNL): refined genetic mapping in Romani (Gypsy) families from several European countries

Hereditary motor and sensory neuropathy type Lom, initially identified in Roma (Gypsy) families from Bulgaria, has been mapped to 8q24. Further refined mapping of the region has been undertaken on DNA from patients diagnosed across Europe. The refined map consists of 25 microsatellite markers over approximately 3 cM. In this collaborative study we have identified a number of historical recombinations resulting from the spread of the hereditary motor and sensory neuropathy type Lom gene through Europe with the migration and isolation of Gypsy groups. Recombination mapping and the minimal region of homozygosity reduced the original 3 cM hereditary motor and sensory neuropathy type Lom region to a critical interval of about 200 kb.     

The National NeuroAIDS Tissue Consortium: a new paradigm in brain banking with an emphasis on infectious disease

The National NeuroAIDS Tissue Consortium (NNTC) was founded in 1998, in response to the scientific need for well-characterized central nervous system (CNS) and peripheral nervous system (PNS) tissues and fluids from HIV-infected individuals. In addition to performing the routine functions of non-transplant anatomic tissue banks, the Consortium offers a unique model for the integration of independent research entities in order to provide well-characterized tissues and fluids for the international research community. Herein, we describe the structure of the Consortium, pointing out the inherent strengths of linking together multiple independent sites for the purpose of banking HIV-infected nervous system tissues. We describe the neuropathology protocol that was adopted and successfully implemented at the four participating banks of the Consortium.     

The Family Questionnaire (FQ): a scale for measuring symptom appraisal in relatives of schizophrenic patients

OBJECTIVE: This study examined the psychometric properties of the Family Questionnaire (FQ): a self-report measure of relatives' perceptions of the behaviours and symptoms of schizophrenic patients in terms of three dimensions: the frequency of symptoms, the relatives' concern (primary appraisal) and their ability to cope (secondary appraisal) with the symptoms. METHOD: Factor analysis of the FQ, test-retest and inter-rater reliability, and measures of validity were examined. RESULTS: Factor analysis supported the validity of five subscales labelled negative symptoms, antisocial behaviours, interpersonal problems, affective symptoms and psychotic symptoms. Test-retest reliability for all scales was good and the prediction that there would be limited correspondence between two different relatives' scores was supported for the subscales of negative symptoms and affective symptoms. Concurrent measures of relatives' distress, burden and patients' symptomatology indicated that the FQ showed acceptable validity. In particular, the study showed that high expressed emotion relatives have higher scores on the appraisal dimensions of some subscales. CONCLUSION: The study provides evidence that the FQ is a useful tool for measuring relatives' perceptions of schizophrenic illness, particularly within the context of family interventions where it may be utilized to help to understand the factors mediating relatives' burden and distress.     

Dancing With The Devil: A Personal Essay On My Encounters With Sexual Abuse In The Catholic Church

In this article, I will address the polarized reactions evoked by my roles as speaker, writer, advocate, and expert witness in the Catholic Church's sexual abuse crisis. The volleys of horror and awe, terror and transcendence, often characteristic of work with survivors of sexual abuse, are even more powerful when the evil reported was committed by sexually violating priests, the hierarchs who protected them, and the people in the pews who supported them.