Management of shoulder and proximal upper limb spasticity using botulinum toxin and concurrent therapy interventions: A preliminary analysis of goals and outcomes

Purpose. To explore the role of Botulinum Toxin type A (BoNT-A) in the management of the spastic hemiplegic shoulder and identify the common achievable goals for treatment.

Method. Set in a regional spasticity management service in the UK, a prospective observational cohort study was undertaken. Patients (n = 16) were receiving BoNT-A (Dysport©) injection and concurrent therapy for spasticity of the shoulder girdle or proximal upper limb following stroke/other acquired brain injury. Mean age 54.5 (SD 15.7) years. Mean time since injury: 15.7 months. Functional goals for intervention were determined through agreement with the patient or their carers using Goal Attainment Scaling (GAS). Evaluation of spasticity (Modified Ashworth Scale), pain (numbered graphic rating scale) and three standard passive function tasks (washing, dressing and positioning) were also undertaken.

Results. Sixteen weeks post-injection, significant improvements were identified in spasticity (Z = ?3.535, p <0.0001), pain (Z = ?1.942, p = 0.052) and passive function (Z = ?3.172, p = 0.002). GAS scores had improved in all but one subject, with goals either achieved or over-achieved.

Conclusions. BoNT-A injection of the proximal upper limb, with combined therapy, produced a reduction in spasticity, improvement in passive function and pain. Management of upper limb spasticity should include evaluation and, if necessary treatment, of the shoulder girdle and proximal musculature.     

The effects and experiences of goal setting in stroke rehabilitation – a systematic review

Objective: To systematically integrate and appraise the evidence for effects and experiences of goal setting in stroke rehabilitation.

Design: Systematic review of quantitative and qualitative studies.

Methods: Relevant databases were searched from start of database to 30 April 2011. Studies of any design employing goal setting, reporting stroke-specific data and evaluating its effects and/ or experiences were included.

Results: From a total of 53998 hits, 112 full texts were analysed and 17 studies were included, of which seven evaluated effects while ten explored experiences of goal setting. No eligible randomized controlled trials were identified. Most of the included studies had weak to moderate methodological strengths. The design, methods of goal setting and outcome measures differed, making pooling of results difficult. Goal setting appeared to improve recovery, performance and goal achievement, and positively influenced patients’ perceptions of self-care ability and engagement in rehabilitation. However, the actual extent of patient involvement in the goal setting process was not made clear. Patients were often unclear about their role in this process. Professionals reported higher levels of collaboration during goal setting than patients. Patients and professionals differed on how they set goals, types of goals set, and on how they perceived goal attainment. Barriers to goal setting outnumbered the facilitators.

Conclusion: Due to the heterogeneity and quality of included studies, no firm conclusions could be made on the effectiveness, feasibility and acceptability of goal setting in stroke rehabilitation. Further rigorous research is required to strengthen the evidence base. Better collaboration and communication between patients and professionals and relevant education are recommended for best practice.

Implications for Rehabilitation

• Communication is key to collaborative goal setting.

• Education and training of professionals regarding goal setting is recommended, especially in relation to methods of involving people with communication and cognitive impairments.

• Educating patients about stroke and goal setting could enhance their participation in goal setting.

     

Addressing the Challenges of Collaborative Goal Setting with Children and Their Families

ABSTRACT

Collaborative goal setting between clinicians and clients/families is considered a fundamental component of the pediatric rehabilitation process. However, truly client-centered goal setting is not without its challenges. The purpose of this paper is to highlight theoretical concepts relevant to rehabilitation goal setting, review clinical studies directly evaluating relationships between goal setting and pediatric rehabilitation outcomes, and provide recommendations to facilitate collaborative goal processes. Four theoretical frameworks were identified that may lie behind and help explain the effectiveness of collaborative goal setting. The four relevant outcome studies found in the review revealed that individualized goal setting is an important component of the intervention, engages families more actively in therapy, and is associated to some extent with positive outcomes. The evidence suggests that the impact of fully collaborative goal setting is sufficiently positive to support investment of organizational and individual time, energy, and resources to make it an integral part of the rehabilitation process.     

学业不良和优良大学生成就动机与解释风格的比较研究

目的探讨不同学业成绩大学生成就动机和解释风格的特点。方法采用成就动机量表和解释风格量表对165名学业不良大学生和148名学业优良大学生进行问卷调查。结果学业不良大学生追求成功的动机和对积极情境的解释的得分低于学业优良大学生,而避免失败的动机和对不利事件的希望的得分高于学业优良大学生,差异均有统计学意义(P<0.05或P<0.01)。学业不良男生对积极情境的解释的得分高于女生,差异有统计学意义(P<0.01)。结论学业不良和学业优良大学生的成就动机与解释风格存在差异。     

Comparison of Indicators for Achievement of Pain Control With a Personalized Pain Goal in a Comprehensive Cancer Center

Context

The achievement of a personalized pain goal (PPG) is advocated as an individualized pain relief indicator.

112名大学生考试应激心理反应与学习成绩的比较研究

目的通过大学生考试前心理测试结果与考试成绩的比较,以发现心理因素与学习成绩的关系。方法选择南京林业大学112名大学生,在期末考试前,采用症状自评量表(SCL-90)进行心理测验,并与全国常模组对比,再用高分组与低分组做比较、文科组与理科组相比较进行统计学分析。结果 SCL-90结果显示,除敌对、恐怖因子分外,考试前大学生在躯体化、强迫、人际敏感、抑郁、焦虑、偏执、精神病因子分与全国常模相比较,差异有统计学意义(P<0.05或P<0.01);高分组与低分组相比较,除敌对、恐怖、精神病外,其余差异均有统计学意义(P<0.05或P<0.01);文科组与理科组相比较,除强迫、焦虑、敌对、恐怖、偏执外,在躯体化、人际敏感、抑郁、精神病因子分方面,差异也有统计学意义(P<0.05或P<0.01)。结论大学生在考试前的心理应激反应明显增多,且对学习成绩有一定的影响。     

大学生自我评价与成就动机的关系

目的考察大学生的成就动机和自我评价之间的关系。方法对来自临沂市的265名大学生采用个人自我评价量表(PE I)和成就动机量表(AM S)进行调查。结果①在自我评价方面,存在显著的性别、学科和年级差异(F=2.230,2.76,3.784;P<0.05)。进一步的检验显示,男生和理科生要显著高于女生和文科生,大一学生显著高于大三学生,大二学生显著高于大四学生;②在成就动机方面,追求成功和避免失败均存在显著的性别差异(F=3.176,P<0.01;F=-1.759,P<0.05),在追求成功维度上存在显著的学科差异(F=2.853,P<0.01)。进一步的检验显示,男生、理科生在追求成功维度上得分均比女生和文科生显著高,但是女生在避免失败的得分上高于男生;③自我评价与成就动机各因子存在明显相关(r=0.246,P<0.01;0.134,P<0.05),成就动机对自我评价有显著地预测作用(R2=0.061,P<0.001;R2=0.018,P<0.05)。结论自我评价与成就动机有密切的关系,成就动机对自我评价有显著预测作用。     

A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa

The objectives of the present study were the following: to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11–18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.

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Zusammenfassung Die Ziele der vorliegenden Studie bestanden darin, die sozio-familiären, bildungsmäßigen und interpersonellen Charakteristika zu bestimmen, die für Patienten mit Anorexia nervosa spezifisch sind. Außerdem wurde die Komorbidität der Patienten ebenso wie die Morbidität der Eltern untersucht. Es sollte geklärt werden, ob die spanischen Patienten mit Anorexia nervosa mit Patienten aus anderen Ländern vergleichbar sind. Die Forschungsgruppe untersuchte die Krankengeschichte von 185 spanischen Jugendlichen mit AN im Alter von 11 bis 18 Jahren. Die Ergebnisse wurden mit einer psychiatrischen Kontrollgruppe verglichen, die im Hinblick auf Geschlecht, Alter, Vorstellungszeitpunkt und -Zentrum parallelisiert war. Es fanden sich keine signifikanten Unterschiede im Hinblick auf den Anteil zerrütteter Familien, Geburtsrang oder Konflikte zwischen Eltern und den Patienten. Die Eltern von Patienten mit Anorexia hatten eine höherwertige Ausbildung; sie zeigten häufiger affektive Störungen. Im Vergleich zu anderen Patienten schneiden die Anorexia nervosa-Patienten in bezug auf Schulerfolge besser ab, sie sind jedoch in sozialer Hinsicht zurückgezogener. Männliche Jugendliche mit Anorexia nervosa wiesen schlechtere Schulleistungen auf als die weiblichen und litten häufiger unter Angststörungen. Patienten mit Anorexia nervosa weisen eine hohe Komorbidität mit affektiven Störungen und Zwangsstörungen auf. Insgesamt ähnelt die Symptomatik der Patienten aus Spanien der anderer Länder. Die beiden Charakteristika, die für diese Patienten spezifisch sind, sind der hohe schulische Leistungsstandard und der ausgeprägte soziale Rückzug, obwohl es bestimmte Faktoren gibt, die sich auch bei anderen psychiatrischen Störungen im Jugendalter häufiger finden.

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Résumé Les objectifs de cette étude étaient: de déterminer le caractéristiques socio-familiales, scolaires et interpersonnelles spécifiques à l'anorexie mentale; d'étudier la comorbidité des patients anorexiques et la morbidité de leurs parents; et de vérifier si les patients anorexiques espagnols ressemblent à ceux des autres pays. L'équipe de recherche a réexaminé les histoires cliniques de 185 adolescents espagnols anorexiques (âgées de 11 à 18 ans). Les résultats obtenus ont été comparés avec ceux d'une groupe des 185 patients psychiatriques sans anorexie mentale appariés selon le sexe, l'âge, da durée de la consultation et le service. Aucune différence significatives n'ont été trouvées concernant les ruptures familiales, l'ordre de naissance ou les conflits entre parents et patients. Les parents des patients anorexiques ont un niveau d'éducation plus élevé et développent plus souvent des troubles affectifs. Par rapport aux autres patients, les patients anorexiques ont des performances scolaires plus élevées mais sont plus inhibés socialement. Les gar¢ons avec une anorexie mental ont un moindre niveau scolaire que les filles et ont plus souvent un diagnostic d'anxiété. Les patients anorexiques ont une comorbidité plus importante concernant les troubles affectifs et obsessionnels compulsifs. Les patients anorexiques espagnols ressemblent cliniquement à ceux des autres pays. Les deux caractéristiques propres à ces patients sont un niveau élevé de performance scolaire et un degré intense d'inhibition sociale bien qu'ils présentent également certains facteurs communs aux autres pathologies de l'adolescence.

     

基建审计中的目标置换现象

高校基建审计中普遍存在目标置换现象 ,即偏重核减额和核减率 ,忽略对基建全程的日常审计 ,从而使审计工作流于表面。审计管理部门应该注重研究和运用目标管理的方法 ,把难以规划的抽象目标转变为适当具体的工作任务 ,使个人的行动目的与部门的组织目标有机地联系起来。     

全国20所医学院校获奖科技成果和医学科研论文统计分析

通过对全国20所高等医学院校近10年的国家级、部级科技成果奖和近年发表的科研论文以及被《SCI》引用情况进行分析,以求对我国医学院校的科研作一较完整系统的综合评价。