Cardiac rehabilitation for the elderly: Qi Gong and group discussions.

BACKGROUND: Over the last decade several studies have shown that patients with coronary artery disease even above the age of 70 can be successfully treated with advanced medical and surgical methods. Unfortunately, rehabilitation programmes for this group are rarely offered. It is important to develop forms of rehabilitation that are adapted to the specific needs of this increasing group of elderly patients. The aim of this randomized study was to investigate whether the combination of Qi Gong and group discussions would increase physical ability for elderly patients > or =73 years with coronary artery disease. METHODS: A total of 95 patients (66 men and 29 women), with documented coronary artery disease, were randomized to an intervention group (n=48) mean age 77+/-3 (73-82) or to a control group (n=47) mean age 78+/-3 (73-84). The intervention groups met weekly over 3 months. The control group got usual care. Physical ability was assessed at baseline and after the intervention. RESULTS: Patients in the intervention group increased their self-estimated level of physical activity (P=0.011), and their performance in the one-leg stance test for the right leg (P=0.029), co-ordination (P=0.021) and the box-climbing test for right leg (P=0.035). CONCLUSION: A combination of Qi Gong and group discussions appear to be a promising rehabilitation for elderly cardiac patients in terms of improving self-reported physical activity, balance and co-ordination. This could be an option for elderly patients who do not participate in the ordinary cardiac rehabilitation.     

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

Purpose: Two studies are presented that evaluated the Communication Supports Inventory-Children & Youth (CSI-CY), an instrument designed to facilitate the development of communication-related educational goals for students with complex communication needs (CCN). The CSI-CY incorporates a code set based on the ICF-CY. The studies were designed to determine the effect of using the CSI-CY on IEP goals for students with CCN and to evaluate consumer satisfaction.

Method: In Study 1, sixty-one educators and speech–language pathologists were randomly assigned to either (a) provide a student’s current IEP (control group) or (b) complete the CSI-CY prior to preparing a student’s next IEP and to submit the new IEP (experimental group). Study 2 was a field test to generate consumer satisfaction data.

Results: Study 1 showed that IEP goals submitted by participants in the experimental group referenced CSI-CY-related content significantly more frequently than did those submitted by control participants. Study 2 revealed high satisfaction with the instrument.

Conclusions: The code set basis of the CSI-CY extends the common language of the ICF-CY to practical educational use for children with CCN across diagnostic groups. The CSI-CY is well regarded as an instrument to inform the content of communication goals related to CCN.

• Implications for Rehabilitation

• The CSI-CY will guide rehabilitation professionals to develop goals for children with complex communication impairments.

• The CSI-CY is a new instrument that is based on the ICF-CY for documentation of communication goals.

     

Behaviour style and interaction between seven children with multiple disabilities and their caregivers

Introduction Recent studies show that the existing interaction patterns of children with multiple disabilities should be taken into consideration when planning communication interventions. For children with disabilities, it is especially important that the partner in interaction is sensitive and well aware of the importance of a qualitatively successful interaction. Wilder (unpublished report) found that the behaviour style of 30 children with multiple disabilities was more related to the caregiver‐perceived interaction than the communicative skills and functional abilities of the children. This study inductively explored the caregivers’ perceptions of interaction within seven caregiver–child dyads. The research questions were: How do the caregivers perceive the interaction? How do the caregivers perceive the children's behaviour style to be related to the interaction with the caregivers? Method The children were selected individually from the participants in Wilder (unpublished report) depending upon the responses the caregivers had given about the children's self‐regulation and reactivity in the Carolina Record of Individual Behaviour questionnaire. The study was undertaken by means of home visits where the caregivers participated in an interview asking about their strategies for interaction, how they perceived the roles of the children and their own roles in interaction, the caregivers’ opinion of what an interaction constituted of and the caregivers’ aims and aspiration for interaction. The data analysis was performed by meaning concentration and categorization through a pendulum between the parts and the entirety of the interviews. In this way, hermeneutics and thematic analysis were both being practised. Results The results of the interviews are presented as a model with categorizations as a network. The categorizations reflect the system of themes that permeate how the caregivers perceived interaction in the dyad. The themes are: sharing of experience, successful interaction, role of the child, role of the caregiver, interaction methods, obstacles and facilitators and aims and aspirations. Discussion The caregivers perceived their own role in interaction to be of a sensitive leading kind. The caregivers lead the interaction by using their knowledge about the children's usual way of interacting, the children's behaviour styles, functional abilities, the children's current mood and situation as well as the whole context. They monitored the interaction such that, throughout an interaction sequence, the caregivers always tried to optimize the interaction between the parties in the dyad. The behaviour style was a background factor that the caregivers had knowledge of and scanned in their everyday turn taking. Although there were differences in the children's behaviour styles, the caregivers discussed the same themes in the interviews. The behaviour style became a facilitator for the whole interaction, forced the interaction in certain directions and made the interaction more complete with turn taking of different kinds from both parties. The findings show that it is imperative to see caregivers as experts on their children and to make them assertive in this in relation to professionals. Furthermore, as a successful interaction can boost the development of children, it is essential to direct interventions to the everyday interaction in caregiver–child dyads.     

A discussion of individual variability, in activity-based interventions, using the niche concept

BACKGROUND: Activity-based intervention has been defined as a child-directed, transactional approach that uses logically occurring antecedents and consequences to develop functional and generative skills by embedding intervention of children's individual goals and objectives in routine, planned or child-initiated activities. In this approach, clear goals and objectives that are functional and embedded in a play activities or routines are developed. The teacher mediates the child's environment to facilitate learning with the child directing the teacher on the pace, duration spent on the objective. Learning and development in this framework occur through both a carefully planned environment and adult facilitation. Progress made by a child using this approach focuses on observational data that describe if the child is able to respond in functional and generative ways. While activity-based interventions are usually provided for a group of children, progress is measured by describing individual children's responses. Individual variations in the children's progress, despite exposure to the same interventions are an area that is seldom discussed. This article aims to explore the niche concept and its application to explaining this variation between individuals. METHODS: Four children participated in this single-subject, multiple-probe study across four participants. A 3-week long activity-based aided language stimulation programme was developed. The effect of the programme was determined by describing the individual participants understanding of the 24 targeted vocabulary items. RESULTS: The results of the activity-based language programme are presented and the variability among the participants is discussed using the niche concept. The role of the niche concept in individual development is described and the implications thereof are discussed. CONCLUSIONS: Finally, activity-based intervention research is placed in a systems perspective and possible outcome measures of this intervention are discussed from a multidimensional ecological perspective.     

Contrast column interruption artefact in computed tomography pulmonary angiography

Interruption of the contrast column during inspiration can lead to non‐diagnostic CT pulmonary angiograms. The importance of this artefact will increase with more CT studies being performed for pulmonary embolism on multidetector row CT. We describe here an instance of such an artefact and discuss its aetiology.     

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage

Background  

Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania