Giving up driving in Alzheimer's disease—an integrative therapeutic approach

For patients with Alzheimer's disease (AD), a recommendation to stop operating a motor vehicle can be a serious event complicated by a loss of self-esteem and personal dignity. Patients are often reluctant to give up an activity so essential, both practically and symbolically, to independent living. We describe here a patient with moderately progressed AD who lacked insight of his need to cease driving. Through an integrative treatment approach, combining behavioral and psychodynamic modalities, we helped him to formulate effective ways of coping with his loss of access to independent transportation. We favor a psychotherapeutic strategy that combines behavioral and managerial measures with dynamic patient interaction, thereby developing the patient's insight of the need to give up driving while fostering his sense of autonomy.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

A Comparison of a Monofocal Acrysoft IOL Using the “Blended Monovision” Formula with the Multifocal Array IOL for Glasses Independence After Cataract Surgery

We compared the Acrysoft monofocal intraocular lens (IOL) in the mini monovision formula (n = 20) with the Array multifocal intraocular lens (n = 20) for glasses independence after cataract surgery. The Acrysoft monofocal IOL group showed similar and even slightly better results than the Array multifocal IOL group. The monofocal Acrysoft IOL using the mini monovision (blended vision) formula is a good alternative for providing post-cataract surgery glasses independence. Drs. Chen, Clinical Assistant Professor of Ophthalmology and Neal H. Atebara are at University of Hawaii School of Medicine, Honolulu, Hawaii, USA. Dr. Te Tsaw Chen, Past Professor & Director, was at Department of Ophthalmology, Taipei Medical University, Taipei, ROC. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors compared the Acrysoft monofocal intraocular lens in the mini monovision formula to the Array multifocal intraocular lens for glasses independence after cataract surgery.     

Evidence for effector independent and dependent representations and their differential time course of acquisition during motor sequence learning

To investigate the representation of motor sequence, we tested transfer effects in a motor sequence learning paradigm. We hypothesize that there are two sequence representations, effector independent and dependent. Further, we postulate that the effector independent representation is in visual/spatial coordinates, that the effector dependent representation is in motor coordinates, and that their time courses of acquisition during learning are different. Twelve subjects were tested in a modified 2x10 task. Subjects learned to press two keys (called a set) successively on a keypad in response to two lighted squares on a 3x3 display. The complete sequence to be learned was composed of ten such sets, called a hyperset. Training was given in the normal condition and sequence recall was assessed in the early, intermediate, and late stages in three conditions, normal, visual, and motor. In the visual condition, finger-keypad mapping was rotated 90 degrees while the keypad-display mapping was kept identical to normal. In the motor condition, the keypad-display mapping was also rotated 90 degrees, resulting in an identical finger-display mapping as in normal. Subjects formed two groups with each group using a different normal condition. One group learned the sequence in a standard keypad-hand setting and subsequently recalled the sequence using a rotated keypad-hand setting in the test conditions. The second group learned the sequence with a rotated keypad-hand setting and subsequently recalled the sequence with a standard keypad-hand setting in the test conditions. Response time (RT) and sequencing errors during recall were recorded. Although subjects committed more sequencing errors in both testing conditions, visual and motor, as compared to the normal condition, the errors were below chance level. Sequencing errors did not differ significantly between visual and motor conditions. Further, the sequence recall accuracy was over 70% even by the early stage when the subjects performed the sequence for the first time with the altered conditions, visual and motor. There were parallel improvements thereafter in all the conditions. These results of positive transfer of sequence knowledge across conditions that use dissimilar finger movements point to an effector independent sequence representation, possibly in visual/spatial coordinates. Initially the RTs were similar in the visual and the motor conditions, but with training RTs in the motor condition became significantly shorter than in the visual condition, as revealed by significant interaction for the testing stage and condition term in the repeated measures ANOVA. Moreover, using RTs for single key pressing in the three conditions as baseline indices, it was again observed that RTs in the visual and motor conditions were not significantly different in the early stage, but motor RTs became significantly shorter by the late testing stage. These results support the hypothesis that the motor condition benefits more than the visual because it uses identical effector movements to the normal condition. Further, these results argue for the existence of effector dependent sequence representation, in motor coordinates, which is acquired relatively slowly. The difference in the time course of learning of these two representations may account for the differential involvement of brain areas in early and late learning phases found in lesion and imaging studies.     

The failed repressor: EEG asymmetry as a moderator of the relation between defensiveness and depressive symptoms

This study assessed the joint effects of defensiveness and frontal asymmetry in predicting symptoms of depression and anxiety. Depression symptoms were measured with the Beck Depression Inventory (BDI) and anxiety symptoms with the Taylor Manifest Anxiety Scale (TMAS). Defensiveness was assessed with both the Marlowe Crowne Social Desirability Scale (MCSD) and the Eysenck Personality Questionnaire L scale (EPQL). Participants completed two EEG recording sessions 3 weeks apart. Six baselines, three eyes open and three eyes closed, were recorded in each session. Alpha power (8–13 Hz) was computed and log transformed. R–L asymmetry was computed at eight pairs of homologous sites for aggregated data. Defensiveness (EPQL and MCSD scores) and depression symptoms (BDI) were assessed at the beginning of the first session. L and MCSD correlated positively with anterior R–L asymmetries. For both scales, the highest correlations were observed at F8–F7. L interacted with F8–F7 asymmetry to predict depressive symptoms. Among left frontally active individuals, there was trend toward a negative correlation between L and BDI. Among the right frontally active individuals, the correlation between L and the BDI was positive. MCSD did not moderate the relation between F8–F7 asymmetry and BDI. The results are consistent with the hypothesis that defensiveness protects against symptoms of depression in the context of left frontal activity, and serves as a diathesis for depression in the context of right frontal activity. High-defensive individuals who are right frontally active may represent “failed repressors,” i.e. individuals for whom defensiveness does not protect against depression, and may even exacerbate it.     

空间ICA在fMRI数据上的应用与分析

独立成分分析(ICA)技术试图将多维数据分解成若干个相互统计独立的分量。时间ICA和空间ICA都可以用于分析功能核磁共振成像(fMRI)数据。但由于fMRI数据空间维数远远大于时间维数，为计算方便，在分析fMRI数据时。则更多的使用空间ICA方法。本文在单任务激励实验中，利用ICA方法从fMRI数据中分离出若干个与任务相关的独立分量，其中包括与任务相关的恒定分量(CTR)和与任务相关的暂态分量(TTR)；通过将这些独立分量进行空间映射，得到了与任务相关的脑部激活区域。将此结果与SPM的分析比较，得到了一致的结果。在对结果的分析中，我们进一步指出了ICA方法的特点和局限性。     

Understanding the financial impact of a diagnosis of young onset dementia on individuals and families in the United Kingdom: Results of an online survey

Although literature on postdiagnostic support for people affected by young onset dementia acknowledges financial concerns, this topic has remained underresearched. The aim of this study was to explore the financial impact of a diagnosis of young onset dementia on individuals and families. An online survey, comprising binary yes/no, multiple-response and open-ended questions, was codesigned with people living with young onset dementia. The survey was promoted via networks and online platforms. Data were collected from August to October 2019. Survey respondents across the United Kingdom (n = 55) who had received a diagnosis of young onset dementia were aged between 45 and 64, were at different stages of dementia and had been diagnosed with thirteen different types of dementia. Of the 55 respondents, 71% (n = 39) had received assistance from family members when completing the survey. The main financial impact of a diagnosis of young onset dementia resulted from premature loss of income and reduced and often deferred pension entitlements. In some cases, care-costs became unaffordable. Lack of clarity of processes and procedures around needs assessments, carers' assessments and financial assessments by different organisations resulted in some families having to ask for legal advice and, in some cases, involved lengthy appeal processes. Future research needs to involve Adult Social Care and Third Sector organisations to help codesign and test financial management interventions to support people affected by this progressive health condition.     

早期卧位踏车训练对造血干细胞移植患儿平衡能力和功能独立性的影响

目的 观察早期卧位踏车训练对造血干细胞移植(HSCT)患儿住院期间平衡能力和功能独立性的影响。 方法 回顾性分析苏州大学附属儿童医院血液科2020年2月至2022年8月收治进行HSCT治疗的儿童资料106例,但最终完成本研究病例69例,根据患儿HSCT出仓后是否采用卧位踏车训练,分为踏车组（32例）和非踏车组（37例）。2组患儿均行常规临床治疗和护理,并接受移植前后健康宣教,内容包含运动锻炼对移植患儿的益处和提供运动方案,运动方案的执行由家长监督完成,每日1次,每次20~30 min,训练频率为每周4~5 d;踏车组在此基础上于HSCT出仓后增加卧位踏车训练,每次30 min,5次/周,连续6周。分别于干预前和干预6周后（干预后）,采用Berg平衡量表(BBS)、儿童功能独立性评定量表(WeeFIM）、儿童多维疲乏量表（PedsQLTM MFS）对2组患儿的平衡能力、功能独立性水平和疲乏度进行评估。 结果 干预训练6周后,踏车组患儿BBS评分［（31.73±4.88）分］、WeeFIM量表中的运动功能领域评分［（61.18±13.44）分］、WeeFIM量表总评分［（95.25±10.93）分］、PedsQLTM MFS评分中的一般疲乏维度得分［（61.86±10.41）分］、睡眠或休息疲乏维度得分［（60.36±6.90）分］均较组内干预前有显著改善（P<0.05）,且改善程度优于非踏车组［（27.52±5.02）、（51.37±12.76）、（85.93±12.59）、（52.11±9.37）和（55.26±8.41）分］,组间差异均有统计学意义（P<0.05）。 结论 早期卧位踏车训练可显著改善住院期间HSCT患儿的平衡功能,促进患儿的运动功能恢复。     

电针刺激对外伤性脊髓损伤患者功能独立性评定影响的临床研究

目的:通过观察电针刺激疗法对外伤性脊髓损伤患者的生活独立功能的影响,为脊髓损伤患者寻求一条有效的康复治疗途径。方法:62例外伤性脊髓损伤患者被随机分成治疗组32例,接受电针刺激加运动治疗、作业治疗;对照组30例,接受单纯性运动治疗、作业治疗。在治疗前后进行功能独立性评定。结果:治疗组与对照组的功能独立性积分均明显高于治疗前(P<0.01),而治疗组治疗后的分值97.78±19.55明显高于对照组的分值87.53±16.67(P<0.05)。同样,治疗组的住院效率明显高于对照组(P<0.05)。结论:电针刺激加运动与作业治疗的综合康复手段能明显改善外伤性脊髓损伤患者的生活独立能力,且能科学地提高住院效率。