Science.gov

Sample records for patient advocacy movement

  1. Building a Latin American cancer patient advocacy movement: Latin American cancer NGO regional overview.

    PubMed

    Durstine, Alessandra; Leitman, Elizabeth

    2009-01-01

    The objective of the this paper is to assess and identify the key strengths and weaknesses for cancer control NGOs in Latin America, with the goal to make recommendations about how to improve thev impact of the patient advocacy movement as it pertains to cancer. The methods included literature review, expert interviews and site visits to Latin American cancer hospitals and NGOs. The overall findings conclude that NGOs currently do not take a leadership role in cancer control in Latin America. The lack of a survivorship movement, faulty patient information services and failure of the governments to include NGOs in policy creation are identified as areas for further project work and collaboration. The stigma of cancer still remains and a burgeoning patient movement can be created to help destigmatize and debunk the myths that surround cancer.

  2. Patient advocacy: the technologist's role.

    PubMed

    Church, Elizabeth J

    2004-01-01

    This article provides an overview of the various ways in which imaging professionals can demonstrate patient advocacy on a day-to-day basis and throughout their careers. Advocacy encompasses a wide range of attitudes and activities, and implementing its principles can bring new enthusiasm to the workplace and increase job satisfaction. After completing this article, readers will: Describe the fundamental aspects of advocacy. Know how to handle conflict and explain why conflict is necessary. Understand the challenges to advocacy. Apply patient advocacy in the context of diagnostic imaging. Recognize the radiologic technologist's important role in ensuring patient safety. Identify how professional codes and standards, as well as federal and state laws, encourage advocacy efforts.

  3. Seeking a Closer Partnership with the Self-Advocacy Movement.

    ERIC Educational Resources Information Center

    Dudley, James R.

    1996-01-01

    Suggestions are provided for mental retardation service providers interested in closer cooperation with the self-advocacy movement. Tips emphasize sharing information, establishing local self-advocacy groups, encouraging convention participation, encouraging staff involvement, listening to consumers, and listening to the voices of the…

  4. Movement Advocacy, Personal Relationships, and Ending Health Care Disparities.

    PubMed

    Chin, Marshall H

    2017-01-01

    Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases.

  5. Patient advocacy and arthritis: moving forward.

    PubMed Central

    Leong, Amye L.; Euller-Ziegler, Liana

    2004-01-01

    Patient advocacy is based on the premise that people have the right to make their own choices about their health care. Personal advocacy is centred on the experiential expertise of the individual affected by the condition, whereas group advocacy is grounded on patient-centred strategies and actions. The first patient advocacy groups for arthritis were set up over 20 years ago in the USA and have subsequently spread to many other countries. This paper discusses the growth and impact of personal advocacy as well as recent developments in group advocacy in the Asia-Pacific region, Europe, and North America, in terms of arthritis awareness, research, corporate partnerships, and the Bone and Joint Decade global initiative. PMID:15042233

  6. Social movements and public health advocacy in action: the UK people's health movement.

    PubMed

    Kapilashrami, Anuj; Smith, Katherine E; Fustukian, Suzanne; Eltanani, Mor Kandlik; Laughlin, Sue; Robertson, Tony; Muir, Janet; Gallova, Eva; Scandrett, Eurig

    2016-09-01

    There are growing calls within public health for researchers and practitioners working to improve and protect the public's health to become more involved in politics and advocacy. Such a move takes practitioners and researchers beyond the traditional, evidence-based public health paradigm, raising potential dilemmas and risks for those who undertake such work. Drawing on the example of the People's Health Movement, this short paper argues that advocacy and social movements are an essential component of public health's efforts to achieve great health equity. It outlines how the Scottish branch of the People's Health Movement sought to overcome potential tensions between public health evidence and advocacy by developing a regional manifesto for health via transparent and democratic processes which combine empirical and experiential evidence. We suggest that this is an illustrative example of how potential tensions between public health research and advocacy can be overcome, through bottom-up movements of solidarity and action. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Patient advocacy in the USA: key communication role functions.

    PubMed

    Martin, Donald R; Tipton, Bryan K

    2007-09-01

    Researchers have long documented the importance of patient advocacy programs as a means of providing customer service in health-care organizations. Yet, while effective communication is often acknowledged as key to effective patient advocacy, knowledge of the specific communication role functions enacted by patient advocates remains limited, as does our understanding of the function of patient advocacy at the organizational level. This qualitative investigation not only provides a typology of communication roles enacted by patient advocates while solving problems on behalf of patients and their family members, but also integrates scholarly research on "boundary-spanning" as a means of theoretically contextualizing the advocacy role at the organizational level.

  8. Patient advocacy and DSM-5.

    PubMed

    Stein, Dan J; Phillips, Katharine A

    2013-05-17

    The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

  9. Advocacy.

    ERIC Educational Resources Information Center

    Scarr, Margaret, Ed.; Varro, Tim, Ed.

    1993-01-01

    This theme issue presents art advocacy as a necessary means of bringing art and art education to an elevated status in the elementary secondary curriculum and educational system. Articles include: (1) "Editor's View" (Margaret Scarr); (2) "Art Education: Why Is It Important" (Arts Education Partnership Working Group); (3)…

  10. Iranian Nurses' Attitudes and Perception towards Patient Advocacy

    PubMed Central

    Motamed-Jahromi, Mohadeseh; Abbaszadeh, Abbas; Borhani, Fariba; Zaher, Homa

    2012-01-01

    Patient advocacy is an inherent component of professional nursing ethics; in other words, nurses' enough knowledge would be essential to gain a positive attitude towards nursing advocacy. Using a descriptive-analytic design, this study aimed to assess the correlation between nurses' perception and attitudes towards patient advocacy, amongst 385 nurses in Kerman, Iran; hence, a three-part questionnaire was applied: part I, a demographic data sheet, part II, attitude measuring instrument, and part III, perception measuring instrument in nursing advocacy. The results implied that fairly positive attitudes and perception were found amongst the participants, and nurses' attitudes, in general, were positively correlated to their perception toward nursing advocacy. This means that with an improvement in perception, the attitude would also improve. In addition to our findings, it seems that these nurses needed more advocacy educational programs and support from responsible employers. PMID:23326680

  11. Patient value: Perspectives from the advocacy community.

    PubMed

    Addario, Bonnie J; Fadich, Ana; Fox, Jesme; Krebs, Linda; Maskens, Deborah; Oliver, Kathy; Schwartz, Erin; Spurrier-Bernard, Gilliosa; Turnham, Timothy

    2017-09-20

    All health-care systems are under financial pressure and many have therefore developed value frameworks to assist decision making regarding access to treatment. Unfortunately, many frameworks simply reflect the clinically focused values held by health-care professionals rather than outcomes that also matter to patients. It is difficult to define one single homogeneous set of patient values as these are shaped by social, religious and cultural factors, and health-care environment, as well as many factors such as age, gender, education, family and friends and personal finances. Instead of focusing on an aggregated set of values, frameworks should attempt to incorporate the broader range of outcomes that patients may regard as more relevant. Patient advocates are well placed to advise assessment bodies on how particular therapies will impact the patient population under consideration and should be closely involved in developing value frameworks. In this paper, a group of patient advocates explore the varying definitions of patient value and make positive recommendations for working together to strengthen the patient voice in this area. The authors call on framework developers, the patient advocacy and research communities, the health-care industry and decision-makers to undertake specific actions to ensure patient value is included in current and future value frameworks. This is justified on compassionate and economic grounds: better health outcomes result when patients receive treatment tailored to individual needs. Paying attention to the patient perspective also results in better use of resources-a goal that should appeal to all stakeholders. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  12. Patient advocacy from the clinical nurses' viewpoint: a qualitative study.

    PubMed

    Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah

    2016-01-01

    One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy.

  13. Patient advocacy from the clinical nurses' viewpoint: a qualitative study

    PubMed Central

    Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah

    2016-01-01

    One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients’ health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy. PMID:27471588

  14. Patient activation and advocacy: which literacy skills matter most?

    PubMed

    Martin, Laurie T; Schonlau, Matthias; Haas, Ann; Derose, Kathryn Pitkin; Rosenfeld, Lindsay; Buka, Stephen L; Rudd, Rima

    2011-01-01

    Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the United States increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy--a component of health literacy itself--when faced with a hypothetical barrier to scheduling a medical appointment. Although all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

  15. The patient movement as an emancipation movement

    PubMed Central

    Williamson, Charlotte

    2008-01-01

    Abstract Objective  To suggest that the patient movement is an emancipation movement. Background  The patient movement is young and fragmented; and it can seem confusing because it lacks an explicit ideology with intellectual and theoretical underpinnings. Methods  Drawing mainly on the experiences and the published writings of patient activists, the author identified eight aspects of the patient movement that could be compared with aspects of recognized emancipation movements: the radicalization of activists; the creation of new knowledge; the identification of guiding principles; the sense of direction; the unmasking of new issues; schisms within the movement and allies outside it; and the gradual social acceptance of some of the ideas (here standards of health care) that activists work to promote. Results  Similarities between certain aspects of the patient movement and of the recognized emancipation movements were close. Conclusion  The patient movement can be regarded as an emancipation movement, albeit an immature one. PMID:18494955

  16. UAVs and Patient Movement

    DTIC Science & Technology

    2016-04-01

    determining factor and is often the deciding element between life and death. An examination of the evolution of patient movement to make the case...AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY UAVs and PATIENT MOVEMENT by Brian R Blanchard, Major, USAF Doctor...depth look at the evolution of patient movement and the utilization of advanced technologies from to ultimately decrease the time to care. Future

  17. Enhancing patient well-being: advocacy or negotiation?

    PubMed Central

    Bird, A W

    1994-01-01

    The United Kingdom Central Council for Nursing, Midwifery and Health Visitors (UKCC) document, Exercising Accountability, states that the role of patient's advocate is an essential aspect of good professional nursing practice (1). The author examines the case for and against the nurse being the best person to act as advocate, and critically evaluates the criteria of advocacy. The problematic moral issues arising are discussed, and a case made for negotiation between the members of the multidisciplinary team and the patient/client (or a significant person to the patient) in order to promote the well-being of the patient and to minimise suffering. She concludes that the health care professional's (including the nurse's) role is to help people to assert control over the factors which affect their lives, that is empowerment, rather than advocacy. PMID:7996560

  18. Swedish registered nurses' and nurse managers' attitudes towards patient advocacy in community care of older patients.

    PubMed

    Josse-Eklund, Anna; Petzäll, Kerstin; Sandin-Bojö, Ann-Kristin; Wilde-Larsson, Bodil

    2013-07-01

    To describe and compare registered nurses' (RNs) and nurse managers' (NMs) attitudes towards patient advocacy in the community care of older patients. RNs may act as patients' advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients. A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used. Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients. This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care. It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care. © 2012 John Wiley & Sons Ltd.

  19. Bridging dermatologists with patient advocacy organizations through smartphones.

    PubMed

    Kourosh, A Shadi; Schoenberg, Evan D; Dejace, Jean M; Bergstresser, Paul R

    2014-03-01

    Patient advocacy organizations seek to increase their benefits for patients with skin disease; low awareness and patient referrals among dermatologists have presented an obstacle to this. To determine whether the Skin Advocate iPhone App would increase awareness and referrals to patient advocacy organizations in the Coalition of Skin Diseases (CSD) among Texas dermatologists and dermatology residents and patient registrations among CSD member organizations. We present results of an institutional review board-exempted investigation conducted among member organizations of the CSD and among dermatologists and dermatology residents in Texas from April 1, 2011, through March 31, 2013. Effects were measured in a blinded fashion subjectively through pre-intervention and post-intervention surveys and objectively through internal analytics that tracked downloads and use of the iPhone app, as well as pre-intervention and post-intervention numbers of registrations for CSD member organizations. The Skin Advocate iPhone App. Awareness and referrals to patient advocacy organizations in the CSD among Texas dermatologists and dermatology residents and patient registrations among CSD member organizations. Throughout the study, mean app use ranged from 3.3 to 3.6 uses per user per month, maintaining the 3-fold improvement compared with self-reported referral for 90% of the study population and a 12-fold improvement for 64% of the study population. Our data revealed substantial improvement in self-reported physician awareness and referrals, and increased patient registrations for CSD organizations. The Skin Advocate iPhone App improved physician awareness and subsequent referrals to CSD member organizations.

  20. Individual patient advocacy, collective responsibility and activism within professional nursing associations.

    PubMed

    Mahlin, Margaret

    2010-03-01

    The systemic difficulties of health care in the USA have brought to light another issue in nurse-patient advocacy - those who require care yet have inadequate or non-existent access. Patient advocacy has focused on individual nurses who in turn advocate for individual patients, yet, while supporting individual patients is a worthy goal of patient advocacy, systemic problems cannot be adequately addressed in this way. The difficulties nurses face when advocating for patients is well documented in the nursing literature and I argue that, through collective advocacy, professional nursing associations ought to extend the reach of individual nurses in order to address systemic problems in health care institutions and bureaucracies.

  1. Patient Education vs. Patient Experiences of Self-advocacy: Changing the Discourse to Support Cancer Survivors.

    PubMed

    Hagan, Teresa L; Medberry, Elizabeth

    2016-06-01

    A growing emphasis on patient self-advocacy has emerged in the public discourse on cancer survivorship. This discourse shapes patients' conceptualizations about self-advocacy and in turn influences their health care attitudes and behaviors. The purpose of this discourse analysis is to explore the language of self-advocacy by comparing a published self-advocacy guide with the lived experiences of women with ovarian cancer. Data sources include (1) a self-advocacy patient education guide published by the National Coalition for Cancer Survivorship and (2) transcripts of focus groups conducted with ovarian cancer survivors. Discourse analysis techniques were used to take a close look at the language used by both to uncover the meaning each group ascribed to self-advocacy. Challenges and inconsistencies were noted between the patient education guide and transcripts including viewing self-advocacy as a skill set to assert one's needs as opposed to a means by which to preserve a positive attitude and maintain a trusting relationship with health care providers, respectively. Some women saw themselves as self-advocates yet struggled to locate relevant health information and hesitated to upset their relationship with their health care providers. This analysis highlights tensions between the discourses and points to ways in which patient education materials can be adjusted to support cancer survivors in advocating for their needs according to their unique situations and preferences.

  2. Patient Education vs. Patient Experiences of Self-advocacy: Changing the Discourse to Support Cancer Survivors

    PubMed Central

    Hagan, Teresa L.; Baldys, Elizabeth

    2015-01-01

    A growing emphasis on patient self-advocacy has emerged in the public discourse on cancer survivorship. This discourse shapes patients’ conceptualizations about self-advocacy and in turn influences their health care attitudes and behaviors. The purpose of this discourse analysis is to explore the language of self-advocacy by comparing a published self-advocacy guide with the lived experiences of women with ovarian cancer. Data sources include 1) a self-advocacy patient education guide published by the National Coalition for Cancer Survivorship and 2) transcripts of focus groups conducted with ovarian cancer survivors. Discourse analysis techniques were used to take a close look at the language used by both to uncover the meaning each group ascribed to self-advocacy. Challenges and inconsistencies were noted between the patient education guide and transcripts including viewing self-advocacy as a skillset to assert one’s needs as opposed to a means by which to preserve a positive attitude and maintain a trusting relationship with health care providers, respectively. Some women saw themselves as self-advocates yet struggled to locate relevant health information and hesitated to upset their relationship with their health care providers. This analysis highlights tensions between the discourses and points to ways in which patient education materials can be adjusted to support cancer survivors in advocating for their needs according to their unique situations and preferences. PMID:25846573

  3. Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest.

    PubMed

    Rose, Susannah L; Highland, Janelle; Karafa, Matthew T; Joffe, Steven

    2017-03-01

    Patient advocacy organizations (PAOs) are influential health care stakeholders that provide direct counseling and education for patients, engage in policy advocacy, and shape research agendas. Many PAOs report having financial relationships with for-profit industry, yet little is known about the nature of these relationships. To describe the nature of industry funding and partnerships between PAOs and for-profit companies in the United States. A survey was conducted from September 1, 2013, to June 30, 2014, of a nationally representative random sample of 439 PAO leaders, representing 5.6% of 7865 PAOs identified in the United States. Survey questions addressed the nature of their activities, their financial relationships with industry, and the perceived effectiveness of their conflict of interest policies. Amount and sources of revenue as well as organizational experiences with and policies regarding financial conflict of interest. Of the 439 surveys mailed to PAO leaders, 289 (65.8%) were returned with at least 80% of the questions answered. The PAOs varied widely in terms of size, funding, activities, and disease focus. The median total revenue among responding organizations was $299 140 (interquartile range, $70 000-$1 200 000). A total of 165 of 245 PAOs (67.3%) reported receiving industry funding, with 19 of 160 PAOs (11.9%) receiving more than half of their funding from industry. Among the subset of PAOs that received industry funding, the median amount was $50 000 (interquartile range, $15 000-$200 000); the median proportion of industry support derived from the pharmaceutical, device, and/or biotechnology sectors was 45% (interquartile range, 0%-100%). A total of 220 of 269 respondents (81.8%) indicated that conflicts of interest are very or moderately relevant to PAOs, and 94 of 171 (55.0%) believed that their organizations' conflict of interest policies were very good. A total of 22 of 285 PAO leaders (7.7%) perceived pressure to conform

  4. The content of advocacy in procedural pain care - patients' and nurses' perspectives.

    PubMed

    Vaartio, Heli; Leino-Kilpi, Helena; Suominen, Tarja; Puukka, Pauli

    2008-12-01

    This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care. Nursing advocacy is every nurse's professional duty, grounded in patients' legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle-blowing event from the nurse's perspective. This cross-sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically. Advocacy in procedural pain care is a process which takes place in the patient-nurse relationship through role identification in decision-making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse's own role identification: in the context of pain care it seems that the nurse's pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision-making about their care; at worst, they are subjected to paternalism. Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on-the-job training, feedback and collaboration.

  5. Predicting Patient Advocacy Engagement: A Multiple Regression Analysis Using Data From Health Professionals in Acute-Care Hospitals.

    PubMed

    Jansson, Bruce S; Nyamathi, Adeline; Heidemann, Gretchen; Duan, Lei; Kaplan, Charles

    2015-01-01

    Although literature documents the need for hospital social workers, nurses, and medical residents to engage in patient advocacy, little information exists about what predicts the extent they do so. This study aims to identify predictors of health professionals' patient advocacy engagement with respect to a broad range of patients' problems. A cross-sectional research design was employed with a sample of 94 social workers, 97 nurses, and 104 medical residents recruited from eight hospitals in Los Angeles. Bivariate correlations explored whether seven scales (Patient Advocacy Eagerness, Ethical Commitment, Skills, Tangible Support, Organizational Receptivity, Belief Other Professionals Engage, and Belief the Hospital Empowers Patients) were associated with patient advocacy engagement, measured by the validated Patient Advocacy Engagement Scale. Regression analysis examined whether these scales, when controlling for sociodemographic and setting variables, predicted patient advocacy engagement. While all seven predictor scales were significantly associated with patient advocacy engagement in correlational analyses, only Eagerness, Skills, and Belief the Hospital Empowers Patients predicted patient advocacy engagement in regression analyses. Additionally, younger professionals engaged in higher levels of patient advocacy than older professionals, and social workers engaged in greater patient advocacy than nurses. Limitations and the utility of these findings for acute-care hospitals are discussed.

  6. Self-Advocacy. Feature Issue.

    ERIC Educational Resources Information Center

    Hayden, Mary F., Ed.; Ward, Nancy, Ed.

    1994-01-01

    This feature issue newsletter looks at issues the self-advocacy movement is raising and the contributions it is making to the lives of people with developmental disabilities. Articles by self-advocates and advisors to self-advocacy organizations talk about their self-advocacy experiences, barriers to self-advocacy, and ways to support it. Primary…

  7. Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study.

    PubMed

    Josse-Eklund, Anna; Jossebo, Marie; Sandin-Bojö, Ann-Kristin; Wilde-Larsson, Bodil; Petzäll, Kerstin

    2014-09-01

    A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. This study's aim was to describe Swedish nurses' perceptions of influencers on patient advocacy. Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse's character traits, was described in the perceptions that advocacy is influenced by nurse's having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse's bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. The nurse's character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies. © The Author(s) 2014.

  8. Social justice advocacy in nursing: what is it? How do we get there?

    PubMed

    Paquin, Siobhan O'Mahony

    2011-01-01

    Social justice advocacy is an expectation of all nurses as expressed in the professional codes that guide nursing practice. Nursing literature reflects this shift in the focus of nursing advocacy, providing insight into the potentials and challenges associated with nursing's evolution toward a broader social justice advocacy model. This article describes the concept of social justice advocacy as currently reflected in professional codes and nursing literature and contrasts this with the individual patient-nurse advocacy model, which continues to dominate in nursing practice today. Challenges associated with movement toward a social justice advocacy model and options for addressing these hurdles are also discussed.

  9. Financial stability in biobanking: unique challenges for disease-focused foundations and patient advocacy organizations.

    PubMed

    Bromley, Russell L

    2014-10-01

    In the last decade, many disease-focused foundations and patient advocacy organizations that support biomedical research have created patient registries and biobanks. This article reviews the motivations behind the creation of those biobanks and how they are different from biobanks sponsored by government or industry. It also discusses some of the different funding models being employed by these organizations. Finally, it highlights some of the unique challenges faced by disease-focused foundations and advocacy organizations that sponsor biobanks, and how they are overcoming those challenges to achieve both financial and operational sustainability.

  10. Collective AIDS Activism and Individuals' Perceived Self-Advocacy in Physician-Patient Communication.

    ERIC Educational Resources Information Center

    Brashers, Dale E.; Haas, Stephen M.; Klingle, Renee S.; Neidig, Judith L.

    2000-01-01

    Describes parallel persuasive processes between social or political activism and personal self-advocacy in a study of AIDS activism and communication patterns between people with HIV or AIDS and health care personnel. Encourages greater patient education about the illness and treatment options. Promotes a more assertive stance toward health care,…

  11. Psoriatic arthritis and psoriasis: role of patient advocacy organisations in the twenty first century

    PubMed Central

    Zimmerman, G; Savage, L; Chandler, D; Maccarone, B

    2005-01-01

    All the psoriatic arthritis and psoriasis patient advocacy organisations are devoted to promoting public awareness and patient education; supporting access to effective treatments and physicians committed to the welfare of patients; working with physicians and other organisations to facilitate development of new treatments; and supporting research for more effective treatments and a cure for psoriasis and psoriatic arthritis. They have participated in the remaking of health politics in the late twentieth century. This was an era in which small patient support and advocacy groups were transformed into sophisticated national health organisations integral to the formation of national health policy and research, treatment, and education funding by working with physicians, legislators, pharmaceutical companies, third party payors, and the media. As we enter the twenty first century, some of these groups have done critical surveys of patients and physicians to discern needs that are redirecting their programming and reshaping directions in the field. Many national leagues have united to form international organisations. Although differences in their national healthcare systems, the age of their organisations, and the diseases they cover are reflected in the focus of their individual activities, much unites them. Whatever their size, as their roles have come to be recognised in the healthcare community, the patient advocacy organisations welcome being invited to the decision making table. This report describes a sampling of these organisations. PMID:15708949

  12. Professionalization as an Advocacy Strategy: A Content Analysis of Canadian Child Care Social Movement Organizations' 2008 Discursive Resources

    ERIC Educational Resources Information Center

    Langford, Rachel; Prentice, Susan; Albanese, Patrizia; Summers, Bernadette; Messina-Goertzen, Brianne; Richardson, Brooke

    2013-01-01

    Do early childhood education and care (ECEC) professionals make good advocates? Canadian advocates have fought for better child care policies since the mid-1940s. What has happened to this advocacy with the recent increased professionalization of the ECEC sector? How does increased professionalization limit, innovate or expand advocacy strategies?…

  13. Advocacy at the end of life: meeting the needs of vulnerable Latino patients.

    PubMed

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Cribbs, Kristen; Lorenz, Karl

    2013-01-01

    This research explores health care professionals' understanding of the problems that arise in managing a terminal condition impacting the Latino population and conceptualizes the components of patient advocacy that address gaps in end-of-life care for patients and their family members. Limited research exists regarding patient advocacy from the perspectives of health care providers working with vulnerable Latino populations utilizing a public sector health care system. Forty-six semi-structured interviews were conducted with providers from different disciplines including medicine, nursing, social work, and chaplaincy. Although roles and responsibilities vary among health providers, it is imperative that all providers become aware of the need for patient advocacy. Doing so is not only in the best interest of vulnerable Latino populations but also has overarching financial benefits and positive outcomes for patients, administrators, and public health care systems. Social workers are the ideal professionals to assume leadership roles and share their knowledge of how to advocate effectively for the most vulnerable populations.

  14. Psychometric Properties of the Patient Self-Advocacy Scale: The Persian Version

    PubMed Central

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hamzehgardeshi, Zeinab; Hessam, Somayeh

    2015-01-01

    Background Advances in science and technology and the changes in lifestyle have changed the concept of health in terms of etiology and mortality. The aim of this study was to test the psychometric properties of the original Patient Self-Advocacy Scale for use with an Iranian population. Methods In the current study, 50 chronic patients between the ages of 25 and 75 were selected as samples. This study was conducted in May 2013 at Bou Ali Sina Hospital in Sari. The translation process and cultural adaptation of the Patient Self-Advocacy Scale were conducted. The face validity and content validity of the instrument were formally verified by analyzing the feedback of patients and health professionals. In order to evaluate questionnaire’s reliability, the intraclass correlation coefficient (ICC) was calculated for each item and each domain; and the Cronbach’s alpha was calculated for the entire instruments and each domain. Results Of the 50 patients participating in the study, 36% were male and 64% were female. The mean age of the patients was 42.5. To comply with the Iranian culture and the study target population, slight changes were applied to the process of translation and validation. In the present study, intraclass correlation coefficient for each item was 0.8-1, which demonstrates excellent reliability of the questionnaire. The Cronbach’s alpha value was 0.75 for overall scale. Conclusion The Persian version of Patient Self-Advocacy Scale was valid and reliable. Hence, it can be used by public health researchers and health system policy makers for programming and offering patient-oriented health services based on patients’ comments, needs, and preferences. PMID:26170522

  15. Ethical conflicts in home care. Patient autonomy and physician advocacy.

    PubMed Central

    Boillat, M. E.; Gee, D.; Bellavance, F.

    1997-01-01

    OBJECTIVE: To identify whether and how family physicians practising home care resolve ethical dilemmas in clinical management of homebound patients and to examine whether the self-reported, theoretical ethical positions of these physicians match their actual patient management. DESIGN: Cross-sectional survey. SETTING: Quebec community-based home care program. PARTICIPANTS: Quebec family physicians actively involved in community-based home care: 85 men and 65 women. MAIN OUTCOME MEASURES: Physician level of agreement with theoretical ethical statements about autonomy, caregiver needs, and resource allocation; management options chosen for a clinical case vignette; and mechanisms used for resolving conflicts. RESULTS: There were 209 respondents to the 279 questionnaires sent (75%). Of these, 59 who were not currently involved in home care were excluded, leaving 150 participants. Most (83.3%) physicians surveyed agreed with the ethical principle of patient autonomy; 88.7% agreed that the interests of family caregivers are important in decisions regarding patients, and 72.0% agreed that limiting home care services is reasonable in the context of limited resources. In managing a patient, 65.3% of physicians thought the patient should be placed in a nursing home against her wishes because of "danger to self," while 82.7% felt she should be placed if the caregiver is "exhausted." Three quarters of physicians did not limit or decrease home care services, despite noncompliance. CONCLUSIONS: Family physicians practising community-based home care in Quebec have practical views on various ethical principles guiding home care practice. Except in the area of limiting or discontinuing home care services, their ethical framework is reflected in a case vignette of patient management. PMID:9426933

  16. Patient advocacy and advance care planning in the acute hospital setting.

    PubMed

    Seal, Marion

    2007-01-01

    The aim of this study was to explain the role of patient advocacy in the Advance Care Planning (ACP-ing) process. Nurses rate prolonging the dying process with inappropriate measures as their most disturbing ethical issue and protecting patients' rights to be of great concern (Johnston et al 2002). Paradoxically ethical codes assume nurses have the autonomy to uphold patients' health-care choices. Advance Directives (AD) designed to improve end-of-life care are poorly taken up and acute hospitals are generally not geared for the few they receive. The Respecting Patient Choices Program (RPCP) improves AD utilisation through providing a supportive framework for ACP-ing and primarily equipping nurses as RPC consultants. Assisting patients with this process requires attributes consistent with patient advocacy arising out of nursing's most basic tenet, the care of others. Likert Scales survey administered pre and six months post-intervention to pilot and control groups, with coinciding focus groups. Selected wards in an acute care public hospital in South Australia. Nurses on the palliative care, respiratory, renal and colo-rectal pilot wards and the haem-oncology, coronary care, cardiology and neurology/geriatric control wards. The RPCP during the 2004-2005 South Australian pilot of the (RPCP). The organisational endorsement of ACP-ing gave nurses the autonomy to be patient advocates with respect to end-of-life care, reconciling clinical practice to their code of ethics and easing distress about prolonging the dying process inappropriately. Statistically significant survey results in the post-intervention group showed nurses experienced: encouragement to ensure patients could make informed choices about their end-of-life treatment (84%); the ability to uphold these wishes in practice (73%); and job satisfaction from delivering appropriate end-of-life care (67%); compared to approximately half (42-55%) of respondents in the pre-intervention and control groups. Focus

  17. What makes a compliant Phase III and pre-launch patient advocacy strategy?

    PubMed Central

    Hicks, Nick; Allan, Keith; Thalheim, Christoph; Woods, Paul

    2016-01-01

    Background A key task for the pharmaceutical industry is to understand the compliance implications of engaging with a patient advocacy group (PAG). This presents challenges for the industry to negotiate the ethical and reputational issues that can arise when working with a PAG. Objective To gain the views of pharmaceutical industry executives on future compliance challenges when working with PAGs. Study design We conducted two surveys among two sets of industry executives: one group focussed on market access roles and the other focussed on non-market access roles. Results Transparency was identified as the biggest challenge, followed by project rationale and then by project ownership. Conclusion We explore how this can be overcome and make recommendations on how best to work compliantly with PAGs. PMID:28003867

  18. Advocacy ABC's

    ERIC Educational Resources Information Center

    Sims, Sandra

    2008-01-01

    Advocacy is a continuous process that involves more than simply passing legislation. It is a year-round commitment that involves educating policymakers about the importance of achieving health and wellness in any state. As such, it is important for the advocacy group to have a plan, be organized, and work together toward a unified goal. Success is…

  19. Advocacy Simplified

    ERIC Educational Resources Information Center

    Dowd, Karen J.; Curva, Fely

    2008-01-01

    Most state professional associations promote and fund at some level, an advocacy program. These advocacy programs usually aim to support or plead for a program, policy, or proposal. They can range from simple communication to complex strategies, from daily interactions to annual productions, and from position papers to onsite, legislative visits.…

  20. A pilot study of selected Japanese nurses' ideas on patient advocacy.

    PubMed

    Davis, Anne J; Konishi, Emiko; Tashiro, Marie

    2003-07-01

    This pilot study had two purposes: (1) to review recent Japanese nursing literature nursing advocacy; and (2) to obtain data from nurses on advocacy. For the second purpose, 24 nurses at a nursing college in Japan responded to a questionnaire. The concept of advocacy, taken from the West, has become an ethical ideal for Japanese nurses but one that they do not always understand, or, if they do, they find it difficult to fulfil. They cite nursing leadership support as necessary to enacting this role. Discussion on meaning of and the rationale for advocacy in a society where goodness or badness is relative to social situations and its impact may reveal two parallel but overlapping views of morality. Such a situation would not only influence notions of advocacy but also possibly render them more complex.

  1. Inadvertent advocacy.

    PubMed

    Wilhere, George F

    2012-02-01

    Policy advocacy is an issue regularly debated among conservation scientists. These debates have focused on intentional policy advocacy by scientists, but advocacy can also be unintentional. I define inadvertent policy advocacy as the act of unintentionally expressing personal policy preferences or ethical judgments in a way that is nearly indistinguishable from scientific judgments. A scientist may be well intentioned and intellectually honest but still inadvertently engage in policy advocacy. There are two ways to inadvertently engage in policy advocacy. First, a scientist expresses an opinion that she or he believes is a scientific judgment but it is actually an ethical judgment or personal policy preference. Second, a scientist expresses an opinion that he or she knows is an ethical judgment or personal policy preference but inadvertently fails to effectively communicate the nature of the opinion to policy makers or the public. I illustrate inadvertent advocacy with three examples: recovery criteria in recovery plans for species listed under the U.S. Endangered Species Act, a scientific peer review of a recovery plan for the Northern Spotted Owl (Strix occidentalis caurina), and the International Union for Conservation of Nature's definition of threatened. In each example, scientists expressed ethical judgments or policy preferences, but their value judgments were not identified as such, and, hence, their value judgments were opaque to policy makers and the public. Circumstances suggest their advocacy was inadvertent. I believe conservation scientists must become acutely aware of the line between science and policy and avoid inadvertent policy advocacy because it is professional negligence, erodes trust in scientists and science, and perpetuates an ethical vacuum that undermines the rational political discourse necessary for the evolution of society's values. The principal remedy for inadvertent advocacy is education of conservation scientists in an effort to

  2. Patient advocacy and the nurse: is there a conflict of interest?

    PubMed

    Robinson, M B

    1985-01-01

    The role of patient advocate has been mandated by law in some states, supported by the American Nurses Association and by nursing theorists. Guidelines have been published to assist the nurse as she pursues the role of patient advocate and to help her decide when she should pursue the role and when she should delegate the advocacy position. Two case studies have been presented to examine the possible conflicts arising between the rights of the patient and the duties of the nurse to society as a whole. Smith, in the final paragraph of her story concludes that: As practicing professionals in any society, we not only have a responsibility to know what we need to know to practice, but also a responsibility to act as advocates for those who cannot speak for themselves. As professionals, we carry a commitment and responsibility to all people in the community in which we practice (p. 625). The situation today, however, continues to present the nurse as patient advocate with an assigned responsibility but without the designated authority to fulfill that responsibility. There is a conflict of interest between the duty to act as the client's advocate and the rights of the nurse to practice nursing in a manner that protects the interests of the nurse, the nursing profession, and the employing institution. Autonomy for the nurse acting as patient advocate remains a theory.

  3. Vergence Eye Movements in Patients with Schizophrenia

    PubMed Central

    Bolding, MS; Lahti, AC; White, D; Moore, C; Gurler, D; Gawne, TJ; Gamlin, PD

    2014-01-01

    Previous studies have shown that smooth pursuit eye movements are impaired in patients with schizophrenia. However, under normal viewing conditions, targets move not only in the frontoparallel plane but also in depth, and tracking them requires both smooth pursuit and vergence eye movements. Although previous studies in humans and non-human primates suggest that these two eye movement subsystems are relatively independent of one another, to our knowledge, there have been no prior studies of vergence tracking behavior in patients with schizophrenia. Therefore, we have investigated these eye movements in patients with schizophrenia and in healthy controls. We found that patients with schizophrenia exhibited substantially lower gains compared to healthy controls during vergence tracking at all tested speeds (e.g. 0.25 Hz vergence tracking mean gain of 0.59 vs. 0.86). Further, consistent with previous reports, patients with schizophrenia exhibited significantly lower gains than healthy controls during smooth pursuit at higher target speeds (e.g. 0.5 Hz smooth pursuit mean gain of 0.64 vs. 0.73). In addition, there was a modest (r≈0.5), but significant, correlation between smooth pursuit and vergence tracking performance in patients with schizophrenia. Our observations clearly demonstrate substantial vergence tracking deficits in patients with schizophrenia. In these patients, deficits for smooth pursuit and vergence tracking are partially correlated suggesting overlap in the central control of smooth pursuit and vergence eye movements. PMID:25088242

  4. IPPF focuses on advocacy. Advocacy for reproductive health: worldwide.

    PubMed

    Puri, S; Ketting, E

    1996-01-01

    The International Planned Parenthood Federation has been advocating human rights since its establishment in 1952. Since the adoption of its global strategic plan, Vision 2000, it has dealt with advocacy in a more systematic manner. Advocacy aims to gain broader support for a cause. In family planning and reproductive health, advocacy is important in counteracting conservative opposition movements. Its most effective tool is high-quality information and services for meeting people's needs. Its target groups are women's groups, youth organizations, parliamentarians, media representatives, and religious leaders. Information, education, and communication (IEC) campaigns differ from advocacy, because the latter is deliberately persuasive and campaign-oriented. An Advocacy Working Group was convened by IPPF and an Advocacy Guide was produced in 1995. Advocacy is needed for the promotion of sexual and reproductive health in the face of opposition from traditional and cultural forces represented by small, vocal, well-financed and organized groups. In 1984 they succeeded in halting funding for IPPF by the United States. This made IPPF resolute in strategic planning and setting goals as contained in Vision 2000. The goals include advocacy for family planning, the prevention of unsafe abortion, women's empowerment, the involvement of youth, the responsibility of men for family life, and the improvement of the status of the female child. The IPPF's 1985 Central Council discussed new initiatives and an Issues Manual was published. The 1989 Members' Assembly held a seminar on critical issues in advocating family planning. A further 1993 resolution urged support for advocacy initiatives. A Public Response Guide was published in 1991 and Language Guidelines were also produced for correct family planning terminology. In addition, an Interregional Training Workshop was held in London in 1995 on the use of the Advocacy Guide. Recommendations were also submitted by participants for

  5. Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing.

    PubMed

    Lauridsen, Sigurd

    2009-06-01

    The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.

  6. International Framework for Cancer Patient Advocacy: Empowering Organizations and Patients to Create a National Call to Action on Cancer

    PubMed Central

    Manasco, Leigh; McGoldrick, Devon; Kajana, Kiti; Rosenthal, Lauren; McMikel, Ann; Lins, Nancy

    2015-01-01

    Purpose With the rate of cancer and other noncommunicable diseases (NCDs) growing globally, cancer prevention and control efforts are critical internationally. Moreover, since the 2011 United Nations High-Level Meeting on NCDs, the international health and development community has shifted its awareness to include NCDs as a global health priority, especially in developing countries where mortality rates are disproportionately high. Simultaneously, with the dissemination of the World Cancer Declaration and the evolution of cancer control policies, the international cancer community has recognized the value of engaging patients in reducing the global cancer burden. Cancer advocacy programs that involve patients, survivors, and nongovernmental organizations (NGOs) have increasing opportunities for global impact. Methods We developed a framework over 4 years through implementation of two pilot projects. We created a series of trainings and tools to build the capacity of local NGOs and patients to plan and implement a forum for patients with cancer and to create and disseminate a national call to action. The framework was piloted in South Africa from 2009 to 2011 and Japan from 2012 to 2014, and results were measured through postproject surveys completed by members of the collaborative working group and interviews with the in-country partner. Results The framework is globally relevant and could be adapted and implemented in low- and middle-income countries to amplify patient voices in the policymaking process, increase grassroots mobilization, and improve health systems and infrastructure through addressing patient needs. Conclusion With the dominant paradigm of global health in developing countries—which has previously focused on HIV/AIDS, maternal and child health, tuberculosis, and malaria—shifting to adapt to the burgeoning NCD burden, effective patient-centered advocacy frameworks are critical to the success of NCD control. PMID:28804777

  7. Mirror movements in patients with Parkinson's disease.

    PubMed

    Ottaviani, Donatella; Tiple, Dorina; Suppa, Antonio; Colosimo, Carlo; Fabbrini, Giovanni; Cincotta, Massimo; Defazio, Giovanni; Berardelli, Alfredo

    2008-01-30

    Mirror movements (MM) refer to ipsilateral involuntary movements that appear during voluntary activity in contralateral homologous body regions. This study aimed to compare the frequency and distribution of MM in an unselected sample of 274 patients with Parkinson's disease (PD) and 100 healthy subjects, and to check a possible relationship between MM and parkinsonian features. MM of the hand were scored according to the Woods and Teuber scale. The frequency of MM was lower in PD patients than in healthy subjects (29% vs. 71%, P < 0.0001). The distribution of MM also differed in the two groups being often bilateral in healthy subjects, invariably unilateral in PD patients. When parkinsonian signs were unilateral, MM always manifested on the unaffected side; when parkinsonian signs were bilateral, MM manifested on the less affected side. PD patients manifesting MM scored significantly lower on Hohen and Yahr staging than patients without MM. Likewise, there was a significant inverse correlation between the intensity of MM as rated by the Woods and Teuber score and HY staging (r = -0.16, P < 0.01). The low frequency of MM in PD probably relates to the complex interactions between the pathophysiological mechanisms leading to parkinsonian signs and the mechanisms responsible for movement lateralization.

  8. Effect of movement frequency on repetitive finger movements in patients with Parkinson's disease.

    PubMed

    Stegemöller, Elizabeth L; Simuni, Tanya; MacKinnon, Colum

    2009-06-15

    Performance of repetitive hand movements in patients with Parkinson's disease (PD) is characterized by slowness, reduced movement amplitude, and hesitation or arrests in ongoing movement. Currently, the factors and mechanisms contributing to impaired performance of these types of movement remain poorly understood. This study examined the effects of movement frequency and medication on the performance of unconstrained index finger flexion movements in patients with PD and matched control subjects. Movements were synchronized with an auditory tone as the frequency of the tone was increased from 1 to 3 Hz in 0.25 Hz increments. Movement performance was quantified based upon finger kinematics and electromyography (EMG) recorded from the index finger flexors and extensors. The principal finding was that patients with PD showed a dramatic reduction in movement amplitude, an increase in movement frequency, and a loss of phase when the movement frequency reached or exceeded 2 Hz. This deficit was not significantly improved with medications. In contrast, all control subjects could synchronize to 3 Hz. These findings show that movement frequency is a major determinant of hypokinesia during repetitive movements and may contribute to hesitations and movement arrest during clinical testing of bradykinesia in the upper limb of patients with PD. (c) 2009 Movement Disorder Society.

  9. Advocacy skills in resident doctors.

    PubMed

    DeCesare, Julie; Jackson, Jessica

    2016-02-01

    The objective of this project was to study whether a standardised patient clinical encounter learning exercise improved an Obstetrics and Gynaecology (OBGYN) resident's ability to perform patient advocacy, a systems-based practice skill. Case-control study: each of the 12 residents functioned as their own control. Additionally, aggregate data from the programme was reviewed. Twelve residents from a mid-sized OBGYN residency programme performed a standardised patient clinical encounter exercise in March of 2014. As demonstrated by the Assessment for Professional Behavior (APB) 360° evaluation, the overall total scores for the programme on patient advocacy improved, with statistical significance, when analysed by the signed ranked test. Additionally, the residents' self-identified capability to perform advocacy improved after the programme, with statistical significance, when analysed by the signed rank test. A standardised patient clinical encounter, used as a learning exercise, can demonstrate meaningful improvement in the advocacy skills of a resident doctor. © 2015 John Wiley & Sons Ltd.

  10. Advocacy for eye care.

    PubMed

    Ravilla, Thulasiraj D; Ramasamy, Dhivya

    2012-01-01

    The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services - such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support - either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

  11. Consumer advocacy, elective surgery, and the "golden era of medicine".

    PubMed

    Reiter, R C; Lench, J B; Gambone, J C

    1989-11-01

    The process of medical quality assurance evolved logically from the consumer advocacy movement of the past decades. This process has fundamentally altered the personal and legal relationship between patients and physicians. The need for development and adoption of a medically, ethically, and fiscally sound standard of elective surgical practice is clear and immediate. A system that may be used to evaluate the appropriateness of elective surgical procedures is proposed.

  12. Advocacy for Art Education: Beyond Tee-Shirts and Bumper Stickers

    ERIC Educational Resources Information Center

    Bobick, Bryna; DiCindio, Carissa

    2012-01-01

    Advocacy is not new to art education. Over the years, Goldfarb (1979), Hodsoll (1985), and Erickson and Young (1996) have written about the importance of arts advocacy, but the concept of advocacy has evolved with the times. For example, in the 1970s, arts advocacy was described as a "movement" and brought together art educators,…

  13. Advocacy for Art Education: Beyond Tee-Shirts and Bumper Stickers

    ERIC Educational Resources Information Center

    Bobick, Bryna; DiCindio, Carissa

    2012-01-01

    Advocacy is not new to art education. Over the years, Goldfarb (1979), Hodsoll (1985), and Erickson and Young (1996) have written about the importance of arts advocacy, but the concept of advocacy has evolved with the times. For example, in the 1970s, arts advocacy was described as a "movement" and brought together art educators,…

  14. Rethinking the therapeutic misconception: social justice, patient advocacy, and cancer clinical trial recruitment in the US safety net.

    PubMed

    Burke, Nancy J

    2014-09-20

    Approximately 20% of adult cancer patients are eligible to participate in a clinical trial, but only 2.5-9% do so. Accrual is even less for minority and medically underserved populations. As a result, critical life-saving treatments and quality of life services developed from research studies may not address their needs. This study questions the utility of the bioethical concern with therapeutic misconception (TM), a misconception that occurs when research subjects fail to distinguish between clinical research and ordinary treatment, and therefore attribute therapeutic intent to research procedures in the safety net setting. This paper provides ethnographic insight into the ways in which research is discussed and related to standard treatment. In the course of two years of ethnographic fieldwork in a safety net hospital, I conducted clinic observations (n=150 clinic days) and in-depth in-person qualitative interviews with patients (n=37) and providers (n=15). I used standard qualitative methods to organize and code resulting fieldnote and interview data. Findings suggest that TM is limited in relevance for the interdisciplinary context of cancer clinical trial recruitment in the safety net setting. Ethnographic data show the value of the discussions that happen prior to the informed consent, those that introduce the idea of participation in research. These preliminary discussions are elemental especially when recruiting underserved and vulnerable patients for clinical trial participation who are often unfamiliar with medical research and how it relates to medical care. Data also highlight the multiple actors involved in research discussions and the ethics of social justice and patient advocacy they mobilize, suggesting that class, inequality, and dependency influence the forms of ethical engagements in public hospital settings. On the ground ethics of social justice and patient advocacy are more relevant than TM as guiding ethical principles in the context of

  15. The role of support groups, advocacy groups, and other interested parties in improving the care of patients with congenital adrenal hyperplasia: pleas and warnings.

    PubMed

    Lee, Peter A; Houk, Christopher P

    2010-01-01

    In the era of advocacy groups, it seems appropriate to contemplate how best to utilize them for patient benefit in the management of those with disorders of sex development (DSD), including those with congenital adrenal hyperplasia (CAH). Such interactions, to be constructive, require a spirit of cooperation to optimize outcomes. A traditional view of advocacy groups as a type of defender of patients' rights appears outdated and it is time that the benefits of their participation be fully realized. Open dialogue with all patients/families, including those who feel harmed by prior care are paramount. We discuss several recent examples of interactions that illustrate how dialogue in the name of "advocacy" can have a negative impact on developing a framework for ongoing constructive dialogue and actions. Such approaches completely change the dynamics of subsequent interactions. Physicians involved in the care of individuals with DSD, including those with CAH, and patients should be aware of confrontational techniques and legal implications that may be used by some advocacy groups. Hopefully recent efforts to promote a multidisciplinary care approach for patients with DSD/CAH will continue to foster mutual cooperation between team members, where the common goal is improving patient/family outcomes and quality of life.

  16. Pharmaceutical industry, academia and patient advocacy organizations: what is the recipe for synergic (win-win-win) collaborations?

    PubMed

    Rose, Daniel M; Marshall, Richard; Surber, Mark W

    2015-02-01

    Biological complexity and the need for highly differentiated medicines means that drug discovery and development have become increasingly challenging and expensive. Thus, new paradigms for research and drug development need to be created that bring together a wide array of expertise. One potential solution is collaboration between bio-pharma and academic research centres. Two examples are discussed, one with a large pharma company (GlaxoSmithKline) and the other a small biotech (Genoa Pharmaceuticals). Patient advocacy organization can also have role in assisting in the creation of these partnerships by informing patients of ongoing research and clinical trials, and supporting the development of networks that can provide major benefit for both basic research and drug development. A major 'hurdle' for the creation of these relationships is the issue of intellectual property. Examples are provided of how this issue can be resolved. © 2015 Asian Pacific Society of Respirology.

  17. Temporal movement control in patients with Parkinson's disease.

    PubMed Central

    Teasdale, N; Phillips, J; Stelmach, G E

    1990-01-01

    Patients with Parkinson's disease (PD) have been reported to be unable to modify their movement velocity to adapt to changing environmental demands. For example, when movement amplitude is varied, PD patients usually exhibit a nearly constant peak velocity, whereas elderly subjects show an increase of their peak velocity with increased amplitude. The experiment examined the ability of PD patients to vary the duration of their movement (four different percentages of their maximum) under conditions where temporal, but not spatial, control was emphasised. PD patients had longer movement times than control subjects, but were able to vary the duration of their movement with comparable temporal accuracy to that of elderly subjects. For both groups, the agonist EMG activity increased with decreased movement duration. For the PD patients, the number of agonist bursts increased with increased movement duration. PMID:2266367

  18. Community Health Workers and the Patient Protection and Affordable Care Act: An opportunity for a research, advocacy, and policy agenda

    PubMed Central

    Shah, Megha; Heisler, Michele; Davis, Matthew

    2014-01-01

    Community health workers (CHWs) have the potential to be important members of an interdisciplinary health care team. CHWs have been shown to be effective in multiple roles in the provision of culturally appropriate healthcare in a variety of settings. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how to best achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, policy, and advocacy agenda for CHWs. PMID:24509008

  19. Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda.

    PubMed

    Shah, Megha K; Heisler, Michele; Davis, Matthew M

    2014-02-01

    Community health workers (CHWs), who have been shown to be effective in multiple roles in the provision of culturally appropriate health care in a variety of settings, have the potential to be important members of an interdisciplinary health care team. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how best to achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, advocacy, and policy agenda for CHWs.

  20. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations.

    PubMed

    Högl, Birgit; Stefani, Ambra

    2017-05-01

    Restless legs syndrome is a frequent neurological disorder with potentially serious and highly distressing treatment complications. The role and potential implications of periodic leg movements during sleep range from being a genetic risk marker for restless legs syndrome to being a cardiovascular risk factor. The diagnosis of restless legs syndrome in patients with daytime movement disorders is challenging and restless legs syndrome needs to be differentiated from other sleep-related movement disorders. This article provides an update on the diagnosis of restless legs syndrome as an independent disorder and the role of periodic leg movements and reviews the association of restless legs syndrome with Parkinson's disease and other movement disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  1. (R)evolution: toward a new paradigm of policy and patient advocacy for expanded access to experimental treatments.

    PubMed

    Hogan, Melissa

    2016-02-29

    In life-threatening conditions such as cancer and rare diseases, where there is no cure and no U.S. Food and Drug Administration (FDA)-approved therapy, patients sometimes seek access to an unapproved, experimental therapy through expanded access programs as their last, best hope for treatment to save their lives. Since the 1980s, the policies and the practice of expanded access have evolved, but a common challenge remains that there is no obligation, and often little incentive, for manufacturers to offer expanded access programs, especially for individual patients. In recent years, online campaigns seeking access to an experimental therapy have become more common, paralleling growth in and representing an intersection of social media, digital health, and patient advocacy.Mackey and Schoenfeld have examined the evolution of expanded access policy, practice, and trends, as well as case studies of online campaigns to access experimental therapies, to arrive at several recommendations for the future of expanded access. This commentary puts their paper in context, examines their recommendations, and suggests further reforms.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0568-8.

  2. Post-stroke movement disorders: report of 56 patients

    PubMed Central

    Alarcon, F; Zijlmans, J; Duenas, G; Cevallos, N

    2004-01-01

    Background: Although movement disorders that occur following a stroke have long been recognised in short series of patients, their frequency and clinical and imaging features have not been reported in large series of patients with stroke. Methods: We reviewed consecutive patients with involuntary abnormal movements (IAMs) following a stroke who were included in the Eugenio Espejo Hospital Stroke Registry and they were followed up for at least one year after the onset of the IAM. We determined the clinical features, topographical correlations, and pathophysiological implications of the IAMs. Results: Of 1500 patients with stroke 56 developed movement disorders up to one year after the stroke. Patients with chorea were older and the patients with dystonia were younger than the patients with other IAMs. In patients with isolated vascular lesions without IAMs, surface lesions prevailed but patients with deep vascular lesions showed a higher probability of developing abnormal movements. One year after onset of the IAMs, 12 patients (21.4%) completely improved their abnormal movements, 38 patients (67.8%) partially improved, four did not improve (7.1%), and two patients with chorea died. In the nested case–control analysis, the patients with IAMs displayed a higher frequency of deep lesions (63% v 33%; OR 3.38, 95% CI 1.64 to 6.99, p<0.001). Patients with deep haemorrhagic lesions showed a higher probability of developing IAMs (OR 4.8, 95% CI 0.8 to 36.6). Conclusions: Chorea is the commonest movement disorder following stroke and appears in older patients. Involuntary movements tend to persist despite the functional recovery of motor deficit. Deep vascular lesions are more frequent in patients with movement disorders. PMID:15489389

  3. Low back pain patients' responses to videos of avoided movements.

    PubMed

    Pincus, T; Henderson, J

    2013-02-01

    Fear avoidance (FA) has been identified as a risk factor for poor prognosis and a target for intervention in patients with low back pain (LBP), but the mechanisms involved need clarification. Experimental studies would benefit from the use of carefully developed and controlled stimuli representing avoided movements in back pain, and matched stimuli of movements to provide a credible control stimuli. Existing stimuli depicting avoided movements in LBP are static, do not include a set of control stimuli and do not control for possible systematic observer biases. Two studies were carried out aiming to develop and test LBP patients' responses to videos of models depicting commonly avoided movements associated with back pain, and those associated with a control condition, wrist pain. Two samples of LBP patients rated how much pain and harm each movement would cause them. They also reported how often they avoided the movement. The findings from the first study (n = 99) indicate that using videos of commonly avoided movements in low back pain is viable, and that movements associated with wrist pain provide an acceptable control stimuli. Participants in the second study (n = 85) consistently rated movements depicted by females as causing more harm, and more frequently avoided than the same movements depicted by males. The use of video stimuli could advance research into the processes associated with FA through experimental paradigms. However, although small, the model gender effects should be carefully considered. © 2012 European Federation of International Association for the Study of Pain Chapters.

  4. Advocacy and child neglect.

    PubMed

    Krugman, Scott D

    2014-11-01

    Pediatricians have a unique opportunity to intervene in the lives of children to identify and to prevent neglect. While it remains important to care for individual patients affected by neglect, the ecological model of child neglect requires intervention at the parent, family, community, and societal levels. Pediatricians can improve the outcomes for children by advocating for policies and interventions at each level. Effective advocacy principally requires the willingness to tackle broader issues beyond individual clinical care. Working with local, state, and national organizations, pediatricians can contribute a unified voice to promote evidence-based policies and programs that improve the well-being of children.

  5. [Self-Advocacy.

    ERIC Educational Resources Information Center

    Carr, Theresa, Ed.

    1994-01-01

    This theme issue presents personal perspectives and approaches to self-advocacy from individuals who are deaf-blind. Individual articles are: (1) "Self-Advocacy: Attaining Personal Stature" by Michelle J. Smithdas; (2) "The American Association of the Deaf-Blind: A National Consumer Advocacy Organization" by Jeffrey S. Bohrman;…

  6. Frequency of spinal reflex movements in brain-dead patients.

    PubMed

    Döşemeci, L; Cengiz, M; Yilmaz, M; Ramazanoĝlu, A

    2004-01-01

    Spontaneous and reflex movements may occur in brain-dead patients. These movements originate from spinal cord neurons and do not preclude a brain-death diagnosis. In this study, we sought to determine the frequency and characteristics of motor movements in patients who fulfilled diagnostic criteria for brain death. Patients admitted to our department between January 2000 and March 2003 and diagnosed as brain-dead were prospectively evaluated in terms of spinal reflexes. Clinical brain death was diagnosed according to our national law. We also prefer to document the diagnosis of brain death with an EEG and/or TCD. Spinal reflex movements were observed in 18 out of 134 (13.4%) brain-dead patients during the study period. Lazarus sign, the most dramatic and complex movement seen in brain-dead patients, was observed a few times in two patients during an apnea test, an oculocephalic test, after a painful stimulus, and after removal of a ventilator. The other reflex movements observed in our brain-dead patients were finger and toe jerks, extension at arms and shoulders, and flexion of arms and feet. The occurrence of spinal reflexes in brain-dead patients may certainly delay decision making, such as starting a transplantation procedure, because of difficulties in convincing the family or even a physician taking part in the diagnosis of brain death. An awareness of spinal reflexes may prevent delays in and misinterpretations of the brain-death diagnosis.

  7. Advocacy in nursing--a review of the literature.

    PubMed

    Mallik, M

    1997-01-01

    Patient/client advocacy has been claimed as a new role for the professional nurse. This paper presents a critical review of the literature on advocacy in nursing. After briefly outlining the conditions which may have instigated the need for patient advocacy, meanings and models of advocacy are discussed. It is argued that although there are many examples of the advocacy role in health care, models proposed for the nurse as advocate are indeterminate which leads to multiple interpretations and lack of clarity in operationalizing advocacy. Much of the literature focuses on justification arguments for claiming the advocacy role. Key themes are outlined and include: patient advocacy as a traditional role, nurses are in the best position in the health care team, nurses have the knowledge to advocate and finally nurses and patients can be partners in advocacy. However, critical examination reveals many counter-arguments to the above claims and finally concludes that advocacy is a potentially risky role to adopt. It is argued that support systems are inadequate except in low-risk situations and ultimately acts of advocacy remain a moral choice for the individual nurse. Finally the need to conduct research into the interpretation of the patient advocate role by nurses in the United Kingdom is highlighted.

  8. The Big Picture of Advocacy: Counselor, Heal Society and Thyself

    ERIC Educational Resources Information Center

    Roysircar, Gargi

    2009-01-01

    This article, motivational in purpose, encourages counselors to be engaged in the growing movement for social justice advocacy in counseling. Analyses of a macrolevel framework of advocacy extend to microlevel operations of recruitment, sociopolitical education, diversity management, and self-care of counselor-advocates. Case studies and exemplars…

  9. What Is Self-Advocacy? NRC Fact Sheet

    ERIC Educational Resources Information Center

    Hall, Mair

    2010-01-01

    Self-advocacy is about independent groups of people with disabilities working together for justice by helping each other take charge of their lives and fight discrimination. The seeds of the self-advocacy movement go back to 1968 when a Swedish parent's organization held a meeting for people with developmental disabilities. Today, the…

  10. The Big Picture of Advocacy: Counselor, Heal Society and Thyself

    ERIC Educational Resources Information Center

    Roysircar, Gargi

    2009-01-01

    This article, motivational in purpose, encourages counselors to be engaged in the growing movement for social justice advocacy in counseling. Analyses of a macrolevel framework of advocacy extend to microlevel operations of recruitment, sociopolitical education, diversity management, and self-care of counselor-advocates. Case studies and exemplars…

  11. Patient education and self-advocacy: queries and responses on pain management; erythromelalgia.

    PubMed

    Tokarz, Kyle A

    2009-01-01

    Questions from patients concerning a disease process known as erythromelalgia, its diagnosis, symptoms, and treatments are answered to help patients and caregivers understand the disease and its treatment. The responses from the author are intended to educate patients about their disease and make them more effective self-advocates.

  12. Clinical ethics and patient advocacy: the power of communication in health care.

    PubMed

    Emrich, Inken Annegret; Fröhlich-Güzelsoy, Leyla; Bruns, Florian; Friedrich, Bernd; Frewer, Andreas

    2014-06-01

    In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year period of patient advocates' activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate's work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients' advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context.

  13. Advocacy: exploring the concept.

    PubMed

    Mardell, A

    1996-10-01

    The concept of the nurse as the patient's advocate is one that has become popular in the last fifteen years or so in both North America and the United Kingdom, having its basis in nursing theory. The UKCC first embraced the concept, stating in the Code of Professional Conduct that nurses must; 'act always in such a manner so as to promote and safeguard the interests and well being of patients and clients'. This is a laudable principle and one that nurses cannot dispute as there are many members of our society who are weak and vulnerable and may be unable to speak up for themselves. But are nurses always in a position to be an advocate for their patients? As the nature of nursing is so diverse then the nature of advocacy will be different in the multifarious settings in which nurses practise. Can theatre nurses ever be in a position to act as an advocate for a patient who is often anaesthetised? What precisely is advocacy and is the Concise Oxford Dictionary definition of 'one who pleads for another' appropriate in the nursing context? Then there is the position of nurses in the healthcare organisation in which they practise. In advocating for their patients, nurses may find they are pleading a case for a patient, or a group of patients, that could bring the nurse into conflict with their medical colleagues or with the management of the organisation by whom they are employed. Additionally, they may not posses the skills and knowledge to advocate effectively under such circumstances. Nursing is littered with the casualties of such conflicts over the years, the most publicised of whom, in the UK, was probably Graham Pink who lost his job as a charge nurse after drawing public attention to what he considered to be an unacceptable standard of care in the hospital in which he worked.

  14. Pacing and lapping movements among institutionalized patients with dementia.

    PubMed

    Nakaoka, Akiko; Suto, Shunji; Makimoto, Kiyoko; Yamakawa, Miyae; Shigenobu, Kazue; Tabushi, Kaoru

    2010-03-01

    Wandering is a complex behavior, and defining wandering has been challenging. The current study used the integrated circuit (IC) tag monitoring system to describe the distance moved per day and the spatial movements of patients with dementia. The study was conducted in a 60-bed semiacute dementia care unit in a general hospital in Japan over a 3-month period in 2006. The distance moved per day, the numbers of pacing and lapping movements, and the proportions of the distance moved that was paced or lapped were tabulated in 23 patients diagnosed with dementia. The distance moved per day and the numbers of pacing and lapping movements varied greatly within and among study participants. The median distance moved per day was inversely correlated with participants' age and Mini-Mental State Examination (MMSE) scores (adjusted r(2) = .34, P = .01). Consecutive lapping and pacing movements were rare patients with in Alzheimer's disease (AD), while 2 patients with frontotemporal dementia paced or lapped repeatedly.

  15. Multimodal Movement Prediction - Towards an Individual Assistance of Patients

    PubMed Central

    Kirchner, Elsa Andrea; Tabie, Marc; Seeland, Anett

    2014-01-01

    Assistive devices, like exoskeletons or orthoses, often make use of physiological data that allow the detection or prediction of movement onset. Movement onset can be detected at the executing site, the skeletal muscles, as by means of electromyography. Movement intention can be detected by the analysis of brain activity, recorded by, e.g., electroencephalography, or in the behavior of the subject by, e.g., eye movement analysis. These different approaches can be used depending on the kind of neuromuscular disorder, state of therapy or assistive device. In this work we conducted experiments with healthy subjects while performing self-initiated and self-paced arm movements. While other studies showed that multimodal signal analysis can improve the performance of predictions, we show that a sensible combination of electroencephalographic and electromyographic data can potentially improve the adaptability of assistive technical devices with respect to the individual demands of, e.g., early and late stages in rehabilitation therapy. In earlier stages for patients with weak muscle or motor related brain activity it is important to achieve high positive detection rates to support self-initiated movements. To detect most movement intentions from electroencephalographic or electromyographic data motivates a patient and can enhance her/his progress in rehabilitation. In a later stage for patients with stronger muscle or brain activity, reliable movement prediction is more important to encourage patients to behave more accurately and to invest more effort in the task. Further, the false detection rate needs to be reduced. We propose that both types of physiological data can be used in an and combination, where both signals must be detected to drive a movement. By this approach the behavior of the patient during later therapy can be controlled better and false positive detections, which can be very annoying for patients who are further advanced in rehabilitation, can be

  16. Pharmaceuticals and the consumer movement: the ambivalences of 'patient power'.

    PubMed

    Lofgren, Hans

    2004-11-08

    Consumer and patient advocacy groups (PAGs) are important participants in the politics of pharmaceuticals. Yet very little is known about the precise nature and extent of their influence. It is argued in this article that PAGs fulfil a mixed role within the health system at national and transnational levels, and that they are at times fully incorporated into economic and political power structures. Their frequent dependence on pharma industry funding is of particular concern. PAGs provide a means of direct industry interaction with the final customer, thereby partially bypassing and putting additional pressure on doctors and regulators. The article presents the case for research to establish a better empirical base for discussions about the role of PAGs within contemporary neo-liberal governance structures.

  17. Twenty-First Century Pathologists' Advocacy.

    PubMed

    Allen, Timothy Craig

    2017-07-01

    Pathologists' advocacy plays a central role in the establishment of continuously improving patient care quality and patient safety, and in the maintenance and progress of pathology as a profession. Pathology advocacy's primary goal is the betterment of patient safety and quality medical care; however, payment is a necessary and appropriate component to both, and has a central role in advocacy. Now is the time to become involved in pathology advocacy; the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) and the Protecting Access to Medicare Act of 2014 (PAMA) are 2 of the most consequential pieces of legislation impacting the pathology and laboratory industry in the last 20 years. Another current issue of far-reaching impact for pathologists is balance billing, and yet many pathologists have little or no understanding of balance billing. Pathologists at all stages of their careers, and in every professional setting, need to participate. Academic pathologists have a special obligation to, if not become directly involved in advocacy, at least have a broad and current understanding of those issues, as well as the need and responsibility of pathologists to actively engage in advocacy efforts to address them, in order to teach residents the place of advocacy, and its value, as an inseparable and indispensable component of their professional responsibilities.

  18. Patient advocacy: one agency's positive results with the administrative law judge process.

    PubMed

    Kimaid, Y; Votava, K M; Myers, E

    1994-01-01

    The Visiting Nurse Service of Rochester and Monroe County, Inc., is a progressive, certified home health agency that is committed to providing a broad range of specialized high-quality care services. To assist in meeting this goal, the Visiting Nurse Service has developed a Network of Support to maximize the patients' access to Medicare home care benefits. This commitment as a patient advocate follows through to the process of dealing with Medicare denials up to the level of the Administrative Law Judge.

  19. Empowerment, self-advocacy and resilience.

    PubMed

    Goodley, Dan

    2005-12-01

    This article critiques the relationship between the aims of 'learning disability' policy and the realities of the self-advocacy movement. A previous study found that self-advocacy can be defined as the public recognition of the resilience of people with learning difficulties. In the current climate of Valuing People, partnership boards and 'user empowerment', understanding resilience is crucial to the support of authentic forms of self-advocacy. This article aims to address such a challenge. First, understandings of resilience in relation to self-empowerment and self-advocacy are briefly considered. Second, the current policy climate and service provision rhetoric are critically explored. Third, it is argued that we need to recognize how self-advocacy groups celebrate resilience through a variety of social and identity-shifting actions. How current policy responds to these aspects of resilience is questioned. It is concluded that the lived reality of self-advocacy needs to be foregrounded in any attempt to understand empowerment.

  20. 76 FR 78931 - Food and Drug Administration Rare Disease Patient Advocacy Day; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-20

    ... Disorders, and the Genetic Alliance. FDA encourages all attendees to also plan on attending the NIH Rare... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Food and Drug Administration Rare Disease Patient...

  1. Analysis of patient movement during 3D USCT data acquisition

    NASA Astrophysics Data System (ADS)

    Ruiter, N. V.; Hopp, T.; Zapf, M.; Kretzek, E.; Gemmeke, H.

    2016-04-01

    In our first clinical study with a full 3D Ultrasound Computer Tomography (USCT) system patient data was acquired in eight minutes for one breast. In this paper the patient movement during the acquisition was analyzed quantitatively and as far as possible corrected in the resulting images. The movement was tracked in ten successive reflectivity reconstructions of full breast volumes acquired during 10 s intervals at different aperture positions, which were separated by 41 s intervals. The mean distance between initial and final position was 2.2 mm (standard deviation (STD) +/- 0.9 mm, max. 4.1 mm, min. 0.8 mm) and the average sum of all moved distances was 4.9 mm (STD +/- 1.9 mm, max. 8.8 mm, min. 2.7 mm). The tracked movement was corrected by summing successive images, which were transformed according to the detected movement. The contrast of these images increased and additional image content became visible.

  2. Working with Mental Health Advocacy Groups.

    ERIC Educational Resources Information Center

    Tenety, Megan; Kiselica, Mark

    There are many factors behind the growing advocacy movement for mentally ill individuals. These factors include the prevalence of mental illness in society, deinstitutionalization, the restrictions of managed care, an increased awareness of the rights of the mentally ill, and empowerment of mentally ill clients. Despite the growing importance of…

  3. Building Trust: The History and Ongoing Relationships Amongst DSD Clinicians, Researchers, and Patient Advocacy Groups.

    PubMed

    Lossie, A C; Green, J

    2015-05-01

    Individuals born with differences or disorders of sex development (DSD) have been marginalized by society and the health care system. Standards of care in the mid-20(th) century were based on fixing the child with a DSD, using hormonal and surgical interventions; these treatments and the diagnoses were almost never disclosed to the child, and sometimes they were not disclosed to the parents. This led to secrecy, shame, and stigma. When these children became adults and demanded access to their medical records, the realization of the depth of secrecy led to the formation of activism groups that shook the medical community. Despite precarious beginnings, advocates, health care professionals, and researchers were able to elicit changes in the standard of care. The 2006 Consensus Statement on Management of Intersex Disorders called for a multidisciplinary approach to care and questioned the evidence for many of the standard procedures. Standard of care moved from a concealment model to a patient-centered paradigm, and funding agencies put resources into determining the future paths of research on DSD. Recognition of the need to address patient priorities led to changing international standards for including patients in research design. Some challenges that remain include: the findings from the Institute of Medicine that sexual and gender minorities experience poor health outcomes; establishing trust across all parties; developing a common language and creating venues where individuals can participate in dialogue that addresses personal experiences, research design, clinical practices and intervention strategies.

  4. Decreased Nocturnal Movements in Patients with Facioscapulohumeral Muscular Dystrophy

    PubMed Central

    Marca, Giacomo Della; Frusciante, Roberto; Dittoni, Serena; Vollono, Catello; Losurdo, Anna; Testani, Elisa; Scarano, Emanuele; Colicchio, Salvatore; Iannaccone, Elisabetta; Tonali, Pietro A.; Ricci, Enzo

    2010-01-01

    Study Objectives: Reduced mobility during sleep characterizes a variety of movement disorders and neuromuscular diseases. Facioscapulohumeral muscular dystrophy (FSHD) is the third most common form of muscular dystrophy in the general population, and people with FSHD have poor sleep quality. The aims of the present study were to evaluate nocturnal motor activity in patients with FSHD by means of videopolysomnography and to verify whether activity was associated with modifications in sleep structure. Methods: We enrolled 32 adult patients affected by genetically confirmed FSHD (18 women and 14 men, mean age 45.1 ± 13.4 years) and 32 matched control subjects, (18 women and 14 men, mean age 45.5 ± 11.4 years). Major body movements (MBM) were scored in videopolygraphic recordings in accordance with established criteria. An MBM index was calculated (number of MBM per hour of sleep). Results: The FSHD group showed a decrease in the MBM index (FSHD: 1.2 ± 1.1; control subjects: 2.3 ± 1.2, analysis of variance F = 13.672; p = 0.008). The sleep pattern of patients with FSHD, as compared with that of controls, was characterized by longer sleep latencies, shorter sleep durations, an increased percentage of wake during sleep, and a decreased percentage of rapid eye movement sleep. In the patient group, the MBM index was inversely correlated with severity of disease (Spearman test: r30 = −0.387; p < 0.05). Conclusions: The present findings suggest that patients with FSHD have a reduced number of nocturnal movements, which is related to disease severity. Reduced movement in bed may contribute to the sleep modifications observed in these patients. Citation: Marca GD; Frusciante R; Dittoni S; Vollono C; Losurdo A; Testani E; Scarano E; Colicchio S; Iannaccone E; Tonali PA; Ricci E. Decreased nocturnal movements in patients with facioscapulohumeral muscular dystrophy. J Clin Sleep Med 2010;6(3):276-280. PMID:20572422

  5. Two faces of patient advocacy: the current controversy in newborn screening.

    PubMed

    Arnold, Cosby G

    2014-08-01

    Newborn screening programmes began in the 1960s, have traditionally been conducted without parental permission and have grown dramatically in the last decade. Whether these programmes serve patients' best interests has recently become a point of controversy. Privacy advocates, concerned that newborn screening infringes upon individual liberties, are demanding fundamental changes to these programmes. These include parental permission and limiting the research on the blood samples obtained, an agenda at odds with the viewpoints of newborn screening advocates. This essay presents the history of newborn screening in the USA, with attention to factors that have contributed to concerns about these programmes. The essay suggests that the rapid increase in the number of disorders screened for and the addition of research without either public knowledge or informed consent were critical to the development of resistance to mandatory newborn screening and research. Future newborn screening initiatives should include public education and comment to ensure continued support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Citizen Advocacy Resources.

    ERIC Educational Resources Information Center

    Michael, Mary Ellen, Comp.; Rudy, Carolyn D., Ed.

    The document presents an annotated bibliography of literature, training materials, and other resources relevant to citizen advocacy for developmentally disabled persons, with special emphasis on materials produced in the last 5 years. The focus is on publications that can be useful to advocacy programs staffed largely by laypersons and volunteers;…

  7. Improving Music Education Advocacy

    ERIC Educational Resources Information Center

    Elpus, Kenneth

    2007-01-01

    Music education has always required advocacy to solidify its place in the school curriculum. Music teachers are increasingly called on to justify their existence and importance in the schools, and yet, are often unprepared to advocate on their own behalf without the use of advocacy materials that are created on the basis of questionable research,…

  8. Handbook for Rehabilitation Advocacy.

    ERIC Educational Resources Information Center

    National Rehabilitation Association, Alexandria, VA.

    This handbook is intended to help advocates for persons with disabilities organize for advocacy, build effective coalitions, frame key issues, package critical information, and use the media to advance the cause. Individual sections address the following topics: how to change public policy; myths about advocacy; what makes politicians tick;…

  9. The Importance of Quality Patient Advocacy to Biobanks: A Lay Perspective from Independent Cancer Patients Voice (ICPV), Based in the United Kingdom.

    PubMed

    Wilcox, Maggie; Grayson, Margaret; MacKenzie, Mairead; Stobart, Hilary; Bulbeck, Helen; Flavel, Robert

    2015-01-01

    Biobanking in the twentieth century will become of increasing importance in health research. Regulation and governance of biobanks must be open and transparent to ensure public trust and confidence and increase donation. Effective Lay Involvement all levels in biobank organisations should be standard practice helping ensure patient benefit remains the central aim and assisting the Promotion of Biobanks and Recruitment of Donors. Properly selected, educated and supported, they become valued members of the Biobank Team. This chapter is based on the work of Independent Cancer Patients' Voice (ICPV) in the UK and recognises that the National Health Service provides a framework which is not universal and neither is the model of patient advocacy which has been developed particularly in cancer research. However, although it has not been easy to find potential members for ICPV, nor to attract funding, we have earned the respect of our professional colleagues by our commitment in giving time and developing the skills necessary to provide effective involvement. These colleagues have enthusiastically mentored and supported us and have provided venues and tutoring for Educational Events. We are sure that patient advocates in other countries would welcome the opportunity for similar involvement and hope our experiences will be of interest.

  10. Sequential analysis of head movement during mandibular open-close movements in TMD patients with disc displacement with reduction.

    PubMed

    Kon, Haruka; Sakurai, Naoki; Tanaka, Mikako; Kobayashi, Hiroshi; Sato, Naoko; Makita, Saori; Yoshida, Rumi; Kai, Asako; Nomura, Shuichi

    2012-10-01

    This study examined relationships between starting points of head and mandibular movements in 11 female control subjects and 10 TMD patients showing disc displacement with reduction during consecutive open-close movements, using a six-degree-of-freedom measuring device. During the first mandibular opening cycle, in the TMD group, head movement was significantly preceded in relation to mandibular movement when compared with the control group, and major differences in onset were seen between maximum and minimal values at the beginning of mandibular movements. After the second cycle, significant differences in starting points were not evident. In TMD patients showing disc displacement with reduction, in the first cycle, at the commencement of opening movements, it is proposed that the head precedes the mandible in order to compensate for irregular condylar movements, and the degree of the condylar movement irregularity might affect the onset relation between the head and the mandible.

  11. Breast Cancer Survivor Advocacy at a University Hospital: Development of a Peer Support Program with Evaluation by Patients, Advocates, and Clinicians.

    PubMed

    Mirrielees, Jennifer A; Breckheimer, Kayla R; White, Teresa A; Denure, Deb A; Schroeder, Michelle M; Gaines, Martha E; Wilke, Lee G; Tevaarwerk, Amye J

    2017-03-01

    Peer-to-peer support programs provide unique psychosocial and educational support for breast cancer patients. A Patient Survivor Advocacy (PSA) program was developed by the University of Wisconsin Breast Center (UWBC) to provide support for newly diagnosed patients from peers who had completed primary treatment. In this study, we evaluated patient, advocate, and clinician experience with the PSA program. A program matching volunteer peer advocates at least 1 year removed from primary treatment with newly diagnosed patients was developed. Peer advocates were recruited from the practices of UWBC clinicians and received in-person training on six dimensions of peer advocacy. Trained advocates were then paired based on demographic and medical history with new patients referred to the program. Survey assessment tools were distributed to assess peer advocate and patient satisfaction, as well as clinician experience. Forty patients have been matched with seven advocates, with contact largely by email (53 %) or phone (36 %). Patients and peer advocates reported satisfaction with the program. The majority of patients (92.9 %) reported that the program was "helpful" and that they would recommend the PSA program to another woman with breast cancer. All peer advocates (100 %) responded with a sense of achievement in their advocate roles. Clinicians noted challenges in referral to the program. Peer advocates can provide key emotional and psychosocial support to newly diagnosed breast cancer patients. The peer advocate, patient, and clinician feedback collected in this study will inform the future development of this program at our and peer institutions.

  12. Movement.

    ERIC Educational Resources Information Center

    Roberts, Lynda S.

    This document summarizes 20 articles and books which stress the importance of movement in the overall development of the human species. Each summary ranges in length from 100 to 200 words and often includes direct quotations. A wide range of movement activities suitable for people of all ages (from infants to adults) are discussed. Many summaries…

  13. Missouri Advocacy for the Arts Advocacy Plan.

    ERIC Educational Resources Information Center

    Muszynski, Gary; Iman, Kyna

    1990-01-01

    Lists a time frame to assist in knowing which legislators to contact and when to contact them to advocate the arts. Offers four arguments in support of a state-level Fine Arts Supervisor. Advocates letters and phone calls as effective means of advocacy, and offers pointers on writing them. Contains a sample letter and telephone call. (PRA)

  14. Evaluation of Ocular Movements in Patients with Dyslexia

    ERIC Educational Resources Information Center

    Vagge, Aldo; Cavanna, Margherita; Traverso, Carlo Enrico; Iester, Michele

    2015-01-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological…

  15. Evaluation of Ocular Movements in Patients with Dyslexia

    ERIC Educational Resources Information Center

    Vagge, Aldo; Cavanna, Margherita; Traverso, Carlo Enrico; Iester, Michele

    2015-01-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological…

  16. Movement.

    ERIC Educational Resources Information Center

    Online-Offline, 1998

    1998-01-01

    Focuses on movement: movable art, relocating families, human rights, and trains and cars. Describes educational resources for elementary and middle school students, including Web sites, CD-ROMs and software, videotapes, books, additional resources and activities (PEN)

  17. Precision control of trunk movement in low back pain patients.

    PubMed

    Willigenburg, Nienke W; Kingma, Idsart; Hoozemans, Marco J M; van Dieën, Jaap H

    2013-02-01

    Motor control is challenged in tasks with high precision demands. In such tasks, signal-dependent neuromuscular noise causes errors and proprioceptive feedback is required for optimal performance. Pain may affect proprioception, muscle activation patterns and resulting kinematics. Therefore, we investigated precision control of trunk movement in 18 low back pain (LBP) patients and 13 healthy control subjects. The subjects performed a spiral-tracking task requiring precise trunk movements, in conditions with and without disturbance of proprioception by lumbar muscle vibration. Tracking task performance and trunk muscle electromyography were recorded. In conditions without lumbar muscle vibration, tracking errors were 27.1% larger in LBP patients compared to healthy controls. Vibration caused tracking errors to increase by 10.5% in healthy controls, but not in LBP patients. These results suggest that reduced precision in LBP patients might be explained by proprioceptive deficits. Ratios of antagonistic over agonistic muscle activation were similar between groups. Tracking errors increased trunk inclination, but no significant relation between tracking error and agonistic muscle activation was found. Tracking errors did not decrease when antagonistic muscle activation increased, so, neither healthy subjects nor LBP patients appear to counteract trunk movement errors by increasing co-contraction. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Patient advocacy and patient centredness in participant recruitment to randomized‐controlled trials: implications for informed consent

    PubMed Central

    Tomlin, Zelda; deSalis, Isabel; Toerien, Merran; Donovan, Jenny L.

    2012-01-01

    Abstract Context  With the routinization of evidence‐based medicine and of the randomized‐controlled trial (RCT), more patients are becoming ‘sites of evidence production’ yet, little is known about how they are recruited as participants; there is some evidence that ‘substantively valid consent’ is difficult to achieve. Objective  To explore the views and experiences of nurses recruiting patients to randomized‐controlled trials and to examine the extent to which their recruitment practices were patient‐centred and patient empowering. Design  Semi‐structured in‐depth interviews; audio recording of recruitment appointments; thematic interactional analysis (drawing on discourse and conversation analysis). Setting and participants  Nurses recruiting patients to five publicly funded RCTs and patients consenting to the recording of their recruitment sessions. Main outcome measures  The views of recruiting nurses about their recruitment role; the extent to which nurse–patient interactions were patient‐centred; the nature of the nurses’ interactional strategies and the nature and extent of patient participation in the discussion. Results  The nurses had a keen sense of themselves as clinicians and patient advocates and their perceptions of the trial and its interventions were inextricably linked to those of the patients. However, many of their recruitment practices made it difficult for patients to play an active and informed part in the discussion about trial participation, raising questions over the quality of consent decisions. Conclusion  Nurses working in patient recruitment to RCTs need to reconcile two different worlds with different demands and ethics. Evidence production, a central task in evidence‐based medicine, poses a challenge to patient‐centred practice and more research and relevant training are needed. PMID:22712887

  19. Diagnostic Agreement in Patients with Psychogenic Movement Disorders

    PubMed Central

    Morgante, Francesca; Edwards, Mark J.; Espay, Alberto J.; Fasano, Alfonso; Mir, Pablo; Martino, Davide

    2013-01-01

    Background The reliability and applicability of published diagnostic criteria for psychogenic movement disorders (PMDs) have never been examined. Methods Eight movement disorder and six general neurologists rated 14 patients diagnosed with PMD and 14 patients diagnosed with organic movement disorders. Raters provided a dichotomous judgment (i.e., psychogenic or organic) upon review of video-based movement phenomenology and a category of diagnostic certainty based on the Fahn-Williams and Shill-Gerber criteria after accessing standardized clinical information. We measured interobserver agreement on the diagnosis and clinical certainty judgment of PMD. Results In both groups of raters, agreements were “fair” on the video-based dichotomous judgment, but improved to “substantial” after access to standardized clinical information. “Slight” to “poor” agreement was reached for the “probable” and “possible” categories of diagnostic certainty corresponding to both diagnostic criteria. Conclusions Diagnosis according to clinical available criteria for PMD yields poor diagnostic agreement. PMID:22488862

  20. Will my job be safe if I defend my patients? When patient advocacy collides with employment law.

    PubMed

    Manthous, Constantine A; Moncrieff, Abigail R

    2013-10-01

    Physicians are moving increasingly from self-employed, private practices to at-will employment relationships. This historic change in the organizational administration of medical services is likely to accelerate as the Affordable Care Act is implemented and as accountable care organizations permeate the medical marketplace. Physicians vow an ascendant oath to safeguard patients' welfare, but as they become employees, they may sign legal contracts that also oblige obedience to the institutions that hire them. What happens when an employer makes a decision that is not in the best interests of patients and the physicians fulfill their Hippocratic obligation to voice dissent on their patients' behalf rather than abiding by their contractual obligation to obey their employer? This article explores the philosophical and legal ramifications of this potential collision of obligations to patients and to employers.

  1. Eye movements during visual search in patients with glaucoma

    PubMed Central

    2012-01-01

    Background Glaucoma has been shown to lead to disability in many daily tasks including visual search. This study aims to determine whether the saccadic eye movements of people with glaucoma differ from those of people with normal vision, and to investigate the association between eye movements and impaired visual search. Methods Forty patients (mean age: 67 [SD: 9] years) with a range of glaucomatous visual field (VF) defects in both eyes (mean best eye mean deviation [MD]: –5.9 (SD: 5.4) dB) and 40 age-related people with normal vision (mean age: 66 [SD: 10] years) were timed as they searched for a series of target objects in computer displayed photographs of real world scenes. Eye movements were simultaneously recorded using an eye tracker. Average number of saccades per second, average saccade amplitude and average search duration across trials were recorded. These response variables were compared with measurements of VF and contrast sensitivity. Results The average rate of saccades made by the patient group was significantly smaller than the number made by controls during the visual search task (P = 0.02; mean reduction of 5.6% (95% CI: 0.1 to 10.4%). There was no difference in average saccade amplitude between the patients and the controls (P = 0.09). Average number of saccades was weakly correlated with aspects of visual function, with patients with worse contrast sensitivity (PR logCS; Spearman’s rho: 0.42; P = 0.006) and more severe VF defects (best eye MD; Spearman’s rho: 0.34; P = 0.037) tending to make less eye movements during the task. Average detection time in the search task was associated with the average rate of saccades in the patient group (Spearman’s rho = −0.65; P < 0.001) but this was not apparent in the controls. Conclusions The average rate of saccades made during visual search by this group of patients was fewer than those made by people with normal vision of a similar average age. There was wide

  2. Eye movements of patients with schizophrenia in a natural environment.

    PubMed

    Dowiasch, Stefan; Backasch, Bianca; Einhäuser, Wolfgang; Leube, Dirk; Kircher, Tilo; Bremmer, Frank

    2016-02-01

    Alterations of eye movements in schizophrenia patients have been widely described for laboratory settings. For example, gain during smooth tracking is reduced, and fixation patterns differ between patients and healthy controls. The question remains, whether such results are related to the specifics of the experimental environment, or whether they transfer to natural settings. Twenty ICD-10 diagnosed schizophrenia patients and 20 healthy age-matched controls participated in the study, each performing four different oculomotor tasks corresponding to natural everyday behavior in an indoor environment: (I) fixating stationary targets, (II) sitting in a hallway with free gaze, (III) walking down the hallway, and (IV) visually tracking a target on the floor while walking straight-ahead. In all conditions, eye movements were continuously recorded binocularly by a mobile lightweight eye tracker (EyeSeeCam). When patients looked at predefined targets, they showed more fixations with reduced durations than controls. The opposite was true when participants were sitting in a hallway with free gaze. During visual tracking, patients showed a significantly greater root-mean-square error (representing the mean deviation from optimal) of retinal target velocity. Different from previous results on smooth-pursuit eye movements obtained in laboratory settings, no such difference was found for velocity gain. Taken together, we have identified significant differences in fundamental oculomotor parameters between schizophrenia patients and healthy controls during natural behavior in a real environment. Moreover, our data provide evidence that in natural settings, patients overcome some impairments, which might be present only in laboratory studies, by as of now unknown compensatory mechanisms or strategies.

  3. Autonomy and advocacy in perinatal nursing practice.

    PubMed

    Simmonds, Anne H

    2008-05-01

    Advocacy has been positioned as an ideal within the practice of nursing, with national guidelines and professional standards obliging nurses to respect patients' autonomous choices and to act as their advocates. However, the meaning of advocacy and autonomy is not well defined or understood, leading to uncertainty regarding what is required, expected and feasible for nurses in clinical practice. In this article, a feminist ethics perspective is used to examine how moral responsibilities are enacted in the perinatal nurse-patient relationship and to explore the interaction between the various threads that influence, and are in turn affected by, this relationship. This perspective allows for consideration of contextual and relational factors that impact on the way perinatal nursing care is given and received, and provides a framework for exploring the ways in which patient autonomy, advocacy and choice are experienced by childbearing women and their nurses during labour and birth.

  4. Paralyzed Patients Regain Voluntary Movement | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Feature: Spinal Cord Stimulation Paralyzed Patients Regain Voluntary Movement Past Issues / Summer 2014 Table of Contents Kent ... training, could help patients with paralysis regain some movement. In the pilot, Rob Summers, a young man ...

  5. How a patient advocacy group developed the first proposed draft guidance document for industry for submission to the U.S. Food and Drug Administration.

    PubMed

    Furlong, Pat; Bridges, John F P; Charnas, Lawrence; Fallon, Justin R; Fischer, Ryan; Flanigan, Kevin M; Franson, Timothy R; Gulati, Neera; McDonald, Craig; Peay, Holly; Sweeney, H Lee

    2015-06-24

    Among the challenges confronting patients with rare diseases is a dearth of treatment options. The development of safe and effective new therapies is hampered by challenges associated with conducting clinical trials in small populations. In this article, we describe how the Duchenne muscular dystrophy community-led by Parent Project Muscular Dystrophy-created a proposed draft guidance document for industry for submission to the U.S. Food and Drug Administration. This unprecedented undertaking involved a broad coalition of more than 80 stakeholders collaborating across nine time zones to produce a document in only 6 months. We hope that other rare disease communities and advocacy organizations can use our experience as a model for developing their own draft guidance documents.

  6. Political advocacy in pharmacy: challenges and opportunities

    PubMed Central

    Apollonio, Dorie E

    2015-01-01

    Many pharmacists have expressed a desire to become more involved in patient care, in part by being compensated for patient counseling, as well as by providing services traditionally offered by physicians and nurse practitioners. Recent efforts to develop collaborative care models, as well as major restructurings of US health insurance coverage, provide a unique opportunity for pharmacists to become recognized as independent health care providers and be reimbursed as primary care providers. Achieving that goal would require addressing advocacy challenges familiar to other health care professionals who have achieved provider status under existing reimbursement rules. Historically, political advocacy has not been a major part of pharmacy practice, or even viewed as necessary. However, pharmacists would be more politically effective with a single organization to speak for them as a profession, and with further education in advocacy. PMID:26301185

  7. Social Justice Advocacy: Community Collaboration and Systems Advocacy

    ERIC Educational Resources Information Center

    Lopez-Baez, Sandra I.; Paylo, Matthew J.

    2009-01-01

    This article discusses the community collaboration and systems advocacy domains of the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). A case illustration is presented, and the 8 Advocacy Competencies within each domain are applied to the case study.

  8. Social Justice Advocacy: Community Collaboration and Systems Advocacy

    ERIC Educational Resources Information Center

    Lopez-Baez, Sandra I.; Paylo, Matthew J.

    2009-01-01

    This article discusses the community collaboration and systems advocacy domains of the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). A case illustration is presented, and the 8 Advocacy Competencies within each domain are applied to the case study.

  9. Is the movement-evoked potential mandatory for movement execution? A high-resolution EEG study in a deafferented patient.

    PubMed

    Kristeva, Rumyana; Chakarov, Vihren; Wagner, Michael; Schulte-Mönting, Jürgen; Hepp-Reymond, M-C

    2006-06-01

    During simple self-paced index finger flexion with and without visual feedback of the finger, we compared the movement-evoked potentials of the completely deafferented patient GL with those of 7 age-matched healthy subjects. EEG was recorded from 58 scalp positions, together with the electromyogram (EMG) from the first dorsal interosseous muscle and the movement trace. We analyzed the movement parameters and the contralateral movement-evoked potential and its source. The patient performed the voluntary movements almost as well as the controls in spite of her lack of sensory information from the periphery. In contrast, the movement-evoked potential was observed only in the controls and not in the patient. These findings clearly demonstrate that the movement-evoked potential reflects cutaneous and proprioceptive feedback from the moving part of the body. They also indicate that in absence of sensory peripheral input the motor control switches from an internal "sensory feedback-driven" to a "feedforward" mode. The role of the sensory feedback in updating the internal models and of the movement-evoked potential as a possible cortical correlate of motor awareness is discussed.

  10. Effectiveness of narrative pedagogy in developing student nurses' advocacy role.

    PubMed

    Gazarian, Priscilla K; Fernberg, Lauren M; Sheehan, Kelly D

    2016-03-01

    The literature and research on nursing ethics and advocacy has shown that generally very few nurses and other clinicians will speak up about an issue they have witnessed regarding a patient advocacy concern and that often advocacy in nursing is not learned until after students have graduated and begun working. To evaluate the effectiveness of narrative pedagogy on the development of advocacy in student nurses, as measured by the Protective Nursing Advocacy Scale. We tested the hypothesis that use of a narrative pedagogy assignment related to ethics would improve student nurse's perception of their advocacy role as measured by the Protective Nursing Advocacy Scale using a quasi-experimental nonrandomized study using a pre-test, intervention, post-test design. Data collection occurred during class time from October 2012 to December 2012. The Protective Nursing Advocacy Scale tool was administered to students in class to assess their baseline and was administered again at the completion of the educational intervention to assess whether narrative pedagogy was effective in developing the nursing student's perception of their role as a patient advocate. Students were informed that their participation was voluntary and that the data collected would be anonymous and confidential. The survey was not a graded assignment, and students did not receive any incentive to participate. The institutional review board of the college determined the study to be exempt from review. School of Nursing at a small liberal arts college in the Northeastern United States. A consecutive, nonprobability sample of 44 senior-level nursing students enrolled in their final nursing semester was utilized. Results indicated significant differences in student nurse's perception of their advocacy role related to environment and educational influences following an education intervention using an ethics digital story. Using the Protective Nursing Advocacy Scale, we were able to measure the effectiveness of

  11. Going "social" to access experimental and potentially life-saving treatment: an assessment of the policy and online patient advocacy environment for expanded access.

    PubMed

    Mackey, Tim K; Schoenfeld, Virginia J

    2016-02-02

    Social media is fundamentally altering how we access health information and make decisions about medical treatment, including for terminally ill patients. This specifically includes the growing phenomenon of patients who use online petitions and social media campaigns in an attempt to gain access to experimental drugs through expanded access pathways. Importantly, controversy surrounding expanded access and "compassionate use" involves several disparate stakeholders, including patients, manufacturers, policymakers, and regulatory agencies-all with competing interests and priorities, leading to confusion, frustration, and ultimately advocacy. In order to explore this issue in detail, this correspondence article first conducts a literature review to describe how the expanded access policy and regulatory environment in the United States has evolved over time and how it currently impacts access to experimental drugs. We then conducted structured web searches to identify patient use of online petitions and social media campaigns aimed at compelling access to experimental drugs. This was carried out in order to characterize the types of communication strategies utilized, the diseases and drugs subject to expanded access petitions, and the prevalent themes associated with this form of "digital" patient advocacy. We find that patients and their families experience mixed results, but still gravitate towards the use of online campaigns out of desperation, lack of reliable information about treatment access options, and in direct response to limitations of the current fragmented structure of expanded access regulation and policy currently in place. In response, we discuss potential policy reforms to improve expanded access processes, including advocating greater transparency for expanded access programs, exploring use of targeted economic incentives for manufacturers, and developing systems to facilitate patient information about existing treatment options. This includes

  12. Research Frontiers of Corporate Advocacy.

    ERIC Educational Resources Information Center

    Judd, Larry R.

    Corporate advocacy is the study and practice of communication efforts to advance the policies of business, education, governmental, and nonprofit institutions. The functions of the advocate include gathering information, providing advice based on the information, conducting advocacy programing, and evaluating results. Advocacy research is…

  13. Interagency Cooperation through Organizational Advocacy.

    ERIC Educational Resources Information Center

    And Others; Tesolowski, Dennis G.

    1980-01-01

    Outlines the need for interagency cooperation in the vocational development of the handicapped and disadvantaged and develops a futuristic model to be implemented. Discusses advocacy and its role in professional associations, potential barriers to organizational advocacy, and the role of professional associations in organizational advocacy. (CT)

  14. Evaluation of ocular movements in patients with dyslexia.

    PubMed

    Vagge, Aldo; Cavanna, Margherita; Traverso, Carlo Enrico; Iester, Michele

    2015-04-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological examinations, and eye movement analysis, specifically, stability analysis on fixating a still target, tracking saccades, analysis of fixation pauses, speed reading, saccades, and regressions through the reading of a text. Stability analysis on fixating a still target showed a significant (p < 0.001) difference between the two groups showing an increased amount of loss of fixation among dyslexic subjects (5.36 ± 2.5 s and 0.82 ± 2.1, respectively). Tracking saccades (left and right horizontal axis) did not show a significant difference. When reading parameters were looked into (number of saccades, number of regressions, reading time through the reading of a text), a significant (p < 0.001) difference was found between the groups. This study supports the belief that the alteration of eye movement does not depend on oculo-motor dysfunction but is secondary to a defect in the visual processing of linguistic material. Inclusion of assessment of this defect might prove beneficial in determining the presence of dyslexia in young children at a younger age, and an earlier intervention could be initiated.

  15. Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients.

    PubMed

    Arzi, Harel; Krasovsky, Tal; Pritsch, Moshe; Liebermann, Dario G

    2014-07-01

    Open surgery to correct shoulder instability is deemed to facilitate recovery of static and dynamic motor functions. Postoperative assessments focus primarily on static outcomes (e.g., repositioning accuracy). We introduce kinematic measures of arm smoothness to assess shoulder patients after open surgery and compare them with nonoperated patients. Performance among both groups of patients was hypothesized to differ. Postsurgery patients were expected to match healthy controls. All participants performed pointing movements with the affected/dominant arm fully extended at fast, preferred, and slow speeds (36 trials per subject). Kinematic data were collected (100 Hz, 3 seconds), and mixed-design analyses of variance (group, speed) were performed with movement time, movement amplitude, acceleration time, and model-observed similarities as dependent variables. Nonparametric tests were performed for number of velocity peaks. Nonoperated and postsurgery patients showed similarities at preferred and faster movement speeds but not at slower speed. Postsurgery patients were closer to maximally smoothed motion and differed from healthy controls mainly during slow arm movements (closer to maximal smoothness, larger movement amplitude, shorter movement time, and lower number of peaks; i.e., less movement fragmentation). Arm kinematic analyses suggest that open surgery stabilizes the shoulder but does not necessarily restore normal movement quality. Patients with recurrent anterior shoulder instability (RASI) seem to implement a "safe" but nonadaptive mode of action whereby preplanned stereotypical movements may be executed without depending on feedback. Rehabilitation of RASI patients should focus on restoring feedback-based movement control. Clinical assessment of RASI patients should include higher order kinematic descriptors. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  16. Abnormal brain activation during movement observation in patients with conversion paralysis.

    PubMed

    Burgmer, Markus; Konrad, Carsten; Jansen, Andreas; Kugel, Harald; Sommer, Jens; Heindel, Walter; Ringelstein, Erich B; Heuft, Gereon; Knecht, Stefan

    2006-02-15

    Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.

  17. Advocacy by School Administrators.

    ERIC Educational Resources Information Center

    Macchiarola, Frank J.

    1984-01-01

    Describes the cornerstones of Ron Edmonds's advocacy on behalf of school children: commitment to equality, a belief in the educability of all, and the schools' responsibility for actively promoting equality and educability. Sees a continuing need for greater system-wide responsibility and for the development of output measures of school…

  18. Public health and media advocacy.

    PubMed

    Dorfman, Lori; Krasnow, Ingrid Daffner

    2014-01-01

    Media advocacy blends communications, science, politics, and advocacy to advance public health goals. In this article, we explain how media advocacy supports the social justice grounding of public health while addressing public health's "wicked problems" in the context of American politics. We outline media advocacy's theoretical foundations in agenda setting and framing and describe its practical application, from the layers of strategy to storytelling, which can illuminate public health solutions for journalists, policy makers, and the general public. Finally, we describe the challenges in evaluating media advocacy campaigns.

  19. Advocacy communication, vaccines and the role of scientific societies.

    PubMed

    Signorelli, C; Odone, A

    2015-01-01

    In 1986 the Ottawa Charter underlined the importance of advocacy in health. This article analyzes the role of advocacy in Public Health making the case of immunization, whose coverage rates are decreasing in many countries. An effective advocacy action could counteract the growing phenomenon of the vaccine hesitancy within both the general population and an increasing share of healthcare providers as well as contrast antivax movements' action. We identify who are the advocates focusing on Italy and on the crucial role of scientific societies which share the responsibility of making the latest scientific evidence and most effective infectious diseases' control strategies available to health policy makers. The Italian Society of Hygiene (SItI) has been actively engaged for several years in a number of initiatives of advocacy communication and vaccines including research, training, media exposure and a dedicated website portal (vaccinarSì).

  20. Smooth pursuit eye movements in patients with macular degeneration

    PubMed Central

    Shanidze, Natela; Fusco, Giovanni; Potapchuk, Elena; Heinen, Stephen; Verghese, Preeti

    2016-01-01

    Currently, there are no quantitative studies of smooth pursuit, a behavior attributed to the fovea, in individuals with macular degeneration (MD). We hypothesize that pursuit in MD patients depends on the relative positions of the scotoma and target trajectory. We tested this hypothesis with a scanning laser ophthalmoscope (SLO), which allows for direct visualization of the target on the damaged retina. Monocular microperimetry and eye movements were assessed in eleven individuals with differing degrees of MD. Observers were asked to visually track a 1.7° target that moved in one of eight radial directions at 5°/s–6°/s. Consistent with our hypothesis, pursuit metrics depended on whether the target moved into or out of scotoma. Pursuit gains decreased with increasing scotoma extent in the target's heading direction (p = 0.017). Latencies were higher when the scotoma was present along the target trajectory (in either starting or heading directions, p < 0.001). Furthermore, an analysis of retinal position shows that targets fell on the fixational locus nearly 50% of the time. The results suggest that MD patients are capable of smooth pursuit eye movements, but are limited by target trajectory and scotoma characteristics. PMID:26830707

  1. Speech and voice disorders in patients with psychogenic movement disorders.

    PubMed

    Baizabal-Carvallo, José Fidel; Jankovic, Joseph

    2015-11-01

    Psychogenic speech and voice disorders (PSVDs) may occur in isolation but more typically are encountered in the setting of other psychogenic disorders. We aimed to characterize the phenomenology, frequency, and correlates of PSVDs in a cohort of patients with psychogenic movement disorders (PMDs). We studied 182 consecutive patients with PMDs, 30 of whom (16.5 %) also exhibited PSVD. Stuttering was the most common speech abnormality (n = 16, 53.3 %), followed by speech arrests (n = 4, 13.3 %), foreign accent syndrome (n = 2, 6.6 %), hypophonia (n = 2, 6.6 %), and dysphonia (n = 2, 6.6 %). Four patients (13.2 %) had more complex presentations with different combinations of these patterns. No differences in gender, age at onset, and distribution of PMDs were observed between patients with and without PSVD. PSVDs are relatively frequent in patients with PMDs and are manifested by a wide variety of abnormal speech and voice phenomena, with stuttering being the most common presentation. Speech therapy and insight-oriented counseling may be helpful to some patients.

  2. Recent data on rapid eye movement sleep behavior disorder in patients with Parkinson disease: analysis of behaviors, movements, and periodic limb movements.

    PubMed

    Cochen De Cock, Valérie

    2013-08-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a fascinating parasomnia in which patients are able to enact their dreams because of a lack of muscle atonia during REM sleep. RBD represents a unique window into the dream world. Frequently associated with Parkinson's disease (PD), RBD raises various issues about dream modifications in this pathology and about aggressiveness during RBD episodes in placid patients during wakefulness. Studies on these behaviors have underlined their non-stereotyped, action-filled and violent characteristics but also their isomorphism with dream content. Complex, learnt behaviors may reflect the cortical involvement in this parasomnia but the more frequent elementary movements and the associated periodic limb movements during sleep also implicate the brainstem. Surprisingly, patients with PD have an improvement of their movements during their RBD as if they were disease-free. Also not yet understood, this improvement of movement during REM sleep raises issues about the pathways involved in RBD and about the possibility of using this pathway to improve movement in PD during the day. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. Do periodic leg movements influence patients' perception of sleep quality?

    PubMed

    Hornyak, Magdolna; Riemann, Dieter; Voderholzer, Ulrich

    2004-11-01

    Periodic leg movements in sleep (PLMS) are a common finding in various sleep disorders. Whether PLMS are an epiphenomenon or are causally related to the presence of sleep-wake disturbances is still being debated. We investigated the relationship of the occurrence of PLMS to patients' perception of sleep quality during a night of polysomnography in various sleep disorders. The retrospective evaluation included PLMS recordings over two nights of 78 consecutive patients diagnosed with a restless legs syndrome, primary insomnia or insomnia associated with a psychiatric disorder. The subjects' perception of sleep during the polysomnography night was assessed by the subscale 'sleep quality' of the validated self-rating sleep questionnaire SFA (SFA-SQ). SFA-SQ scores correlated with the PLMS index (number of PLMS per hour of sleep) only in patients with restless legs syndrome during the first of the two nights investigated (r=-0.464, P<0.01). PLMS appear to have a low impact on the subjects' perception of sleep quality. The correlation of subjective sleep quality to PLMS index in the first of the two investigated nights in RLS patients may reflect an adaptation effect. The results of our study favor the hypothesis that PLMS most likely are not the primary cause of sleep disturbances in these patient groups.

  4. Assessment of Fundamental Movement Skills in Childhood Cancer Patients.

    PubMed

    Naumann, Fiona L; Hunt, Mitchell; Hunt, Mitchel; Ali, Dulfikar; Wakefield, Claire E; Moultrie, Kevin; Cohn, Richard J

    2015-12-01

    The improved treatment protocols and subsequent improved survival rates among childhood cancer patients have shifted the focus toward the long-term consequences arising from cancer treatment. Children who have completed cancer treatment are at a greater risk of delayed development, diminished functioning, disability, compromised fundamental movement skill (FMS) attainment, and long-term chronic health conditions. The aim of the study was to compare FMS of childhood cancer patients with an aged matched healthy reference group. Pediatric cancer patients aged 5-8 years (n = 26; median age 6.91 years), who completed cancer treatment (<5 years) at the Sydney Children's Hospital, were assessed performing seven key FMS: sprint, side gallop, vertical jump, catch, over-arm throw, kick, and leap. Results were compared to the reference group (n = 430; 6.56 years). Childhood cancer patients scored significantly lower on three out of seven FMS tests when compared to the reference group. These results equated to a significantly lower overall score for FMS. This study highlighted the significant deficits in FMS within pediatric patients having completed cancer treatment. In order to reduce the occurrence of significant FMS deficits in this population, FMS interventions may be warranted to assist in recovery from childhood cancer, prevent late effects, and improve the quality of life in survivors of childhood cancer. © 2015 Wiley Periodicals, Inc.

  5. Effects of object size on unimanual and bimanual movements in patients with schizophrenia.

    PubMed

    Wang, Shu-Mei; Kuo, Li-Chieh; Ouyang, Wen-Chen; Hsu, Hsiao-Man; Lin, Keh-Chung; Ma, Hui-Ing

    2014-01-01

    Schizophrenia affects not only mental function but also movement. We compared the movement of patients with mild schizophrenia and healthy control participants during a bimanual assembly task and examined whether changes in object size affected unimanual and bimanual movements. Fifteen patients with schizophrenia and 15 age- and gender-matched control participants were instructed to bimanually reach for and assemble objects. We manipulated the object size for the left hand (large vs. small) and measured movement time, peak velocity, and bimanual synchronization to represent movement speed, forcefulness, and bimanual coordination. Patients with schizophrenia showed slower and less forceful unimanual movements and less coordinated bimanual movements than control participants. Increasing the object size elicited faster and more forceful unimanual movements and more coordinated bimanual movements in patients. The results suggest the need for movement rehabilitation in patients with schizophrenia and the possibility of manipulating object size to optimize patients' movements. These results benefit the practice of evidence-based therapy. Copyright © 2014 by the American Occupational Therapy Association, Inc.

  6. Information Politics, Transnational Advocacy, and Education for All

    ERIC Educational Resources Information Center

    Magrath, Bronwen

    2015-01-01

    This article explores transnational activism within Education for All (EFA), looking specifically at the strategic use of information and research by transnational advocacy organizations. Through a comparative case-study examination of two prominent civil society organizations within the EFA movement--the Asia South Pacific Association for Basic…

  7. Information Politics, Transnational Advocacy, and Education for All

    ERIC Educational Resources Information Center

    Magrath, Bronwen

    2015-01-01

    This article explores transnational activism within Education for All (EFA), looking specifically at the strategic use of information and research by transnational advocacy organizations. Through a comparative case-study examination of two prominent civil society organizations within the EFA movement--the Asia South Pacific Association for Basic…

  8. Minority women and advocacy for women's health.

    PubMed

    Kumanyika, S K; Morssink, C B; Nestle, M

    2001-09-01

    US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered.

  9. From Individuals to International Policy: Achievements and Ongoing Needs in Diabetes Advocacy

    PubMed Central

    Oser, Sean M.; Close, Kelly L.; Liu, Nancy F.; Hood, Korey K.; Anderson, Barbara J.

    2015-01-01

    Diabetes impacts tens of millions of people in the United States of America and 9 % of the worldwide population. Given the public health implications and economic burden of diabetes, the needs of people with diabetes must be addressed through strategic and effective advocacy efforts. Diabetes advocacy aims to increase public awareness about diabetes, raise funds for research and care, influence policy impacting people with diabetes, and promote optimal individual outcomes. We present a framework for diabetes advocacy activities by individuals and at the community, national, and international levels and identify challenges and gaps in current diabetes advocacy. Various groups have organized successful diabetes advocacy campaigns toward these goals, and lessons for further advancing diabetes advocacy can be learned from other health-related populations. Finally, we discuss the role of healthcare providers and mental/behavioral health professionals in advocacy efforts that can benefit their patients and the broader population of people with diabetes. PMID:26194156

  10. Ictal SPECT in patients with rapid eye movement sleep behaviour disorder.

    PubMed

    Mayer, Geert; Bitterlich, Marion; Kuwert, Torsten; Ritt, Philipp; Stefan, Hermann

    2015-05-01

    Rapid eye movement sleep behaviour disorder is a rapid eye movement parasomnia clinically characterized by acting out dreams due to disinhibition of muscle tone in rapid eye movement sleep. Up to 80-90% of the patients with rapid eye movement sleep behaviour disorder develop neurodegenerative disorders within 10-15 years after symptom onset. The disorder is reported in 45-60% of all narcoleptic patients. Whether rapid eye movement sleep behaviour disorder is also a predictor for neurodegeneration in narcolepsy is not known. Although the pathophysiology causing the disinhibition of muscle tone in rapid eye movement sleep behaviour disorder has been studied extensively in animals, little is known about the mechanisms in humans. Most of the human data are from imaging or post-mortem studies. Recent studies show altered functional connectivity between substantia nigra and striatum in patients with rapid eye movement sleep behaviour disorder. We were interested to study which regions are activated in rapid eye movement sleep behaviour disorder during actual episodes by performing ictal single photon emission tomography. We studied one patient with idiopathic rapid eye movement sleep behaviour disorder, one with Parkinson's disease and rapid eye movement sleep behaviour disorder, and two patients with narcolepsy and rapid eye movement sleep behaviour disorder. All patients underwent extended video polysomnography. The tracer was injected after at least 10 s of consecutive rapid eye movement sleep and 10 s of disinhibited muscle tone accompanied by movements registered by an experienced sleep technician. Ictal single photon emission tomography displayed the same activation in the bilateral premotor areas, the interhemispheric cleft, the periaqueductal area, the dorsal and ventral pons and the anterior lobe of the cerebellum in all patients. Our study shows that in patients with Parkinson's disease and rapid eye movement sleep behaviour disorder-in contrast to wakefulness

  11. Finger movement improves ankle control for gait initiation in patients with Parkinson's disease.

    PubMed

    Hiraoka, K; Kamata, N; Iwata, A; Minamida, F; Abe, K

    2008-01-01

    The purpose of this study was to investigate the effect of finger movement on ankle control for gait initiation in patients with Parkinson's disease (PD patients). The subjects were 13 PD patients and 6 age-matched healthy adults. The subjects moved fingers before or after gait initiation, or initiated gait without finger movement. Ankle joint movement in the stance leg was recorded to estimate the duration of ankle dorsiflexion (DIF duration), which reflects the degree of disturbance in ankle control for gait initiation in PD patients. In the PD patients with prolonged D/F duration, finger movement that preceded gait initiation shortened the D/F duration, but in the PD patients without prolonged D/F duration and in healthy subjects, the effect was not found. Accordingly, finger movement that precedes gait initiation improves ankle control for gait initiation in PD patients who suffer disturbance in ankle control for gait initiation.

  12. Media Advocacy. Technical Assistance Packet.

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

    Media advocacy is an environmental strategy that can be used to support alcohol and other drug prevention and policy development efforts. It helps shift the focus from understanding public health issues as individual problems to understanding them as social conditions that require collective behavior changes. Successful media advocacy uses the…

  13. Dental cone beam CT image quality possibly reduced by patient movement.

    PubMed

    Donaldson, K; O'Connor, S; Heath, N

    2013-01-01

    Patient artefacts in dental cone beam CT scans can happen for various reasons. These range from artefacts from metal restorations to movement. An audit was carried out in the Glasgow Dental Hospital analysing how many scans showed signs of "motion artefact", and then to assess if there was any correlation between patient age and movement artefacts. Specific age demographics were then analysed to see if these cohorts were at a higher risk of "movement artefacts".

  14. "People power" or "pester power"? YouTube as a forum for the generation of evidence and patient advocacy.

    PubMed

    Mazanderani, Fadhila; O'Neill, Braden; Powell, John

    2013-12-01

    Venoplasty has been proposed, alongside the theory of chronic cerebrospinal venous insufficiency (CCSVI), as a treatment for multiple sclerosis (MS). Despite concerns about its efficacy and safety, thousands of patients have undergone the procedure. This paper analyses YouTube videos where patients have shared their treatment experiences. Content analysis on the 100 most viewed videos from over 4000 identified in a search for 'CCSVI', and qualitative thematic analysis on popular 'channels' demonstrating patients' experiences. Videos adopt an overwhelmingly positive stance towards CCSVI; many were uploaded by patients and present pre- and/or post-treatment experiences. Patients demonstrate rather than merely describe their symptoms, performing tests on themselves before and after treatment to quantify improvement. Videos combine medical terminology and tests with personal experiences of living with MS. Social media technologies provide patients with novel opportunities for advocating for particular treatments; generating alternative forms of 'evidence' built on a hybrid of personal experience and medical knowledge. Healthcare practitioners need to engage with new digital forms of content, including online social media. Instead of disregarding sources not considered 'evidence-based', practitioners should enhance their understanding of what 'experiential-evidence' is deemed significant to patients, particularly in contested areas of healthcare. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Pedunculopontine nucleus microelectrode recordings in movement disorder patients.

    PubMed

    Weinberger, Moran; Hamani, Clement; Hutchison, William D; Moro, Elena; Lozano, Andres M; Dostrovsky, Jonathan O

    2008-06-01

    The pedunculopontine nucleus (PPN) lies within the brainstem reticular formation and is involved in the motor control of gait and posture. Interest has focused recently on the PPN as a target for implantation of chronic deep brain stimulation (DBS) electrodes for Parkinson's disease (PD) and progressive supranuclear palsy (PSP) therapy. The aim of this study was to examine the neurophysiology of the human PPN region and to identify neurophysiological landmarks that may aid the proper placement of DBS electrodes in the nucleus for the treatment of PD and PSP. Neuronal firing and local field potentials were recorded simultaneously from two independently driven microelectrodes during stereotactic neurosurgery for implantation of a unilateral DBS electrode in the PPN in five PD patients and two PSP patients. Within the PPN region, the majority (57%) of the neurons fired randomly while about 21% of the neurons exhibited 'bursty' firing. In addition, 21% of the neurons had a long action potential duration and significantly lower firing rate suggesting they were cholinergic neurons. A change in firing rate produced by passive and/or active contralateral limb movement was observed in 38% of the neurons that were tested in the PPN region. Interestingly, oscillatory local field potential activity in the beta frequency range ( approximately 25 Hz) was also observed in the PPN region. These electrophysiological characteristics of the PPN region provide further support for the proposed role of this region in motor control. It remains to be seen to what extent the physiological characteristics of the neurons and the stimulation-evoked effects will permit reliable identification of PPN and determination of the optimal target for DBS therapy.

  16. Stuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the patient advocacy reporting system.

    PubMed

    Hultman, C Scott; Gwyther, Robert; Saou, Michael A; Pichert, James W; Catron, Thomas F; Cooper, William O; Hickson, Gerald B

    2015-06-01

    Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased risk of malpractice claims, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by trained counselors in patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry. We examined the patient complaint profiles and risk scores of 31,077 physicians (3935 surgeons, 338 plastic and reconstructive surgeons, and 519 dermatologists), who participated in the Patient Advocacy Reporting System, a national registry of UPCs. Patient complaint data were collected from 70 community and academic hospitals across 29 states, from 2009 to 2012. In addition to determining the specific complaint mix for plastic surgery compared to all physicians, each physician was assigned a patient complaint risk score, based on a proprietary weighted-sum algorithm, with a score higher than 70, indicative of high risk for malpractice claims. Patient complaint profiles and risk scores were compared between all groups, using Wilcoxon rank and χ analysis. P values less than 0.05 were assigned statistical significance. Over this 4-year period, the majority of plastic surgeons (50.8%) did not generate any patient complaints, but those who did received an average of 9.8 complaints from 4.8 patients. The percentage of physicians at high risk for malpractice claims, based upon the Patient Advocacy Reporting System index score of patient complaints, was as follows: all physicians, 2.0%; all surgeons, 4.1%; plastic and reconstructive surgeons, 2.4%; dermatologists, 1.4%. Physicians (from 2012 only) who were identified by their sponsoring institutions as "reconstructive" plastic surgeons (n = 41) were 5 times as likely to have a high risk score, compared to physicians who were identified as "plastic" surgeons

  17. Rapid eye movement sleep behaviour disorder in patients with narcolepsy is associated with hypocretin-1 deficiency.

    PubMed

    Knudsen, Stine; Gammeltoft, Steen; Jennum, Poul J

    2010-02-01

    Rapid eye movement sleep behaviour disorder is characterized by dream-enacting behaviour and impaired motor inhibition during rapid eye movement sleep. Rapid eye movement sleep behaviour disorder is commonly associated with neurodegenerative disorders, but also reported in narcolepsy with cataplexy. Most narcolepsy with cataplexy patients lack the sleep-wake, and rapid eye movement sleep, motor-regulating hypocretin neurons in the lateral hypothalamus. In contrast, rapid eye movement sleep behaviour disorder and hypocretin deficiency are rare in narcolepsy without cataplexy. We hypothesized that rapid eye movement sleep behaviour disorder coexists with cataplexy in narcolepsy due to hypocretin deficiency. In our study, rapid eye movement sleep behaviour disorder was diagnosed by the International Classification of Sleep Disorders (2nd edition) criteria in 63 narcolepsy patients with or without cataplexy. Main outcome measures were: rapid eye movement sleep behaviour disorder symptoms; short and long muscle activations per hour rapid eye movement and non-rapid eye movement sleep; and periodic and non-periodic limb movements per hour rapid eye movement and non-rapid eye movement sleep. Outcome variables were analysed in relation to cataplexy and hypocretin deficiency with uni- and multivariate logistic/linear regression models, controlling for possible rapid eye movement sleep behaviour disorder biasing factors (age, gender, disease duration, previous anti-cataplexy medication). Only hypocretin deficiency independently predicted rapid eye movement sleep behaviour disorder symptoms (relative risk = 3.69, P = 0.03), long muscle activations per hour rapid eye movement sleep (ln-coefficient = 0.81, P < 0.01), and short muscle activations per hour rapid eye movement sleep (ln-coefficient = 1.01, P < 0.01). Likewise, periodic limb movements per hour rapid eye movement and non-rapid eye movement sleep were only associated with hypocretin deficiency (P < 0.01). A significant

  18. Advocacy for mental health: roles for consumer and family organizations and governments.

    PubMed

    Funk, Michelle; Minoletti, Alberto; Drew, Natalie; Taylor, Jacob; Saraceno, Benedetto

    2006-03-01

    The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

  19. Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia

    PubMed Central

    Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang

    2012-01-01

    Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia. PMID:25337108

  20. The Role of Social Networks, Medical-Legal Climate, and Patient Advocacy on Surgical Options: A New Era.

    PubMed

    Tracy, Erin E; Bortoletto, Pietro

    2016-04-01

    The dissemination of information online and resultant public discourse through social media and other online channels has influenced the practice of medicine in dramatic ways. Physicians have historically worked to develop new techniques and devices for the benefit of their patients. It is only a more recent phenomenon, however, that these tools are either removed or their use is curtailed largely driven by anecdotal reports; passionate, vocal, often media-savvy advocates; and plaintiff attorneys. The use of power morcellation, hysteroscopic tubal sterilization, and mesh in urogynecologic procedures all have been victims of these societal pressures. It is important for health care professionals to be involved in the debate to ensure that public outcry does not unduly influence what we, as clinicians, are able to safely offer our patients. By being better advocates for our field, our instruments, and our patients, we can ensure medical decision-making is driven by good science and not public fervor.

  1. Cerebral Activations Related to Ballistic, Stepwise Interrupted and Gradually Modulated Movements in Parkinson Patients

    PubMed Central

    Toxopeus, Carolien M.; Maurits, Natasha M.; Valsan, Gopal; Conway, Bernard A.; Leenders, Klaus L.; de Jong, Bauke M.

    2012-01-01

    Patients with Parkinson’s disease (PD) experience impaired initiation and inhibition of movements such as difficulty to start/stop walking. At single-joint level this is accompanied by reduced inhibition of antagonist muscle activity. While normal basal ganglia (BG) contributions to motor control include selecting appropriate muscles by inhibiting others, it is unclear how PD-related changes in BG function cause impaired movement initiation and inhibition at single-joint level. To further elucidate these changes we studied 4 right-hand movement tasks with fMRI, by dissociating activations related to abrupt movement initiation, inhibition and gradual movement modulation. Initiation and inhibition were inferred from ballistic and stepwise interrupted movement, respectively, while smooth wrist circumduction enabled the assessment of gradually modulated movement. Task-related activations were compared between PD patients (N = 12) and healthy subjects (N = 18). In healthy subjects, movement initiation was characterized by antero-ventral striatum, substantia nigra (SN) and premotor activations while inhibition was dominated by subthalamic nucleus (STN) and pallidal activations, in line with the known role of these areas in simple movement. Gradual movement mainly involved antero-dorsal putamen and pallidum. Compared to healthy subjects, patients showed reduced striatal/SN and increased pallidal activation for initiation, whereas for inhibition STN activation was reduced and striatal-thalamo-cortical activation increased. For gradual movement patients showed reduced pallidal and increased thalamo-cortical activation. We conclude that PD-related changes during movement initiation fit the (rather static) model of alterations in direct and indirect BG pathways. Reduced STN activation and regional cortical increased activation in PD during inhibition and gradual movement modulation are better explained by a dynamic model that also takes into account enhanced

  2. Study of Repetitive Movements Induced Oscillatory Activities in Healthy Subjects and Chronic Stroke Patients

    PubMed Central

    Hsu, Chuan-Chih; Lee, Wai-Keung; Shyu, Kuo-Kai; Chang, Hsiao-Huang; Yeh, Ting-Kuang; Hsu, Hao-Teng; Chang, Chun-Yen; Lan, Gong-Yau; Lee, Po-Lei

    2016-01-01

    Repetitive movements at a constant rate require the integration of internal time counting and motor neural networks. Previous studies have proved that humans can follow short durations automatically (automatic timing) but require more cognitive efforts to track or estimate long durations. In this study, we studied sensorimotor oscillatory activities in healthy subjects and chronic stroke patients when subjects were performing repetitive finger movements. We found the movement-modulated changes in alpha and beta oscillatory activities were decreased with the increase of movement rates in finger lifting of healthy subjects and the non-paretic hands in stroke patients, whereas no difference was found in the paretic-hand movements at different movement rates in stroke patients. The significant difference in oscillatory activities between movements of non-paretic hands and paretic hands could imply the requirement of higher cognitive efforts to perform fast repetitive movements in paretic hands. The sensorimotor oscillatory response in fast repetitive movements could be a possible indicator to probe the recovery of motor function in stroke patients. PMID:27976723

  3. Kinematic analysis of laryngeal movements in patients with neurogenic dysphagia before and after swallowing rehabilitation.

    PubMed

    Prosiegel, M; Heintze, M; Sonntag, E W; Schenk, T; Yassouridis, A

    2000-01-01

    To examine whether kinematic analysis of laryngeal movements (which are closely linked to pharyngeal swallowing) can differentiate between normal and disturbed swallowing, we used a three-dimensional ultrasound movement recording system to measure the movements of the larynx during swallowing in 32 patients with neurogenic dysphagia caused by central nervous system lesions and in 32 age- and sex-matched healthy individuals. At the beginning of an inpatient rehabilitation swallowing program, laryngeal movements in 24 patients were highly disturbed in terms of velocity curve irregularities. After rehabilitation, the majority of patients with hitherto irregular velocity profiles exhibited laryngeal kinematics that were indistinguishable from those of 32 healthy subjects. Kinematic analysis of laryngeal movements, therefore, is suitable for monitoring motor recovery of swallowing disturbances in patients with neurogenic dysphagia while undergoing swallowing rehabilitation.

  4. Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.

    PubMed

    Källman, Ulrika; Bergstrand, Sara; Ek, Anna-Christina; Engström, Maria; Lindgren, Margareta

    2016-12-01

    The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

  5. Parliamentary advocacy in Europe.

    PubMed

    Cossey, D

    1996-01-01

    At the European Parliamentary Forum held in Brussels in May 1995 the responsibility of parliamentarians for implementing the Cairo program of action was voiced. The Danish and Finnish family planning associations are raising the awareness of parliamentarians about sexual and reproductive health and drawing attention to the commitments accepted at three international conferences on population, social development, and women's status. The British set up a parliamentary group in 1979 to deal with such issues as did the European Parliament in 1991. In 1994 and 1995 three major UN conferences were the focus of parliamentary debates to formulate national policy. In April 1994 the Danish association launched an advocacy activity in the Parliament followed by a forum on reproductive health with the goal of assisting in the drafting of national policy. In Finland collaborating with professional organizations and nongovernmental organizations (NGOs) in seminars, meetings, and consultations has been in the forefront of the issues of population and development and reproductive health. The briefing materials for parliamentarians include a pack designed by Marie Stopes International referring to development programs. A 1995 survey of parliamentarians assessed their attitudes toward development cooperation. Building links between NGOs and parliamentarians has been another scheme in this effort including the European Parliamentary Forum for Action attended by parliamentarians from 28 European countries. In January 1995 a party of European parliamentarians visited Pakistan to see problems at the grassroots. In February 1996 a meeting was held in Madrid for parliamentarians to follow up on the Beijing and Cairo conferences. Advocacy requires perseverance to create personal contacts and networks to keep the discussion on these crucial issues alive.

  6. The nature of advocacy vs. paternalism in nursing: clarifying the 'thin line'.

    PubMed

    Zomorodi, Meg; Foley, Barbara Jo

    2009-08-01

    This paper is an exploration of the concepts of advocacy and paternalism in nursing and discusses the thin line between the two. Nurses are involved in care more than any other healthcare professionals and they play a central role in advocating for patients and families. It is difficult to obtain a clear definition of advocacy, yet the concepts of advocacy and paternalism must be compared, contrasted, and discussed extensively. In many situations, only a thin line distinguishes advocacy from paternalism. A literature search was conducted using PubMed and CINAHL databases (2000-2008) as well as a library catalogue for texts. Four case stories were described in order to discuss the 'thin line' between advocacy and paternalism and develop communication strategies to eliminate ambiguity. Weighing the ethical principles of beneficence and autonomy helps to clarify advocacy and paternalism and provides an avenue for discussion among nurses practicing in a variety of settings. Advocacy and paternalism should be discussed at interdisciplinary rounds, and taken into consideration when making patient care decisions. It is difficult to clarify advocacy vs. paternalism, but strategies such as knowing the patient, clarifying information, and educating all involved are initial steps in distinguishing advocacy from paternalism. Truly 'knowing' patients, their life experiences, values, beliefs and wishes can help clarify the 'thin line' and gain a grasp of these difficult to distinguish theoretical concepts.

  7. The role of movement representation in episodic memory for actions: A study of patients with apraxia.

    PubMed

    Masumoto, Kouhei; Shirakawa, Masayuki; Higashiyama, Takeshi; Yokoyama, Kazumasa

    2015-01-01

    In attempting to memorize a sentence about an action, such as "Pick up the glass," performing the action (motor encoding) results in better memory performance than simply memorizing the words (verbal encoding). Such enhancement of memory is known as the enactment effect. Several theories have been proposed to explain this phenomenon using concepts such as physical motor information associated with speed, form, amplitude of movement and/or movement representations involved in movement imaging, knowledge on manipulating tools, and spatial relationships in the enactment effect. However, there have been no cognitive neuropsychological studies investigating whether the enactment effect is crucially influenced by physical motor information or movement representations. To clarify this issue, we compared healthy adult control participants with two different types of apraxia patients. One patient with left hemisphere lesions caused by cerebral infarction had a disability involving multiple movement representations. The other patient showed symptoms of corticobasal syndrome and was not able to benefit from feedback on the accuracy of her motor movements during enactment. Participants memorized action sentences via either verbal or motor encoding and responded to recall and recognition tests. Results indicated that the patient with the movement representation deficits exhibited worse memory performance than the other patient or control participants following both verbal and motor encoding. Although the enactment effect was present during recall in both patients, the effect was not observed for recognition in the patient with severe movement representation deficits. These results suggest that movement representations are involved in encoding episodic memories of action. Moreover, the role of movement representations appears to depend on the form of retrieval that is being used.

  8. Patient Protection and Affordable Care Act of 2010: summary, analysis, and opportunities for advocacy for the academic emergency physician.

    PubMed

    Kline, Jeffrey A; Walthall, Jennifer D H

    2010-07-01

    The Patient Protection and Affordable Care Bill, commonly referred to as the "Health Care Bill" or the "Health Care Reform Bill," was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care. 2010 by the Society for Academic Emergency Medicine

  9. The personal challenge of advocacy.

    PubMed

    Rocklage, M R

    1992-04-01

    Advocacy is the embracing of a cause or issue, a conversion to a mission that makes a very real claim on the advocate. It is the activity of altering structures, of changing the status quo. Like prophetic ministry, the task of advocacy is to nurture, nourish, and evoke consciousness of different ways of considering and doing things, to champion new models of organization. Effective advocacy entails three distinct steps: envisioning an alternative, challenging the status quo, and energizing persons and communities. It is characterized by the emergence of an alternative community concerned with different issues and different ways of doing things. It also involves the integration of advocacy into our daily lives and a penetration of the numbness of life. How will we know when we are truly serving as advocates of the Church's healing ministry? We will have an inkling that we are on the right track when we move from charity to justice.

  10. Movement characteristics in young patients and the impact on CBCT image quality.

    PubMed

    Spin-Neto, Rubens; Matzen, Louise H; Schropp, Lars; Gotfredsen, Erik; Wenzel, Ann

    2016-01-01

    To assess patient movement characteristics in children and young adults and the impact on CBCT image quality. During 33 CBCT examinations, the patients (age: average, 14 years; range, 9-25 years) who had moved were identified by video observation [movement group (MG)]. The CBCT data sets were matched with those of 33 non-moving patients according to age, diagnostic task, examined region, field of view and voxel resolution [non-movement group (N-MG)]. Three observers scored the videos of MG, regarding motional state second by second (moving/non-moving), and movement characteristics: duration (in seconds), complexity (uniplanar or multiplanar) and distance (<3/≥3 ≤ 10/>10 mm). The observers blindly assessed axial sections of the 66 examinations individually, categorizing the image quality (appropriate/acceptable/inappropriate). Next, the observers blindly assessed axial sections of the matched-pairs images simultaneously, deciding which image in the pair had the highest image quality or if it was impossible to decide. The relationship between image quality and movement/movement characteristics was evaluated. When the 66 CBCT images were evaluated individually, no relationship between image quality and movement was found. However, based on the matched-pairs assessment, accumulated number (≤2 vs ≥3, p = 0.039), duration (≤5 s vs ≥6 s, p = 0.024) and complexity (uniplanar vs multiplanar, p = 0.046) of movements had an impact on image quality; the more severe the movement, the more often the image quality was assessed lower in the MG. Axial CBCT images of young patients who moved during examination did not always present lower quality than images originating from non-moving patients. Image quality was, however, significantly lower in the moving patients when movement occurred several times, had a long duration or was multiplanar.

  11. Effect of Mulligan's mobilization with movement technique on gait function in stroke patients.

    PubMed

    Kim, Sang-Lim; Lee, Byoung-Hee

    2016-08-01

    [Purpose] We examined the effectiveness of Mulligan's mobilization with movement (MWM) technique on spatiotemporal variables of gait in individuals who had a stroke. [Subjects and Methods] Twenty-four subjects were randomly divided into 2 groups: Mulligan's mobilization with movement group (n=12) and "weight-bearing with placebo" mobilization with movement group (n=12). The subjects in the mobilization with movement group performed 5 sets of 10 glides a day, 5 times a week for 4 weeks. The mobilization with movement technique comprised grade III movements that involved gliding and resting. The control group subjects performed lunges in the same conditions as those of the experimental group. Gait function was measured in terms of spatiotemporal parameters to determine the effect of mobilization with movement. [Results] The mobilization with movement group showed significant improvements in velocity, cadence, stride length, single-support time, and step length of the affected side, and step length and stride length of the non-affected side. Overall, the mobilization with movement group showed significantly greater improvements than the control group in terms of velocity, cadence, and single-support time of the affected side. [Conclusion] Mobilization with movement can be used to improve the gait function of patients recovering from stroke.

  12. Effect of Mulligan’s mobilization with movement technique on gait function in stroke patients

    PubMed Central

    Kim, Sang-Lim; Lee, Byoung-Hee

    2016-01-01

    [Purpose] We examined the effectiveness of Mulligan’s mobilization with movement (MWM) technique on spatiotemporal variables of gait in individuals who had a stroke. [Subjects and Methods] Twenty-four subjects were randomly divided into 2 groups: Mulligan’s mobilization with movement group (n=12) and “weight-bearing with placebo” mobilization with movement group (n=12). The subjects in the mobilization with movement group performed 5 sets of 10 glides a day, 5 times a week for 4 weeks. The mobilization with movement technique comprised grade III movements that involved gliding and resting. The control group subjects performed lunges in the same conditions as those of the experimental group. Gait function was measured in terms of spatiotemporal parameters to determine the effect of mobilization with movement. [Results] The mobilization with movement group showed significant improvements in velocity, cadence, stride length, single-support time, and step length of the affected side, and step length and stride length of the non-affected side. Overall, the mobilization with movement group showed significantly greater improvements than the control group in terms of velocity, cadence, and single-support time of the affected side. [Conclusion] Mobilization with movement can be used to improve the gait function of patients recovering from stroke. PMID:27630424

  13. How detrimental is eye movement during photorefractive keratectomy to the patient's postoperative vision?

    NASA Astrophysics Data System (ADS)

    Taylor, Natalie M.; van Saarloos, Paul P.; Eikelboom, Robert H.

    2000-06-01

    This study aimed to gauge the effect of the patient's eye movement during Photo Refractive Keratectomy (PRK) on post- operative vision. A computer simulation of both the PRK procedure and the visual outcome has been performed. The PRK simulation incorporated the pattern of movement of the laser beam to perform a given correction, the beam characteristics, an initial corneal profile, and an eye movement scenario; and generated the corrected corneal profile. The regrowth of the epithelium was simulated by selecting the smoothing filter which, when applied to a corrected cornea with no patient eye movement, produced similar ray tracing results to the original corneal model. Ray tracing several objects, such as letters of various contrast and sizes was performed to assess the quality of the post-operative vision. Eye movement scenarios included no eye movement, constant decentration and normally distributed random eye movement of varying magnitudes. Random eye movement of even small amounts, such as 50 microns reduces the contrast sensitivity of the image. Constant decentration decenters the projected image on the retina, and in extreme cases can lead to astigmatism. Eye movements of the magnitude expected during laser refractive surgery have minimal effect on the final visual outcome.

  14. The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction.

    PubMed

    Pelletier, David; Haider, Rukhsana; Hajeebhoy, Nemat; Mangasaryan, Nune; Mwadime, Robert; Sarkar, Satyajit

    2013-09-01

    Advocacy represents an intervention into complex, dynamic and highly contextual socio-political systems, in which strategies and tactics must be adjusted on a continual basis in light of rapidly changing conditions, reactions from actors and feedback. For this reason, the practice of advocacy is often considered more art than science. However, capacities and practices for advocacy can be strengthened by sharing and analysing experiences in varying contexts, deriving general principles and learning to adapt these principles to new contexts. Nutrition is a particular context for advocacy, but to date, there has been little systematic analysis of experiences. The purpose of this paper is to illustrate and draw lessons from the practice of nutrition advocacy, especially in relation to stunting and complementary feeding, and suggest ways to strengthen capacities and practices in the future. The strategies and tactics, achievements and lessons learnt are described for three case studies: Uganda, Vietnam and Bangladesh. These cases, and experience from elsewhere, demonstrate that concerted, well-planned and well-implemented advocacy can bring significant achievements, even in short period of time. In light of the global and national attention being given to stunting reduction through the SUN (Scaling Up Nutrition) movement and other initiatives, there is now a need for much stronger investments in strategic and operational capacities for advocacy, including the human, organisational and financial resources for the advocacy and strategic communication themselves, as well as for monitoring and evaluation, supportive research and institutional capacity-building.

  15. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders.

    PubMed

    Pareés, Isabel; Brown, Harriet; Nuruki, Atsuo; Adams, Rick A; Davare, Marco; Bhatia, Kailash P; Friston, Karl; Edwards, Mark J

    2014-11-01

    Functional movement disorders require attention to manifest yet patients report the abnormal movement to be out of their control. In this study we explore the phenomenon of sensory attenuation, a measure of the sense of agency for movement, in this group of patients by using a force matching task. Fourteen patients and 14 healthy control subjects were presented with forces varying from 1 to 3 N on the index finger of their left hand. Participants were required to match these forces; either by pressing directly on their own finger or by operating a robot that pressed on their finger. As expected, we found that healthy control subjects consistently overestimated the force required when pressing directly on their own finger than when operating a robot. However, patients did not, indicating a significant loss of sensory attenuation in this group of patients. These data are important because they demonstrate that a fundamental component of normal voluntary movement is impaired in patients with functional movement disorders. The loss of sensory attenuation has been correlated with the loss of sense of agency, and may help to explain why patients report that they do not experience the abnormal movement as voluntary.

  16. Eye movement during facial affect recognition by patients with schizophrenia, using Japanese pictures of facial affect.

    PubMed

    Shiraishi, Yuko; Ando, Kazuhiro; Toyama, Sayaka; Norikane, Kazuya; Kurayama, Shigeki; Abe, Hiroshi; Ishida, Yasushi

    2011-10-01

    A possible relationship between recognition of facial affect and aberrant eye movement was examined in patients with schizophrenia. A Japanese version of standard pictures of facial affect was prepared. These pictures of basic emotions (surprise, anger, happiness, disgust, fear, sadness) were shown to 19 schizophrenic patients and 20 healthy controls who identified emotions while their eye movements were measured. The proportion of correct identifications of 'disgust' was significantly lower for schizophrenic patients, their eye fixation time was significantly longer for all pictures of facial affect, and their eye movement speed was slower for some facial affects (surprise, fear, and sadness). One index, eye fixation time for "happiness," showed a significant difference between the high- and low-dosage antipsychotic drug groups. Some expected facial affect recognition disorder was seen in schizophrenic patients responding to the Japanese version of affect pictures, but there was no correlation between facial affect recognition disorder and aberrant eye movement.

  17. Achieving fire-safe cigarette legislation through coalition-based legislative advocacy.

    PubMed

    Goldstein, Adam O; Grant, Ernest; McCullough, Anna; Cairns, Bruce; Kurian, Ann

    2010-02-01

    Advocates who work for tobacco control legislation through coalition-based policy advocacy have access to a broad base of support and resources that are critical to overcoming the tobacco industry lobby. This article provides an example of how a coalition-based advocacy strategy that engaged a diverse group of stakeholders and was supported by a national coordinating movement achieved state level fire-safe cigarette legislation in a tobacco-producing and manufacturing state.

  18. Litigation as TB Rights Advocacy

    PubMed Central

    2016-01-01

    Abstract One thousand people die every day in India as a result of TB, a preventable and treatable disease, even though the Constitution of India, government schemes, and international law guarantee available, accessible, acceptable, quality health care. Failure to address the spread of TB and to provide quality treatment to all affected populations constitutes a public health and human rights emergency that demands action and accountability. As part of a broader strategy, health activists in India employ Public Interest Litigation (PIL) to hold the state accountable for rights violations and to demand new legislation, standards for patient care, accountability for under-spending, improvements in services at individual facilities, and access to government entitlements in marginalized communities. Taking inspiration from right to health PIL cases (PILs), lawyers in a New Delhi-based rights organization used desk research, fact-findings, and the Right To Information Act to build a TB PIL for the Delhi High Court, Sanjai Sharma v. NCT of Delhi and Others (2015). The case argues that inadequate implementation of government TB schemes violates the Constitutional rights to life, health, food, and equality. Although PILs face substantial challenges, this paper concludes that litigation can be a crucial advocacy and accountability tool for people living with TB and their allies. PMID:27781000

  19. Effect of visual biofeedback of posterior tongue movement on articulation rehabilitation in dysarthria patients.

    PubMed

    Yano, J; Shirahige, C; Oki, K; Oisaka, N; Kumakura, I; Tsubahara, A; Minagi, S

    2015-08-01

    Articulation is driven by various combinations of movements of the lip, tongue, soft palate, pharynx and larynx, where the tongue plays an especially important role. In patients with cerebrovascular disorder, lingual motor function is often affected, causing dysarthria. We aimed to evaluate the effect of visual biofeedback of posterior tongue movement on articulation rehabilitation in dysarthria patients with cerebrovascular disorder. Fifteen dysarthria patients (10 men and 5 women; mean age, 70.7 ± 10.3 years) agreed to participate in this study. A device for measuring the movement of the posterior part of the tongue was used for the visual biofeedback. Subjects were instructed to produce repetitive articulation of [ka] as fast and steadily as possible between a lungful with/without visual biofeedback. For both the unaffected and affected sides, the range of ascending and descending movement of the posterior tongue with visual biofeedback was significantly larger than that without visual biofeedback. The coefficient of variation for these movements with visual biofeedback was significantly smaller than that without visual biofeedback. With visual biofeedback, the range of ascent exhibited a significant and strong correlation with that of descent for both the unaffected and affected sides. The results of this study revealed that the use of visual biofeedback leads to prompt and preferable change in the movement of the posterior part of the tongue. From the standpoint of pursuing necessary rehabilitation for patients with attention and memory disorders, visualization of tongue movement would be of marked clinical benefit.

  20. Movement disorders in adult surviving patients with maple syrup urine disease.

    PubMed

    Carecchio, Miryam; Schneider, Susanne A; Chan, Heidi; Lachmann, Robin; Lee, Philip J; Murphy, Elaine; Bhatia, Kailash P

    2011-06-01

    Maple syrup urine disease is a rare metabolic disorder caused by mutations in the branched-chain α-keto acid dehydrogenase complex gene. Patients generally present early in life with a toxic encephalopathy because of the accumulation of the branched-chain amino acids leucine, isoleucine, and valine and the corresponding ketoacids. Movement disorders in maple syrup urine disease have typically been described during decompensation episodes or at presentation in the context of a toxic encephalopathy, with complete resolution after appropriate dietary treatment. Movement disorders in patients surviving childhood are not well documented. We assessed 17 adult patients with maple syrup urine disease (mean age, 27.5 years) with a special focus on movement disorders. Twelve (70.6%) had a movement disorder on clinical examination, mainly tremor and dystonia or a combination of both. Parkinsonism and simple motor tics were also observed. Pyramidal signs were present in 11 patients (64.7%), and a spastic-dystonic gait was observed in 6 patients (35.2%). In summary, movement disorders are common in treated adult patients with maple syrup urine disease, and careful neurological examination is advisable to identify those who may benefit from specific therapy. © 2011 Movement Disorder Society.

  1. Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis.

    PubMed

    Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

    2015-01-01

    Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Prospective cohort study. 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. The participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'. Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.

  2. Attention Deficit Hyperactivity Disorder in a Patient With Congenital Mirror Movement Disorder and Colpocephaly

    PubMed Central

    Yaroglu Kazanci, Selcen

    2015-01-01

    Introduction: Congenital mirror movement disorder designates involuntary movements on one side of the body that occur as mirror of the intentional movements on the contralateral side. Colpocephaly is described as persistence of fetal configuration of lateral ventricles. Case Presentation: A two-month old male infant was brought to the hospital due to bilateral identical movements of the hands. Except for bilateral involuntary synkinetic imitative movements in hands, neurological and physical examination was normal. Cranial MRI showed corpus callosum dysgenesis, hypogenesis and dilation of bilateral lateral ventricular posterior horns (colpocephaly). At the age of 7 years, he was started to use metylphenydate to mitigate attention deficit and hyperactivity disorder. The mirror movements were decreasing in amplitude by years and were not so serious to affect normal life activities. Conclusions: Mirror movements, diagnosed usually during childhood, may be congenital or secondary to neurological diseases. Although they generally do not affect normal life activities, in some cases severity of mirror movements causes a real debilitating disease. In our case the patient was diagnosed at the age of 2 months and on follow-up no debilitating problems were observed. This is the first case to describe the association of colpocephaly and mirror movements. The exact mechanism of this association is not known. Although it is known that mirror movements may be in relation with some pychiatric pathologies, this is the first report of attention deficit and hyperactivity disorder in conjunction with mirror movements and/or colpocephaly. Managing comorbidities, either physical or psyhchological, will help the patient to live in good health without trying to cope with other pathological diseases. PMID:26495087

  3. Assessing the outcome of making it easier for patients to change general practitioner: practice characteristics associated with patient movements.

    PubMed Central

    Thomas, K; Nicholl, J; Coleman, P

    1995-01-01

    BACKGROUND. The government white paper, Promoting better health, suggested that primary health care services should be made more responsive to patient needs and that competition, brought about by the freer movement of patients between practices, could act as a mechanism for improving the quality of the services provided. Policy changes reflecting these aims were introduced with the 1990 contract for general practitioners. AIM. A study was carried out to estimate the volume of patient movement between practices not attributable to a patient's change of address or to a major change in the practice they had left, and to investigate which practice characteristics patients moved towards and which they moved away from when changing general practitioner. METHOD. Data on 2617 patient movements during June 1991 were collected from five family health services authorities. These patient movements were analysed in relation to data on practice characteristics obtained from family health services authority records. RESULTS. The estimated volume of movement of patients between practices was small (1.6% of the registered population per year). The majority of movements were between group practices; a quarter of the movements recorded were to single-handed general practitioners. However, the ratio of the number of movements from group practices to single-handed general practitioners compared with those from single-handed general practitioners to group practices was 1.37 (95% confidence interval 1.19 to 1.57). In choosing single-handed general practitioners these patients were willing to forgo access to a woman general practitioner, extended services and greater hours of general practitioner availability. Among the subset of movements between group practices, patients were more likely to gain access to a practice nurse, longer surgery hours and a woman general practitioner as a consequence of their move. CONCLUSION. The scale of patient movement observed did not indicate any

  4. Detecting and classifying movement-related cortical potentials associated with hand movements in healthy subjects and stroke patients from single-electrode, single-trial EEG.

    PubMed

    Jochumsen, Mads; Niazi, Imran Khan; Taylor, Denise; Farina, Dario; Dremstrup, Kim

    2015-10-01

    To detect movement intention from executed and imaginary palmar grasps in healthy subjects and attempted executions in stroke patients using one EEG channel. Moreover, movement force and speed were also decoded. Fifteen healthy subjects performed motor execution and imagination of four types of palmar grasps. In addition, five stroke patients attempted to perform the same movements. The movements were detected from the continuous EEG using a single electrode/channel overlying the cortical representation of the hand. Four features were extracted from the EEG signal and classified with a support vector machine (SVM) to decode the level of force and speed associated with the movement. The system performance was evaluated based on both detection and classification. ∼ 75% of all movements (executed, imaginary and attempted) were detected 100 ms before the onset of the movement. ∼ 60% of the movements were correctly classified according to the intended level of force and speed. When detection and classification were combined, ∼ 45% of the movements were correctly detected and classified in both the healthy and stroke subjects, although the performance was slightly better in healthy subjects. The results indicate that it is possible to use a single EEG channel for detecting movement intentions that may be combined with assistive technologies. The simple setup may lead to a smoother transition from laboratory tests to the clinic.

  5. Further Examination of Modifying Patient-Preferred Movement and Alignment Strategies in Patients with Low Back Pain During Symptomatic Tests

    PubMed Central

    Van Dillen, Linda R.; Maluf, Katrina S.; Sahrmann, Shirley A.

    2009-01-01

    Our purpose was to examine the effect of modifying symptomatic movement and alignment tests in a sample of people with LBP referred to physical therapy. Fifty-one patients (19 males, 32 females; mean age 37±10.59 y) with LBP and a mean Oswestry Disability Index score of 34±18% were examined. The examination included 28 primary tests in which patients used their preferred movement or alignment strategy and reported symptoms. Symptomatic tests were followed by a secondary test in which the patient’s strategy was standardly modified to correct the spinal alignment or movement that occurred with the primary test. Symptoms and directions of movement or alignment modified were recorded. For 82% of the secondary tests, the majority of the patients’ symptoms improved. For 54% of the secondary tests, some patients required modification of more than one direction of movement or alignment to eliminate symptoms. The findings suggest that the modifications described are generalizable across a number of tests with a moderately involved group of patients, and for individual tests there is variability in the numbers and directions of movements or alignments that appear to contribute to symptoms. Information obtained from the modifications is important because it can be used to confirm the patient’s LBP classification and, within the context of the examination, immediately be used to teach the patient strategies to change movements and positions that appear to be contributing to his LBP. PMID:18032090

  6. Movement related slow cortical potentials in severely paralyzed chronic stroke patients

    PubMed Central

    Yilmaz, Ozge; Birbaumer, Niels; Ramos-Murguialday, Ander

    2015-01-01

    Movement-related slow cortical potentials (SCPs) are proposed as reliable and immediate indicators of cortical reorganization in motor learning. SCP amplitude and latency have been reported as markers for the brain's computational effort, attention and movement planning. SCPs have been used as an EEG signature of motor control and as a main feature in Brain-Machine-Interfaces (BMIs). Some reports suggest SCPs are modified following stroke. In this study, we investigated movement-related SCPs in severe chronic stroke patients with no residual paretic hand movements preceding and during paretic (when they try to move) and healthy hand movements. The aim was to identify SCP signatures related to cortex integrity and complete paralysis due to stroke in the chronic stage. Twenty severely impaired (no residual finger extension) chronic stoke patients, of whom ten presented subcortical and ten cortical and subcortical lesions, underwent EEG and EMG recordings during a cue triggered hand movement (open/close) paradigm. SCP onset appeared and peaked significantly earlier during paretic hand movements than during healthy hand movements. Amplitudes were significantly larger over the midline (Cz, Fz) for paretic hand movements while contralateral (C4, F4) and midline (Cz, Fz) amplitudes were significantly larger than ipsilateral activity for healthy hand movements. Dividing the participants into subcortical only and mixed lesioned patient groups, no significant differences observed in SCP amplitude and latency between groups. This suggests lesions in the thalamocortical loop as the main factor in SCP changes after stroke. Furthermore, we demonstrated how, after long-term complete paralysis, post-stroke intention to move a paralyzed hand resulted in longer and larger SCPs originating in the frontal areas. These results suggest SCP are a valuable feature that should be incorporated in the design of new neurofeedback strategies for motor neurorehabilitation. PMID:25642177

  7. [Video Instruction for Synchronous Video Recording of Mimic Movement of Patients with Facial Palsy].

    PubMed

    Schaede, Rebecca Anna; Volk, Gerd Fabian; Modersohn, Luise; Barth, Jodi Maron; Denzler, Joachim; Guntinas-Lichius, Orlando

    2017-05-03

    Photografy and video are necessary to record the severity of a facial palsy or to allow offline grading with a grading system. There is no international standard for the video recording urgently needed to allow a standardized comparison of different patient cohorts. A video instruction was developed. The instruction was shown to the patient and presents several mimic movements. At the same time the patient is recorded while repeating the presented movement using commercial hardware. Facial movements were selected in such a way that it was afterwards possible to evaluate the recordings with standard grading systems (House-Brackmann, Sunnybrook, Stennert, Yanagihara) or even with (semi)automatic software. For quality control, the patients evaluated the instruction using a questionnaire. The video instruction takes 11 min and 05 and is divided in 3 parts: 1) Explanation of the procedure; 2) Foreplay and recreating of the facial movements; 3) Repeating of sentences to analyze the communication skills. So far 13 healthy subjects and 10 patients with acute or chronic facial palsy were recorded. All recordings could be assessed by the above mentioned grading systems. The instruction was rated as well explaining and easy to follow by healthy persons and patients. There is now a video instruction available for standardized recording of facial movement. This instruction is recommended for use in clinical routine and in clinical trials. This will allow a standardized comparison of patients within Germany and international patient cohorts. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Detection and correction of patient movement in prostate brachytherapy seed reconstruction

    NASA Astrophysics Data System (ADS)

    Lam, Steve T.; Cho, Paul S.; Marks, Robert J., II; Narayanan, Sreeram

    2005-05-01

    Intraoperative dosimetry of prostate brachytherapy can help optimize the dose distribution and potentially improve clinical outcome. Evaluation of dose distribution during the seed implant procedure requires the knowledge of 3D seed coordinates. Fluoroscopy-based seed localization is a viable option. From three x-ray projections obtained at different gantry angles, 3D seed positions can be determined. However, when local anaesthesia is used for prostate brachytherapy, the patient movement during fluoroscopy image capture becomes a practical problem. If uncorrected, the errors introduced by patient motion between image captures would cause seed mismatches. Subsequently, the seed reconstruction algorithm would either fail to reconstruct or yield erroneous results. We have developed an algorithm that permits detection and correction of patient movement that may occur between fluoroscopy image captures. The patient movement is decomposed into translational shifts along the tabletop and rotation about an axis perpendicular to the tabletop. The property of spatial invariance of the co-planar imaging geometry is used for lateral movement correction. Cranio-caudal movement is corrected by analysing the perspective invariance along the x-ray axis. Rotation is estimated by an iterative method. The method can detect and correct for the range of patient movement commonly seen in the clinical environment. The algorithm has been implemented for routine clinical use as the preprocessing step for seed reconstruction.

  9. Coordination of eye and head movements during smooth pursuit in patients with vestibular failure.

    PubMed

    Waterston, J A; Barnes, G R; Grealy, M A; Luxon, L M

    1992-12-01

    During pursuit of smoothly moving targets with combined eye and head movements in normal subjects, accurate gaze control depends on successful interaction of the vestibular and head movement signals with the ocular pursuit mechanisms. To investigate compensation for loss of the vestibulo-ocular reflex during head-free pursuit in labyrinthine-deficient patients, pursuit performance was assessed and compared under head-fixed and head-free conditions in five patients with isolated bilateral loss of vestibular function. Target motion consisted of predictable and unpredictable pseudo-random waveforms containing the sum of three or four sinusoids. Comparison of slow-phase gaze velocity gains under head-free and head-fixed conditions revealed no significant differences during pursuit of any of the three pseudo-random waveforms. The finding of significant compensatory eye movement during active head movements in darkness in labyrinthine-deficient patients, which were comparable in character and gain to the vestibular eye movement elicited in normal subjects, probably explains the similarity of the head-fixed and head-free responses. In two additional patients with cerebellar degeneration and vestibular failure, no compensatory eye movement response was observed, implying that the cerebellum is necessary for the generation of such responses in labyrinthine-deficient patients.

  10. Movement disorders in adult patients with classical galactosemia.

    PubMed

    Rubio-Agusti, Ignacio; Carecchio, Miryam; Bhatia, Kailash P; Kojovic, Maja; Parees, Isabel; Chandrashekar, Hoskote S; Footitt, Emma J; Burke, Derek; Edwards, Mark J; Lachmann, Robin H L; Murphy, Elaine

    2013-06-01

    Classical galactosemia is an autosomal recessive inborn error of metabolism leading to toxic accumulation of galactose and derived metabolites. It presents with acute systemic complications in the newborn. Galactose restriction resolves these symptoms, but long-term complications, such as premature ovarian failure and neurological problems including motor dysfunction, may occur despite adequate treatment. The objective of the current study was to determine the frequency and phenotype of motor problems in adult patients with classical galactosemia. In this cross-sectional study, adult patients with a biochemically confirmed diagnosis of galactosemia attending our clinic were assessed with an interview and neurological examination and their notes retrospectively reviewed. Patients were classified according to the presence/absence of motor dysfunction on examination. Patients with motor dysfunction were further categorized according to the presence/absence of reported motor symptoms. Forty-seven patients were included. Thirty-one patients showed evidence of motor dysfunction including: tremor (23 patients), dystonia (23 patients), cerebellar signs (6 patients), and pyramidal signs (4 patients). Tremor and dystonia were often combined (16 patients). Thirteen patients reported motor symptoms, with 8 describing progressive worsening. Symptomatic treatment was effective in 4 of 5 patients. Nonmotor neurological features (cognitive, psychiatric, and speech disorders) and premature ovarian failure were more frequent in patients with motor dysfunction. Motor dysfunction is a common complication of classical galactosemia, with tremor and dystonia the most frequent findings. Up to one third of patients report motor symptoms and may benefit from appropriate treatment. Progressive worsening is not uncommon and may suggest ongoing brain damage in a subset of patients.

  11. Essentials of Advocacy in Case Management: Part 2: Client Advocacy Model and Case Manager's Advocacy Strategies and Competencies.

    PubMed

    Tahan, Hussein M

    2016-01-01

    This article describes a client advocacy model for use by case managers. It delineates necessary competencies for the case manager and shares important strategies for effective client advocacy. All practice settings across the continuum of health and human services and case managers of diverse professional backgrounds. Advocacy is a primary role and necessary competency of professional case managers functioning in various care settings. It is rooted in ethical theory and principles. Successful case managers apply ethical principles of advocacy at every step of the case management process and in the decisions they make. Part II of this two-part article presents a client advocacy model for case managers to apply in their practice, describes the role of advocacy in client engagement, and identifies important strategies and a set of essential competencies for effective case management advocacy. Part I already explored the ethical theories and principles of advocacy, the perception of case management-related professional organizations of advocacy, and the common types of advocacy based on scope, complexity, impact, and reach. Acquiring foundational knowledge, skills, and competencies in what advocacy is and how to effectively enact its related behaviors is essential for success of case managers and for achieving desired outcomes for both the clients and health care agencies/providers alike. Case management leaders are urged to use the knowledge shared in this article to develop advocacy training and competency management programs for their case managers.

  12. Comparative functional MRI study to assess brain activation upon active and passive finger movements in patients with cerebral infarction.

    PubMed

    Fu, Yue; Zhang, Quan; Zhang, Jing; Zhang, Yun Ting

    2015-01-01

    To compare the effects of active and passive movements on brain activation in patients with cerebral infarction using fMRI. Twenty-four hemiplegic patients with cerebral infarction were evaluated using fMRI. All patients performed active and passive finger opposition movements. Patients were instructed to perform the finger opposition movement for the active movement task. For the passive movement task, the subject's fingers were moved by the examiner to perform the finger opposition movement. Statistical parametric mapping software was used for statistical analyses and to process all data. In the affected hemisphere, sensorimotor cortex (SMC) activation intensity and range were significantly stronger during the passive movement of the affected fingers compared to the active movement of the affected fingers (p < 0.05). However, there were no significant differences between active and passive movements of unaffected fingers in SMC activation intensity and range in the unaffected hemisphere (p > 0.05). In addition, the passive movement activated many other regions of the brain. The brain regions activated by passive movements of the affected fingers tended to center toward the contralateral SMC. Our findings suggest that passive movements induce cortical reorganization in patients with cerebral infarction. Therefore, passive movement is likely beneficial for motor function recovery in patients with cerebral infarction.

  13. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome.

    PubMed

    Iriarte, Jorge; Murie-Fernandez, Manuel; Toledo, Estefania; Urrestarazu, Elena; Alegre, Manuel; Viteri, Cesar; Salvador, Javier; Baptista, Peter; Alcaide, Belen; Artieda, Julio

    2009-08-01

    Periodic limb movements (PLM) and obstructive sleep apnea syndrome (OSAS) are two frequent sleep disorders which often occur in the same patient. The goal of this study was to know the influence of the presence of PLM in the sleep architecture in patients with and without OSAS. Two hundred twenty consecutive patients (69 women and 151 men) participated in this transversal study. They were patients with clinical suspicion of dysomnia, including snoring, OSAS, and PLM. All of them underwent a full polysomnography and were interviewed using questionnaires about the sleep quality. The sleep parameters (percentage of sleep stages, rapid eye movement latency, sleep efficiency, awakenings, PLM presence, apnea-hypopnea index) were calculated and compared between groups. Descriptive statistics and nonparametric distribution techniques were used for the analysis. Patients with PLM when compared with patients with OSAS had lower sleep efficiency and less rapid eye movement percentage. The presence of PLM in patients with sleep apnea was less relevant being responsible only for an increase in the rapid eye movement latency and a decrease in the duration of the three to four sleep stages. However, the presence of OSAS was related to a better sleep efficiency (patients with PLM plus OSAS had a better sleep efficiency than patients with only PLM). PLM alters the structure of sleep. In patients with sleep apnea, the presence of PLM is less relevant.

  14. Responding to families' questions about the meaning of physical movements in critically ill patients.

    PubMed

    Engelberg, Ruth A; Wenrich, Marjorie D; Curtis, J Randall

    2008-12-01

    Families may have questions about the meaning of physical movement in critically ill patients for whom movements are likely involuntary. If unresolved, these questions may contribute to difficult communication around end-of-life care. This study used qualitative methods to describe physicians' responses to families' questions about the meaning of patients' movements in critically ill patients. Fifty-one family conferences in which withdrawal of life support or discussion of bad news was addressed were audiotaped and analyzed with a limited application of grounded theory techniques. Patients were identified from intensive care units in 4 Seattle area hospitals. Two hundred twenty-seven family members and 36 physicians participated in the study. Family members' questions indicating lack of resolution about the meaning of patients' movements that were likely involuntary occurred in 6 (12%) of the 51 conferences. Physicians used 3 approaches to respond to the following questions: (1) providing clinical information, (2) acknowledging families' emotions, and (3) exploring the meaning of families' emotions. Physicians were most likely to provide clinical information in these situations and infrequently explored the meaning of families' emotions. Physicians' responses to family questions indicating lack of resolution about the meaning of patients' movements that were likely involuntary can be categorized into 3 types. Physicians may be better able to respond to and resolve these questions by using all 3 types of communication approaches. Future studies should determine if such responses can improve families' experiences and other outcomes.

  15. Surface electromyography shows increased mirroring in Parkinson's disease patients without overt mirror movements.

    PubMed

    Cincotta, Massimo; Giovannelli, Fabio; Borgheresi, Alessandra; Balestrieri, Fabrizio; Vanni, Paola; Ragazzoni, Aldo; Zaccara, Gaetano; Ziemann, Ulf

    2006-09-01

    Patients with Parkinson's disease (PD) may present mirror movements (MM). Transcranial magnetic stimulation data indicate that these movements reflect an abnormal enhancement of the "physiological mirroring" that can be observed in healthy adults during complex and effortful tasks. It was hypothesized that, in PD, enhanced mirroring is caused by a failure of basal ganglia output to support the cortical network that is responsible for the execution of strictly unimanual movements. If so, it is likely that subtle alterations of voluntary unimanual motor control are also present in PD patients without overt MM. We tested this hypothesis by using surface electromyographic (EMG) techniques in 12 mildly to moderately affected PD patients without overt MM, and in 2 control groups (12 age-matched and 10 young healthy volunteers). Subjects performed unilateral phasic thumb abduction during a sustained tonic contraction of the opposite abductor pollicis brevis. All patients were tested on dopaminergic therapy. On a separate day, 7 of 12 patients were re-tested after withdrawal of medication. During this task, involuntary mirror-like increase in surface EMG of the tonically abducting thumb was significantly larger in PD patients than in age-matched or young healthy volunteers. Off therapy, mirroring was slightly greater than on medication, although this difference was not significant. Our findings suggest that dysfunction of unimanual motor control is a general feature of PD. It is likely that this deficient movement lateralization contributes to an impairment of nonsymmetrical bimanual movements in PD.

  16. Adaptation motor learning of arm movements in patients with cerebellar disease.

    PubMed Central

    Deuschl, G; Toro, C; Zeffiro, T; Massaquoi, S; Hallett, M

    1996-01-01

    OBJECTIVE--To design a test of motor learning using arm movements in normal subjects and patients with cerebellar disease. METHODS--Elbow angle was continuously displayed as a cursor (a dot) on a computer screen, and subjects made ballistic elbow flexion and extension movements to try to move the cursor between two targets on the screen. The relation between the arm movement and its visual feedback was changed, and the subjects reacted by adapting the amplitude of their movements in subsequent trials. RESULTS--The consecutive errors showed exponential learning curves during adaptation, which were quantified by their steepness. Ten patients with isolated cerebellar or olivopontocerebellar degeneration had less steep learning curves than normal subjects, indicating a failure of adaptation motor learning in cerebellar disease. The results show that this test may be useful for the analysis of motor learning. Images PMID:8778255

  17. Self-Advocacy in Historical Perspective

    ERIC Educational Resources Information Center

    Buchanan, Ian; Walmsley, Jan

    2006-01-01

    This paper looks at the history of self advocacy in England. Self advocacy has helped many people with learning difficulties to speak up and gain more confidence. But now it is associated with Government policy. After Valuing People, people expect self advocacy organizations to speak up for everyone with learning difficulties. This might mean…

  18. Advocacy and Age: Issues, Experiences, Strategies.

    ERIC Educational Resources Information Center

    Kerschner, Paul A., Ed.

    This monograph seeks to bring understanding to one component of the advocacy field, that of advocacy and the aged, by overviewing this component through a series of articles. (Advocacy is an activity by which changes can be effected in a power structure to improve a subgroup's situation.) There are four parts to the document: part 1, entitled…

  19. Advocacy and Age: Issues, Experiences, Strategies.

    ERIC Educational Resources Information Center

    Kerschner, Paul A., Ed.

    This monograph seeks to bring understanding to one component of the advocacy field, that of advocacy and the aged, by overviewing this component through a series of articles. (Advocacy is an activity by which changes can be effected in a power structure to improve a subgroup's situation.) There are four parts to the document: part 1, entitled…

  20. Approaches to Advocacy for Health Educators.

    ERIC Educational Resources Information Center

    Mahoney, Beverly Saxton, Ed.; Brown, Kelli McCormack, Ed.

    1999-01-01

    This monograph provides a collection of articles on health educators' approaches to advocacy: "The Role of Health Education Advocacy in Removing Disparities in Health Care" (John P. Allegrante, Donald E. Morisky, and Behjat A. Sharif); "The Role of Health Education Associations in Advocacy" (M. Elaine Auld and Eleanor…

  1. Practitioner Perceptions of School Library Advocacy

    ERIC Educational Resources Information Center

    Burns, Elizabeth

    2015-01-01

    School library advocacy is increasingly important due to decreases in funding and staff. National organizations attempt to engage school librarians in advocacy and have developed resources and tools to assist with this task. However, there is little research examining how practicing school librarians engage in advocacy and how their advocacy…

  2. Every Voice Matters: The Importance of Advocacy

    ERIC Educational Resources Information Center

    Royea, Amber J.; Appl, Dolores J.

    2009-01-01

    Over the years parents, professionals, and politicians have come together to advocate on behalf of children's rights. Advocacy can occur individually, collectively, or a combination of both. Although some advocacy efforts are more successful than others, it is the process of the advocacy and voices behind it that matter most. In this guest…

  3. Every Voice Matters: The Importance of Advocacy

    ERIC Educational Resources Information Center

    Royea, Amber J.; Appl, Dolores J.

    2009-01-01

    Over the years parents, professionals, and politicians have come together to advocate on behalf of children's rights. Advocacy can occur individually, collectively, or a combination of both. Although some advocacy efforts are more successful than others, it is the process of the advocacy and voices behind it that matter most. In this guest…

  4. Detection of mental imagery and attempted movements in patients with disorders of consciousness using EEG

    PubMed Central

    Horki, Petar; Bauernfeind, Günther; Klobassa, Daniela S.; Pokorny, Christoph; Pichler, Gerald; Schippinger, Walter; Müller-Putz, Gernot R.

    2014-01-01

    Further development of an EEG based communication device for patients with disorders of consciousness (DoC) could benefit from addressing the following gaps in knowledge—first, an evaluation of different types of motor imagery; second, an evaluation of passive feet movement as a mean of an initial classifier setup; and third, rapid delivery of biased feedback. To that end we investigated whether complex and/or familiar mental imagery, passive, and attempted feet movement can be reliably detected in patients with DoC using EEG recordings, aiming to provide them with a means of communication. Six patients in a minimally conscious state (MCS) took part in this study. The patients were verbally instructed to perform different mental imagery tasks (sport, navigation), as well as attempted feet movements, to induce distinctive event-related (de)synchronization (ERD/S) patterns in the EEG. Offline classification accuracies above chance level were reached in all three tasks (i.e., attempted feet, sport, and navigation), with motor tasks yielding significant (p < 0.05) results more often than navigation (sport: 10 out of 18 sessions; attempted feet: 7 out of 14 sessions; navigation: 4 out of 12 sessions). The passive feet movements, evaluated in one patient, yielded mixed results: whereas time-frequency analysis revealed task-related EEG changes over neurophysiological plausible cortical areas, the classification results were not significant enough (p < 0.05) to setup an initial classifier for the detection of attempted movements. Concluding, the results presented in this study are consistent with the current state of the art in similar studies, to which we contributed by comparing different types of mental tasks, notably complex motor imagery and attempted feet movements, within patients. Furthermore, we explored new venues, such as an evaluation of passive feet movement as a mean of an initial classifier setup, and rapid delivery of biased feedback. PMID:25566029

  5. Front-Line Advocacy: Advocacy Based on Effective Relationships

    ERIC Educational Resources Information Center

    Gooden, Benny L.

    2012-01-01

    When American Association of School Administrators (AASA) and other membership organizations try to engage individuals in advocacy, a frequent exhortation is "Contact your representatives in Congress." Professional membership groups also stress that written communication is more powerful than phone calls to a representative's office, and they…

  6. Reorganization of equilibrium and movement control strategies in patients with knee arthritis.

    PubMed

    Viton, J M; Atlani, L; Mesure, S; Franceschi, J P; Massion, J; Delarque, A; Bardot, A

    1999-03-01

    The purpose of this study was to identify changes in equilibrium and movement control strategies in patients with arthritis of the knee. These strategies were expected to be different from those of healthy subjects because of the impairments caused by knee arthritis. The different phases of a side step were studied in patients with severe knee arthritis using a movement analysis system and force-plates. The duration of the postural phase and the intensity of the horizontal ground reaction forces during the postural phase were increased when the pathological limb was the supporting one. The monopodal phase was shortened on the pathological leg. These results show that knee arthritis patients develop new posturomotor strategies mainly aimed at shortening the monopodal phase when the affected leg is the supporting one. This movement analysis method enables quantification of differences that cannot be observed on clinical examination between knee arthritis patients and control subjects, and provides additional information to the usual clinical evaluation scales.

  7. Illusory movements of the contralesional hand in patients with body image disorders

    PubMed Central

    Zampini, M; Moro, V; Aglioti, S

    2004-01-01

    Methods: Ten RBD patients (three with disorders of bodily representations) were asked to report whether movements of their right hand induced any illusory somatic or motor sensations. Inquiries on anomalous sensation of movement of the left hand were carried out while subjects: 1) observed the moving hand in a mirror propped vertically along the parasagittal plane; 2) looked directly at the moving hand; 3) looked at the still hand; 4) kept their eyes closed. Twelve healthy subjects served as controls. Results: Movement of the right hand induced a very clear sensation of movement of the left, contralesional hand in two patients affected by body image disorders. Remarkably, this occurred mainly while subjects were looking in the mirror, that is, when conflicts between visual, somatic, and motor information were maximal. In no condition did control subjects report any consistent anomalous evoked movement or sensation. Conclusions: Illusory movements of the left, plegic hand contingent upon sensorimotor conflicts can be evoked in brain damaged patients with body image disorders. PMID:15489402

  8. A biological measure of stress levels in patients with functional movement disorders.

    PubMed

    Maurer, Carine W; LaFaver, Kathrin; Ameli, Rezvan; Toledo, Ryan; Hallett, Mark

    2015-09-01

    While the presence of co-existing psychological stressors has historically been used as a supportive factor in the diagnosis of functional neurological disorders, many patients with functional neurological disorders deny the presence of these stressors. The stress response circuitry in these patients remains largely unexplored. We performed an observational study examining biological stress levels in patients with functional movement disorders as compared with matched healthy controls. Specifically, we compared levels of circulating cortisol, the end-product of the hypothalamic-pituitary-adrenal axis. Salivary cortisol samples were collected from patients with "clinically definite" functional movement disorders (n = 33) and their age- and sex-matched controls (n = 33). Collections were performed at five standardized time points, reflecting participants' diurnal cortisol cycles. To rule out confounders, participants also underwent extensive psychological assessment including Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Hamilton Anxiety Rating Scale, and Hamilton Rating Scale for Depression. Patients with functional movement disorders did not differ from matched controls with respect to levels of circulating cortisol. We demonstrate that current stress levels are not altered in patients with functional movement disorders. Our results warrant careful review of current management of patients with functional neurological symptoms, and suggest that the insistence on heightened stress levels in these patients is unjustified. Published by Elsevier Ltd.

  9. Predicting Levels of Policy Advocacy Engagement Among Acute-Care Health Professionals.

    PubMed

    Jansson, Bruce S; Nyamathi, Adeline; Heidemann, Gretchen; Bird, Melissa; Ward, Cathy Rogers; Brown-Saltzman, Katherine; Duan, Lei; Kaplan, Charles

    2016-02-01

    This study aims to describe the factors that predict health professionals' engagement in policy advocacy. The researchers used a cross-sectional research design with a sample of 97 nurses, 94 social workers, and 104 medical residents from eight hospitals in Los Angeles. Bivariate correlations explored whether seven predictor scales were associated with health professionals' policy advocacy engagement and revealed that five of the eight factors were significantly associated with it (p < .05). The factors include patient advocacy engagement, eagerness, skills, tangible support, and organizational receptivity. Regression analysis examined whether the seven scales, when controlling for sociodemographic variables and hospital site, predicted levels of policy advocacy engagement. Results revealed that patient advocacy engagement (p < .001), eagerness (p < .001), skills (p < .01), tangible support (p < .01), perceived effectiveness (p < .05), and organizational receptivity (p < .05) all predicted health professional's policy advocacy engagement. Ethical commitment did not predict policy advocacy engagement. The model explained 36% of the variance in policy advocacy engagement. Limitations of the study and its implications for future research, practice, and policy are discussed. © The Author(s) 2016.

  10. A Novel Education and Training Program to Enhance Student Advocacy

    PubMed Central

    Matzke, Gary R.; McCall, Kenneth L.

    2015-01-01

    Objective. To develop and implement a unique student advocacy program to train student pharmacists to be effective advocates for the profession of pharmacy and the patients it serves. Design. The Academy is a 2-day program hosted annually in Washington, DC, that combines didactic presentations on the legislative process, communication with policymakers, current legislation, and active-learning exercises such as mock congressional visits. The Academy culminates with visits to Capitol Hill where students meet with legislators and their staff to discuss pending legislation. Assessment. Nearly 350 students from 43 schools and colleges of pharmacy completed the program in its 4 years. Students are assessed following the active-learning exercises and meetings with legislators. Conclusion. Advocacy has been listed as a competency that requires more attention in pharmacy education. The Academy provides a model that schools may replicate to enhance their advocacy offerings. PMID:27168608

  11. Breast cancer advocacy internships: student motivations, intentions, and perceptions.

    PubMed

    Trump, Tasha; Henderson, Jessica

    2011-03-01

    Currently, there are no published studies about the impact on students of a structured, breast-cancer-specific advocacy internship. Our goal was to provide the student perspective of participation in a national breast cancer advocacy conference in Washington, D.C. as part of an internship. Both qualitative and quantitative data were collected in three waves: 1 month before the training, during the training, and 1 month post-training. Four themes emerged: (1) empowerment, (2) connection with breast cancer patients and advocates, (3) learning outside the classroom, and (4) action through advocacy and civilian lobbying. This study found strong support for the internship model described here and is recommended for replication at other universities and institutions.

  12. Dance/movement therapy for improving psychological and physical outcomes in cancer patients.

    PubMed

    Bradt, Joke; Goodill, Sharon W; Dileo, Cheryl

    2011-10-05

    Current cancer care increasingly incorporates psychosocial interventions. Cancer patients use dance/movement therapy to learn to accept and reconnect with their bodies, build new self-confidence, enhance self-expression, address feelings of isolation, depression, anger and fear and to strengthen personal resources. To compare the effects of dance/movement therapy and standard care with standard care alone or standard care and other interventions in patients with cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, International Bibliography of Theatre and Dance, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials and the National Research Register (all to March 2011). We handsearched dance/movement therapy and related topics journals, reviewed reference lists and contacted experts. There was no language restriction. We included all randomized and quasi-randomized controlled trials of dance/movement therapy interventions for improving psychological and physical outcomes in patients with cancer. Two review authors independently extracted the data and assessed the methodological quality. Results were presented using standardized mean differences. We included two studies with a total of 68 participants. No evidence was found for an effect of dance/movement therapy on body image in women with breast cancer. The data of one study with moderate risk of bias suggested that dance/movement therapy had a large beneficial effect on participants' quality of life (QoL). The second trial reported a large beneficial effect on fatigue. However, this trial was at high risk of bias. The individual studies did not find support for an effect of dance/movement therapy on mood, distress,and mental health. It is unclear whether this was due to ineffectiveness of the treatment or limited power of the trials. Finally, the

  13. Walker's Sampler: Youth Advocacy Resources.

    ERIC Educational Resources Information Center

    Walker, Clarence; And Others

    This resource book, which provides a sampling of programs developed by the Youth Advocacy Projects of the Teacher Corps on behalf of troubled youth, is organized ln tbree major sections. Section I presents outlines, resources, and critiques of staff development courses, organized according to target youth group(s) and by subject area. Section II…

  14. Internal Process of Corporate Advocacy.

    ERIC Educational Resources Information Center

    Stout, Daniel A.

    1990-01-01

    Focuses on the preliminary process of corporate advocacy, which provides direction for issues management. Provides insights into: (1) the degree to which organizational spokespersons are willing to express a position on a variety of issues; (2) how such positions come to be advocated through organizational communication; and (3) how organizational…

  15. CEC Special Education Advocacy Handbook.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.

    This handbook, for individuals working with people who have disabilities, is designed to empower them to be a force for meeting the policy challenges in the communities in which they live and work. It is designed to help in channeling one's strength, commitment, and knowledge of the special education field into effective advocacy efforts. The…

  16. Comparison of Features for Movement Prediction from Single-Trial Movement-Related Cortical Potentials in Healthy Subjects and Stroke Patients.

    PubMed

    Kamavuako, Ernest Nlandu; Jochumsen, Mads; Niazi, Imran Khan; Dremstrup, Kim

    2015-01-01

    Detection of movement intention from the movement-related cortical potential (MRCP) derived from the electroencephalogram (EEG) signals has shown to be important in combination with assistive devices for effective neurofeedback in rehabilitation. In this study, we compare time and frequency domain features to detect movement intention from EEG signals prior to movement execution. Data were recoded from 24 able-bodied subjects, 12 performing real movements, and 12 performing imaginary movements. Furthermore, six stroke patients with lower limb paresis were included. Temporal and spectral features were investigated in combination with linear discriminant analysis and compared with template matching. The results showed that spectral features were best suited for differentiating between movement intention and noise across different tasks. The ensemble average across tasks when using spectral features was (error = 3.4 ± 0.8%, sensitivity = 97.2 ± 0.9%, and specificity = 97 ± 1%) significantly better (P < 0.01) than temporal features (error = 15 ± 1.4%, sensitivity: 85 ± 1.3%, and specificity: 84 ± 2%). The proposed approach also (error = 3.4 ± 0.8%) outperformed template matching (error = 26.9 ± 2.3%) significantly (P > 0.001). Results imply that frequency information is important for detecting movement intention, which is promising for the application of this approach to provide patient-driven real-time neurofeedback.

  17. Management, leadership, and user control in self-advocacy: an english case study.

    PubMed

    Tilley, Elizabeth

    2013-12-01

    This paper presents findings from a qualitative research project on an English self-advocacy organization. In light of recent political and economic developments that have threatened the sustainability of a number of self-advocacy groups for people with intellectual disability, I seek to explore how one particular organization managed to survive and grow. In particular, the paper explores themes of management, leadership, and user control, linking these to external perceptions about self-advocacy organizations. The organization in my study developed an "interdependent" governance model based on key organizational roles for nondisabled advisors and self-advocates, which proved popular with external funders. Despite the organization's notable achievements, its success raises questions for the wider self-advocacy movement, notably how leadership capacity can be developed among self-advocates.

  18. Measurement of mandibular movements in parafunctional patient using occlusal splint with Bragg gratings: pilot study

    NASA Astrophysics Data System (ADS)

    Franco, Ana Paula G. O.; Gebert, Andréa. O.; Souza, Mauren A.; Jeranoski, Lorena; Kalinowski, Hypolito J.; Abe, Ilda

    2016-05-01

    The aim of the study is to demonstrate the potential of the fibre Braggs grating (FBG) in the measurement of different jaw movements that are performed for patients with occlusal parafunction using occlusal splints. Two silicon plates each 2mm are used, the fibre optic sensor is positioned in the maxillary left first molar region above the point of contact with opposing tooth after pressing the first plate on the model. Then the second silicon plate is pressed. The device has a final thickness of 2 mm. The occlusal splint is installed in the mouth of the patient who underwent different movements on occlusal splint. The maximum frequency bite is monitored. The results demonstrate that the bite shows a difference between grinding and clenching movements. The curves behaviour patterns are presented in order to show these different comparisons. Therefore, it is concluded that the fibre Braggs grating consists in an efficient method for monitoring the mechanical behaviour bite of patients with occlusal splints.

  19. Movement and Other Neurodegenerative Syndromes in Patients with Systemic Rheumatic Diseases

    PubMed Central

    Menezes, Rikitha; Pantelyat, Alexander; Izbudak, Izlem; Birnbaum, Julius

    2015-01-01

    Abstract Patients with rheumatic diseases can present with movement and other neurodegenerative disorders. It may be underappreciated that movement and other neurodegenerative disorders can encompass a wide variety of disease entities. Such disorders are strikingly heterogeneous and lead to a wider spectrum of clinical injury than seen in Parkinson's disease. Therefore, we sought to stringently phenotype movement and other neurodegenerative disorders presenting in a case series of rheumatic disease patients. We integrated our findings with a review of the literature to understand mechanisms which may account for such a ubiquitous pattern of clinical injury. Seven rheumatic disease patients (5 Sjögren's syndrome patients, 2 undifferentiated connective tissue disease patients) were referred and could be misdiagnosed as having Parkinson's disease. However, all of these patients were ultimately diagnosed as having other movement or neurodegenerative disorders. Findings inconsistent with and more expansive than Parkinson's disease included cerebellar degeneration, dystonia with an alien-limb phenomenon, and nonfluent aphasias. A notable finding was that individual patients could be affected by cooccurring movement and other neurodegenerative disorders, each of which could be exceptionally rare (ie, prevalence of ∼1:1000), and therefore with the collective probability that such disorders were merely coincidental and causally unrelated being as low as ∼1-per-billion. Whereas our review of the literature revealed that ubiquitous patterns of clinical injury were frequently associated with magnetic resonance imaging (MRI) findings suggestive of a widespread vasculopathy, our patients did not have such neuroimaging findings. Instead, our patients could have syndromes which phenotypically resembled paraneoplastic and other inflammatory disorders which are known to be associated with antineuronal antibodies. We similarly identified immune-mediated and inflammatory markers

  20. Functional asymmetries in the movement kinematics of patients with Tourette's syndrome

    PubMed Central

    Georgiou, N.; Bradshaw, J.; Phillips, J.; Cunnington, R.; Rogers, M.

    1997-01-01

    OBJECTIVES—This study adopted a concurrent task design and aimed to quantify the efficiency and smoothness of voluntary movement in Tourette's syndrome via the use of a graphics tablet which permits analysis of movement profiles. In particular, the aim was to ascertain whether a concurrent task (digit span) would affect the kinematics of goal directed movements, and whether patients with Tourette's syndrome would exhibit abnormal functional asymmetries compared with their matched controls.
Methods—Twelve patients with Tourette's syndrome and their matched controls performed 12 vertical zig zag movements, with both left and right hands (with and without the concurrent task), to large or small targets over long or short extents. 
Results—With short strokes, controls showed the predicted right hand superiority in movement time more strongly than patients with Tourette's syndrome, who instead showed greater hand symmetry with short strokes. The right hand of controls was less force efficient with long strokes and more force efficient with short strokes, whereas either hand of patients with Tourette's syndrome was equally force efficient, irrespective of stroke length, with an overall performance profile similar to but better than that of the controls' left hand. The concurrent task, however, increased the force efficiency of the right hand in patients with Tourette's syndrome and the left hand in controls.
Conclusions—Patients with Tourette's syndrome, compared with controls, were not impaired in the performance of fast, goal directed movements such as aiming at targets; they performed in certain respects better than controls. The findings clearly add to the growing literature on anomalous lateralisation in Tourette's syndrome, which may be explained by the recently reported loss of normal basal ganglia asymmetries in that disorder.

 PMID:9285457

  1. Rate-dependent impairments in repetitive finger movements in patients with Parkinson's disease are not due to peripheral fatigue.

    PubMed

    Stegemöller, Elizabeth L; Allen, David P; Simuni, Tanya; MacKinnon, Colum D

    2010-09-20

    Performance of repetitive finger movements is an important clinical measure of disease severity in patients with Parkinson's disease (PD) and is associated with a dramatic deterioration in performance at movement rates near 2 Hz and above. The mechanisms contributing to this rate-dependent movement impairment are poorly understood. Since clinical and experimental testing of these movements involve prolonged repetition of movement, a loss of force-generating capacity due to peripheral fatigue may contribute to performance deterioration. This study examined the contribution of peripheral fatigue to the performance of unconstrained index finger flexion movements by measuring maximum voluntary contractions (MVC) immediately before and after repetitive finger movements in patients with PD (both off- and on-medication) and matched control subjects. Movement performance was quantified using finger kinematics, maximum force production, and electromyography (EMG). The principal finding was that peak force and EMG activity during the MVC did not significantly change from the pre- to post-movement task in patients with PD despite the marked deterioration in movement performance of repetitive finger movements. These findings show that the rate-dependent deterioration of repetitive finger movements in PD cannot be explained by a loss of force-generating capacity due to peripheral fatigue, and further suggest that mechanisms contributing to impaired isometric force production in PD are different from those that mediate impaired performance of high-rate repetitive movements.

  2. Higher Prevalence of Periodic Limb Movements of Sleep in Patients with History of Stroke

    PubMed Central

    Coelho, Fernando Morgadinho Santos; Georgsson, Hlynur; Narayansingh, Marc; Swartz, Richard H.; Murray, Brian J.

    2010-01-01

    Study Objectives: The association between obstructive sleep apnea and stroke is well established. Less is known about the relationship between stroke and periodic limb movements of sleep (PLMS). This study sought to assess the frequency of PLMS in patients with a history of stroke. Methods: We reviewed the medical and polysomnographic records of 40 patients with a history of stroke and 40 control patients matched for age, sex, and risk factors. Results: 19 patients with a history of stroke (47.5%) and 5 control patients (12.5%) had a PLMS index > 5/h (p < 0.001). The average PLMS index was also lower in control patients than patients with stroke (1.9 ± 0.7 and 11.7 ± 3.4; p = 0.006). Conclusions: Our patients with a history of stroke had a greater prevalence and severity of PLMS than control patients. These limb movements may have implications for secondary stroke prevention as well as stroke recovery. Citation: Coelho FMS; Georgsson H; Narayansingh M; Swartz RH; Murray BJ. Higher prevalence of periodic limb movements of sleep in patients with history of stroke. J Clin Sleep Med 2010;6(5):428-430. PMID:20957841

  3. Movement disorders are associated with schizotypy in unaffected siblings of patients with non-affective psychosis.

    PubMed

    Koning, J P; Tenback, D E; Kahn, R S; Vollema, M G; Cahn, W; van Harten, P N

    2011-10-01

    Movement disorders and schizotypy are both prevalent in unaffected siblings of patients with schizophrenia and both are associated with the risk of developing psychosis or schizophrenia. However, to date there has been no research into the association between these two vulnerability factors in persons with an increased genetic risk profile. We hypothesized that unaffected siblings of patients with non-affective psychosis have more movement disorders and schizotypy than healthy controls and that these co-occur. In a cross-sectional design we assessed the prevalence and inter-relationship of movement disorders and schizotypy in 115 unaffected siblings (mean age 27 years, 44% males) and 100 healthy controls (mean age 26 years, 51% males). Movement disorders were measured with the Abnormal Involuntary Movement Scale (AIMS), the Unified Parkinson Disease Rating Scale (UPDRS), the Barnes Akathisia Rating Scale (BARS), and one separate item for dystonia. Schizotypy was assessed with the Structured Interview for Schizotypy--Revised (SIS-R). There were significant differences in the prevalence of movement disorders in unaffected siblings versus healthy controls (10% v. 1%, p<0.01) but not in the prevalence of schizotypy. Unaffected siblings with a movement disorder displayed significantly more positive and total schizotypy (p=0.02 and 0.03 respectively) than those without. In addition, dyskinesia correlated with positive schizotypy (r=0.51, p=0.02). The association between movement disorders (dyskinesia in particular) with positive and total schizotypy in unaffected siblings suggests that certain vulnerability factors for psychosis or schizophrenia cluster in a subgroup of subjects with an increased genetic risk of developing the disease.

  4. [Movement analysis of upper extremity hemiparesis in patients with cerebrovascular disease: a pilot study].

    PubMed

    Molina Rueda, F; Rivas Montero, F M; Pérez de Heredia Torres, M; Alguacil Diego, I M; Molero Sánchez, A; Miangolarra Page, J C

    2012-01-01

    As a result of neurophysiological injury, stroke patients have mobility limitations, mainly on the side of the body contralateral to the lesioned hemisphere. The purpose of this study is to quantify motor compensation strategies in stroke patients during the activity of drinking water from a glass. Four male patient with cerebrovascular disease and four right-handed, healthy male control subjects. The motion analysis was conducted using the Vicon Motion System(®) and surface electromyography equipment ZeroWire Aurion(®). We analysed elbow, shoulder and trunk joint movements and performed a qualitative analysis of the sequence of muscle activation. Trunk, shoulder and elbow movements measured in the stroke patient along the sagittal plane decreased during the drinking from a glass activity, while the movements in the shoulder in the coronal plane and trunk increased. As for the sequence of muscle activation, anterior, middle and posterior deltoid all contracted in the patient group during the task, while the upper trapezius activation remained throughout the activity. Quantitative analysis of movement provides quantitative information on compensation strategies used by stroke patients, and is therefore, clinically relevant. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  5. Periodic leg movements during sleep in narcoleptic patients with or without restless legs syndrome.

    PubMed

    Plazzi, Giuseppe; Ferri, Raffaele; Franceschini, Christian; Vandi, Stefano; Detto, Stefania; Pizza, Fabio; Poli, Francesca; De Cock, Valérie C; Bayard, Sophie; Dauvilliers, Yves

    2012-04-01

    We compared periodic and non-periodic leg movements during sleep and polysomnography in patients with narcolepsy with cataplexy (NC) with or without restless legs syndrome (RLS) with matched idiopathic RLS (iRLS) and control subjects. We enrolled 100 patients with NC: 17 having RLS were compared with 34 sex- and age-matched patients without RLS and with 17 normal controls and 17 iRLS subjects. Periodic leg movements were highest in iRLS and lowest in controls, with those in NC with RLS very close to iRLS, but higher than those in NC without RLS. The periodicity indexes showed the highest value in iRLS followed by NC with or without RLS and, finally, by controls. The inter-leg movement intervals peaked between 10 and 50 s in NC with RLS and in iRLS, the former did not display the nocturnal gradual decrease of periodic leg movements typical of iRLS. Periodic leg movements during sleep and polysomnography displayed specific features in RLS and NC, respectively, with NC with RLS showing an intermediate pattern. Even if RLS is only detected by targeted interview in NC, its frequency and impact on night-time sleep architecture and continuity suggest that this condition should be routinely searched for in NC. © 2011 European Sleep Research Society.

  6. The effects of bilateral movement training on upper limb function in chronic stroke patients

    PubMed Central

    Han, Kyoung Ju; Kim, Jin Young

    2016-01-01

    [Purpose] This study compared the functional and kinematic changes associated with two rehabilitation protocols: bilateral and unilateral movement training. [Subjects and Methods] Twenty-five patients with chronic stroke were randomly assigned to two training protocols for four weeks of training. Each training session consisted of three tasks. The tasks were performed with either the impaired and unimpaired arms moving synchronously (bilateral training) or with the impaired arm alone (unilateral training). To compare the changes associated with each rehabilitation protocol, functional and kinematic assessments were performed before and after the interventions. The functional state of each patient was measured by the Box and Block Test, and the kinematic variables were assessed by three-dimensional motion analysis. The Box and Block Test was used to assess the functional abilities of the affected upper limb. Kinematic measurements of upper limb movement were measured with a 3-dimensional motion analysis system. [Results] Results showed that the bilateral movement group had significantly improved motion of the shoulder compared to the unilateral movement group. [Conclusion] Bilateral movement training should be used to improve upper limb function in patients with chronic stroke. PMID:27630418

  7. Effects of constraint-induced movement therapy on spasticity in patients with hemiparesis after stroke.

    PubMed

    Kagawa, Shinji; Koyama, Tetsuo; Hosomi, Masashi; Takebayashi, Takashi; Hanada, Keisuke; Hashimoto, Fumiaki; Domen, Kazuhisa

    2013-05-01

    We sought to examine the effects of constraint-induced movement therapy on spasticity in patients with hemiparesis after stroke in 10 patients with chronic hemiparesis in their upper extremities. Patients underwent a modified version of constraint-induced movement therapy (5 hours daily for 10 weekdays over 2 consecutive weeks). Motor function was assessed by the Fugl-Meyer Assessment, Wolf Motor Function Test, and the Motor Activity Log. Spasticity was assessed by the modified Ashworth scale and electromyography (F frequency, mean F/M ratio). These assessments were obtained immediately before and after the 2-week intervention. Wilcoxon rank sum tests were performed on these data (P < .05). Constraint-induced movement therapy significantly improved hand and arm function as indicated by the Fugl-Meyer Assessment, Wolf Motor Function Test, and the Motor Activity Log scores. Constraint-induced movement therapy also reduced spasticity as assessed by the modified Ashworth scale, F frequency, and mean F/M ratio. Comparable to motor function, constraint-induced movement therapy effectively reduces spasticity as confirmed by electromyography. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Dams and transnational advocacy: Political opportunities in transnational collective action

    NASA Astrophysics Data System (ADS)

    Fu, Teng

    Possible arguments to explain the gradual decline in big dam development and its site transferring from developed to developing countries include technical, economic, and political factors. This study focuses on the political argument---the rise of transnational anti-dam advocacy and its impact on state policy-making. Under what conditions does transnational anti-dam advocacy matter? Under what conditions does transnational advocacy change state dam policies (delay, scale down, or cancel)? It examines the role of transnational anti-dam actors in big dam building in a comparative context in Asia. Applying the social movement theory of political opportunity structure (POS) and using the qualitative case-study method, the study provides both within-case and cross-case analyses. Within-case analysis is utilized to explain the changing dynamics of big dam building in China (Three Gorges Dam and proposed Nu/Salween River dam projects), and to a lesser extent, Sardar Sarovar Project in India and Nam Theun 2 Dam in Laos. Different domestic and international POS (DPOS and IPOS) impact the strategies and outcomes of anti-dam advocacies in these countries. The degree of openness of the POS directly affects the capacity of transnational efforts in influencing state dam policies. The degree of openness or closure is measured by specific laws, institutions, discourse, or elite allies (or the absence of these) for the participation of non-state actors on big dam issues at a particular moment. This degree of openness is relative, varying over time, across countries and regions. This study finds that the impact of transnational anti-dam activism is most effective when both DPOS and IPOS are relatively open. Transnational anti-dam advocacy is least effective in influencing state dam policies when both DPOS and IPOS are relatively closed. Under a relatively open DPOS and closed IPOS, transnational anti-dam advocacy is more likely to successfully change state dam policies and even

  9. Predicting Recovery of Voluntary Upper Extremity Movement in Subacute Stroke Patients with Severe Upper Extremity Paresis

    PubMed Central

    Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

    2015-01-01

    Background and Objective Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Design Prospective cohort study. Methods 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DCSTREAM-UE) and changes between admission and discharge (ΔSTREAM-UE), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. Results The participants showed wide variation in both DCSTREAM-UE and ΔSTREAM-UE. 3.6% of the participants almost fully recovered at discharge (DCSTREAM-UE > 15). A large improvement (ΔSTREAM-UE >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DCSTREAM-UE (R2 = 35.0%) were ‘baseline STREAM-UE score’, ‘hemorrhagic stroke’, ‘baseline National Institutes of Health Stroke Scale (NIHSS) score’, and ‘cortical lesion excluding primary motor cortex’. The three predictors for the ΔSTREAM-UE (R2 = 22.0%) were ‘hemorrhagic stroke’, ‘baseline NIHSS score’, and ‘cortical lesion excluding primary motor cortex’. Conclusions Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients

  10. Antiscience and ethical concerns associated with advocacy of Lyme disease

    PubMed Central

    Auwaerter, Paul G; Bakken, Johan S; Dattwyler, Raymond J; Dumler, J Stephen; Halperin, John J; McSweegan, Edward; Nadelman, Robert B; O’Connell, Susan; Shapiro, Eugene D; Sood, Sunil K; Steere, Allen C; Weinstein, Arthur; Wormser, Gary P

    2015-01-01

    Advocacy for Lyme disease has become an increasingly important part of an antiscience movement that denies both the viral cause of AIDS and the benefits of vaccines and that supports unproven (sometimes dangerous) alternative medical treatments. Some activists portray Lyme disease, a geographically limited tick-borne infection, as a disease that is insidious, ubiquitous, difficult to diagnose, and almost incurable; they also propose that the disease causes mainly non-specific symptoms that can be treated only with long-term antibiotics and other unorthodox and unvalidated treatments. Similar to other antiscience groups, these advocates have created a pseudoscientific and alternative selection of practitioners, research, and publications and have coordinated public protests, accused opponents of both corruption and conspiracy, and spurred legislative efforts to subvert evidence-based medicine and peer-reviewed science. The relations and actions of some activists, medical practitioners, and commercial bodies involved in Lyme disease advocacy pose a threat to public health. PMID:21867956

  11. Perspective of an advocate: a case and framework for research advocacy in Africa

    PubMed Central

    2013-01-01

    In making an experience-based case for research advocacy in Africa and suggesting a framework for building it, this paper covers factors such as basic tenets of patient advocacy, key components and urgent needs in building strong research advocacy, concepts and approaches from which guidance might be taken, and the feasibility of its development and growth throughout the continent. Research advocacy is defined as the meaningful engagement of patient advocates and their representatives in the research system. As the clinical research system in Africa is developing and gaining strength, this is an opportune time for research advocacy to form and take root as an embedded component in the research structures on the continent. That is, the current state of development of the research system and the simultaneous interest in and rise of patient advocacy bode well for the likelihood of developing robust research advocacy, suggesting its feasibility. Even so, several developments are urgently needed to build, shore up, and sustain a framework receptive to maximizing the influence of an active network of patient advocates—many training in the subspecialty of research advocacy—and a research structure that supports and embeds advocate engagement. PMID:23902629

  12. Increasing speed to improve arm movement and standing postural control in Parkinson's disease patients when catching virtual moving balls.

    PubMed

    Su, Kuei-Jung; Hwang, Wen-Juh; Wu, Ching-yi; Fang, Jing-Jing; Leong, Iat-Fai; Ma, Hui-Ing

    2014-01-01

    Research has shown that moving targets help Parkinson's disease (PD) patients improve their arm movement while sitting. We examined whether increasing the speed of a moving ball would also improve standing postural control in PD patients during a virtual reality (VR) ball-catching task. Twenty-one PD patients and 21 controls bilaterally reached to catch slow-moving and then fast-moving virtual balls while standing. A projection-based VR system connected to a motion-tracking system and a force platform was used. Dependent measures included the kinematics of arm movement (movement time, peak velocity), duration of anticipatory postural adjustments (APA), and center of pressure (COP) movement (movement time, maximum amplitude, and average velocity). When catching a fast ball, both PD and control groups made arm movements with shorter movement time and higher peak velocity, longer APA, as well as COP movements with shorter movement time and smaller amplitude than when catching a slow ball. The change in performance from slow- to fast-ball conditions was not different between the PD and control groups. The results suggest that raising the speed of virtual moving targets should increase the speed of arm and COP movements for PD patients. Therapists, however, should also be aware that a fast virtual moving target causes the patient to confine the COP excursion to a smaller amplitude. Future research should examine the effect of other task parameters (e.g., target distance, direction) on COP movement and examine the long-term effect of VR training.

  13. Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients

    PubMed Central

    Liao, Chien-Fen; Liaw, Lih-Jiun; Wang, Ray-Yau; Su, Fong-Chin; Hsu, Ar-Tyan

    2015-01-01

    [Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke. PMID:26504267

  14. Group demographics in the mental patient movement: group location, age, and size as structural factors.

    PubMed

    Emerick, R E

    1989-01-01

    This paper presents a descriptive overview of the mental patient selfhelp movement based on a sample of 104 groups. Groups are classified in terms of group structure, group affiliation, and evaluation of psychiatry and are then described in a demographic profile that includes the factors of location, age and size. After a review of the literature on functional models of selfhelp groups, the mental patient movement is shown to be composed of groups with widely varying political philosophies-from radical "separatist" groups promoting consciousness-raising, empowerment, and social reform to conservative "partnership" groups that emphasize individual reform through "alternative therapy". The movement is shown to be increasingly dominated by moderate "supportive" groups and, as such, is characterized as a true client-controlled social or "community" alternative to the professionally-controlled medical programs that dominate the mental health system today.

  15. Improvement of exploratory eye movements in schizophrenic patients during recovery period.

    PubMed

    Nakayama, Hironobu; Morita, Kiichiro; Mori, Keiichiro; Hirai, Sou; Maeda, Hisao

    2003-04-01

    In the present paper exploratory eye movements were examined as biologic markers in both acute schizophrenic patients (acute patients discharged after approximately 3 months and treated as outpatients, n = 8; acute patients who were still in hospital after 6 months, n = 8) and chronic schizophrenic patients (hospital stay >5 years, n = 15) in comparison with age-matched healthy subjects (n = 30). Using an eye-mark recorder, exploratory eye movements were analyzed for mean gazing time (MGT), and total eye scanning length (TESL) as subjects viewed six simple pictures in preparation for copying them. In acute schizophrenic patients discharged after 6 months (DP), MGT became significantly shorter and TESL became longer after 3 or 6 months treatment. In acute schizophrenic patients during admission after 6 months, TESL became longer after 3 or 6 months of treatment. However, no significant changes were observed in chronic patients in these measures. In schizophrenic patients, negative symptom scores were positively correlated with MGT (r = 0.43; P < 0.001), and negatively correlated with TESL (r = -45; P < 0.001). These findings suggest that exploratory eye movements are a biologic state and trait marker useful for evaluation of schizophrenia.

  16. Motor imagery training improves precision of an upper limb movement in patients with hemiparesis.

    PubMed

    Grabherr, Luzia; Jola, Corinne; Berra, Gilberto; Theiler, Robert; Mast, Fred W

    2015-01-01

    In healthy participants, beneficial effects of motor imagery training on movement execution have been shown for precision, strength, and speed. In the clinical context, it is still debated whether motor imagery provides an effective rehabilitation technique in patients with motor deficits. To compare the effectiveness of two different types of movement training: motor imagery vs. motor execution. Twenty-five patients with hemiparesis were assigned to one of two training groups: the imagery or the execution-training group. Both groups completed a baseline test before they received six training sessions, each of which was followed by a test session. Using a novel and precisely quantifiable test, we assessed how accurately patients performed an upper limb movement. Both training groups improved performance over the six test sessions but the improvement was significantly larger in the imagery group. That is, the imagery group was able to perform more precise movements than the execution group after the sixth training session while there was no difference at the beginning of the training. The results provide evidence for the benefit of motor imagery training in patients with hemiparesis and thus suggest the integration of cognitive training in conventional physiotherapy practice.

  17. Research Advocacy at NCI

    Cancer.gov

    The patient perspective research advocates brings into NCI’s research enterprise helps to inform research focus and support the dissemination of results that lead to new and better cancer prevention, detection, and treatment methods.

  18. Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation.

    PubMed

    Gaffney, Brecca M; Murray, Amanda M; Christiansen, Cory L; Davidson, Bradley S

    2016-03-01

    Patients with unilateral dysvascular transtibial amputation (TTA) have a higher risk of developing low back pain than their healthy counterparts, which may be related to movement compensations used in the absence of ankle function. Assessing components of segmental angular momentum provides a unique framework to identify and interpret these movement compensations alongside traditional observational analyses. Angular momentum separation indicates two components of total angular momentum: (1) transfer momentum and (2) rotational momentum. The objective of this investigation was to assess movement compensations in patients with dysvascular TTA, patients with diabetes mellitus (DM), and healthy controls (HC) by examining patterns of generating and arresting trunk and pelvis segmental angular momenta during gait. We hypothesized that all groups would demonstrate similar patterns of generating/arresting total momentum and transfer momentum in the trunk and pelvis in reference to the groups (patients with DM and HC). We also hypothesized that patients with amputation would demonstrate different (larger) patterns of generating/arresting rotational angular momentum in the trunk. Patients with amputation demonstrated differences in trunk and pelvis transfer angular momentum in the sagittal and transverse planes in comparison to the reference groups, which indicates postural compensations adopted during walking. However, patients with amputation demonstrated larger patterns of generating and arresting of trunk and pelvis rotational angular momentum in comparison to the reference groups. These segmental rotational angular momentum patterns correspond with high eccentric muscle demands needed to arrest the angular momentum, and may lead to consequential long-term effects such as low back pain.

  19. Adaptive Patterns of Movement during Downward Reach and Pick-up Movements in Knee Osteoarthritis Patients with Mild Low Back Pain

    PubMed Central

    Huang, Hsuan-Ti; Liang, Jing-Min; Hung, Wei-Tso; Guo, Lan-Yuen; Wu, Wen-Lan

    2014-01-01

    [Purpose] Patients with severe bilateral knee osteoarthritis (KOA) often suffer from low back pain (LBP). However, few studies have examined the relationship between LBP and KOA in downward reach and pick-up movements. [Subjects] Eight KOA patients with LBP (LBP group), 8 KOA patients without LBP (NLBP group), and 7 healthy participants (Control group), without osteoarthritis or low back pain, were recruited for this study. [Methods] All subjects were asked to pick up a bottle with one hand, placed at the diagonal on the opposite side of the body. A 3D motion analysis system was used to record trunk and lower limb movements. [Results] The knee flexion angle on the side ipsilateral to the bottle was significantly smaller in both KOA groups than in the controls in the downward reach and pick-up movements. KOA patients showed a significantly lower trunk flexion angle and greater pelvis anterior tilt angle than the controls. In addition, no significant differences were found between the LBP and NLBP group. [Conclusion] We suspect that severe knee pain due to OA determines the priority of movement in strategic planning for the execution of pick-up movements. The knee strategy was abandoned by our severe knee OA patients, even when they had mild LBP. PMID:25364103

  20. Scaling of the size of the first agonist EMG burst during rapid wrist movements in patients with Parkinson's disease.

    PubMed

    Berardelli, A; Dick, J P; Rothwell, J C; Day, B L; Marsden, C D

    1986-11-01

    Rapid wrist flexion movements were studied in a group of 10 patients with Parkinson's disease both on and off their normal drug therapy, and were compared with the same movements made by a group of eight normal individuals. When normal subjects made movements through 60 degrees, the first agonist burst of EMG activity in the wrist flexor muscles was longer and larger than that seen in movements of 15 degrees. If a large opposing load of 2.2 Nm was added, this also increased the size and duration of the first agonist EMG burst. Although the movements made by the patients were slower than those of normals, the size and duration of the first agonist EMG burst changed with movement size and added load in the normal way. This shows that patients can produce large, long bursts of EMG activity, but that there is a failure to match these parameters appropriately to the size of movement required. The effect of levodopa therapy on the movements was not dramatic. Although patients produced faster wrist movements when on medication than when off, the change was relatively small compared with the change seen in their overall clinical rating. Changes in the velocity of movements at a single joint are not a good reflection of the overall clinical state of patients with Parkinson's disease.

  1. Discrete and dynamic scaling of the size of continuous graphic movements of parkinsonian patients and elderly controls.

    PubMed

    Longstaff, M G; Mahant, P R; Stacy, M A; Van Gemmert, A W A; Leis, B C; Stelmach, G E

    2003-03-01

    To systematically investigate the ability of Parkinson's disease patients to discretely and dynamically scale the size of continuous movements and to assess the impact of movement size on outcome variability. Ten patients with Parkinson's disease (mean age 72 years) were compared with 12 healthy elderly controls (mean age 70 years). The subjects wrote with a stylus on a graphics tablet. In experiment 1 they drew circles, matching the size of five target circles ranging in magnitude from a radius of 0.5 cm up to 2.5 cm. In experiment 2 they drew spirals with a radius of at least 2 cm. In both experiments the drawings were initially performed as accurately as possible then as fast and accurately as possible. In both experiments the patients and controls drew at a similar speed. The within trial variability of the pen trajectory was greater for patients than controls, and increased disproportionately with the size of the movement. When the emphasis was on size rather than variability (circles), the patients' drawing movements were the same size as controls. When the emphasis was on accuracy of pen trajectory (that is, minimum variability) rather than size (spirals), the patients' drawing movements were smaller than controls. The movements made by Parkinson's disease patients are hypometric partly as an adaptive strategy used to reduce movement variability. This strategy is used primarily when the requirement to make accurate movements outweighs the need to make large movements.

  2. Discrete and dynamic scaling of the size of continuous graphic movements of parkinsonian patients and elderly controls

    PubMed Central

    Longstaff, M; Mahant, P; Stacy, M; Van Gemmert, A W A; Leis, B; Stelmach, G

    2003-01-01

    Objectives: To systematically investigate the ability of Parkinson's disease patients to discretely and dynamically scale the size of continuous movements and to assess the impact of movement size on outcome variability. Methods: Ten patients with Parkinson's disease (mean age 72 years) were compared with 12 healthy elderly controls (mean age 70 years). The subjects wrote with a stylus on a graphics tablet. In experiment 1 they drew circles, matching the size of five target circles ranging in magnitude from a radius of 0.5 cm up to 2.5 cm. In experiment 2 they drew spirals with a radius of at least 2 cm. In both experiments the drawings were initially performed as accurately as possible then as fast and accurately as possible. Results: In both experiments the patients and controls drew at a similar speed. The within trial variability of the pen trajectory was greater for patients than controls, and increased disproportionately with the size of the movement. When the emphasis was on size rather than variability (circles), the patients' drawing movements were the same size as controls. When the emphasis was on accuracy of pen trajectory (that is, minimum variability) rather than size (spirals), the patients' drawing movements were smaller than controls. Conclusions: The movements made by Parkinson's disease patients are hypometric partly as an adaptive strategy used to reduce movement variability. This strategy is used primarily when the requirement to make accurate movements outweighs the need to make large movements. PMID:12588912

  3. Eye movements as probes of lexico-semantic processing in a patient with primary progressive aphasia.

    PubMed

    Seckin, Mustafa; Mesulam, M-Marsel; Rademaker, Alfred W; Voss, Joel L; Weintraub, Sandra; Rogalski, Emily J; Hurley, Robert S

    2016-01-01

    Eye movement trajectories during a verbally cued object search task were used as probes of lexico-semantic associations in an anomic patient with primary progressive aphasia. Visual search was normal on trials where the target object could be named but became lengthy and inefficient on trials where the object failed to be named. The abnormality was most profound if the noun denoting the object could not be recognized. Even trials where the name of the target object was recognized but not retrieved triggered abnormal eye movements, demonstrating that retrieval failures can have underlying associative components despite intact comprehension of the corresponding noun.

  4. What can eye movements tell us about Symbol Digit substitution by patients with schizophrenia?

    PubMed

    Elahipanah, Ava; Christensen, Bruce K; Reingold, Eyal M

    2011-04-01

    Substitution tests are sensitive to cognitive impairment and reliably discriminate patients with schizophrenia from healthy individuals better than most other neuropsychological instruments. However, due to their multifaceted nature, substitution test scores cannot pinpoint the specific cognitive deficits that lead to poor performance. The current study investigated eye movements during performance on a substitution test in order to better understand what aspect of substitution test performance underlies schizophrenia-related impairment. Twenty-five patients with schizophrenia and 25 healthy individuals performed a computerized version of the Symbol Digit Modalities Test while their eye movements were monitored. As expected, patients achieved lower overall performance scores. Moreover, analysis of participants' eye movements revealed that patients spent more time searching for the target symbol every time they visited the key area. Patients also made more visits to the key area for each response that they made. Regression analysis suggested that patients' impaired performance on substitution tasks is primarily related to a less efficient visual search and, secondarily, to impaired memory. Copyright © 2010 Elsevier B.V. All rights reserved.

  5. Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome.

    PubMed

    Wang, Yuexiang; Filius, Anika; Zhao, Chunfeng; Passe, Sandra M; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C

    2014-04-01

    Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in patients with CTS. The purpose of this study was to evaluate the deformability and mobility of the median nerve in patients with CTS compared to healthy subjects. Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Shape and position of initial and final median nerve were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter, and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. The deformation ratio for circularity was significantly less in patients with CTS compared to healthy subjects during wrist flexion (P < .05). The mean vector of median nerve displacement during wrist flexion was significantly different between patients with CTS and healthy subjects (P < .05). The displacement magnitude of the median nerve was found to be less in patients with CTS compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Patients with CTS differ from normal subjects with regard to mobility and deformability of the median nerve. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  6. Altered Median Nerve Deformation and Transverse Displacement during Wrist Movement in Patients with Carpal Tunnel Syndrome

    PubMed Central

    Wang, Yuexiang; Filius, Anika; Zhao, Chunfeng; Passe, Sandra M.; Thoreson, Andrew R.; An, Kai-Nan; Amadio, Peter C.

    2014-01-01

    Rationale and Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in CTS patients. The purpose of this study was to evaluate the deformability and mobility of the median nerve in CTS patients compared to healthy subjects. Materials and Methods: Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Initial and final median nerve shape and position were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. Results: The deformation ratio for circularity was significant less in CTS patients compared to healthy subjects during wrist flexion (P<0.05). The mean vector of median nerve displacement during wrist flexion was significantly different between CTS patients and healthy subjects (P<0.05). The displacement magnitude of the median nerve was found to be less in CTS patients compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Conclusions: CTS Patients differ from normal subjects with regard to mobility and deformability of the median nerve. PMID:24594417

  7. Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea.

    PubMed

    Kim, Keun Tae; Motamedi, Gholam K; Cho, Yong Won

    2017-08-01

    There have been few quality of life studies in patients with idiopathic rapid eye movement sleep behaviour disorder. We compared the quality of life in idiopathic rapid eye movement sleep behaviour disorder patients to healthy controls, patients with hypertension, type 2 diabetes mellitus without complication and idiopathic restless legs syndrome. Sixty patients with idiopathic rapid eye movement sleep behaviour disorder (24 female; mean age: 61.43 ± 8.99) were enrolled retrospectively. The diagnosis was established based on sleep history, overnight polysomnography, neurological examination and Mini-Mental State Examination to exclude secondary rapid eye movement sleep behavior disorder. All subjects completed questionnaires, including the Short Form 36-item Health Survey for quality of life. The total quality of life score in idiopathic rapid eye movement sleep behaviour disorder (70.63 ± 20.83) was lower than in the healthy control group (83.38 ± 7.96) but higher than in the hypertension (60.55 ± 24.82), diabetes mellitus (62.42 ± 19.37) and restless legs syndrome (61.77 ± 19.25) groups. The total score of idiopathic rapid eye movement sleep behaviour disorder patients had a negative correlation with the Pittsburg Sleep Quality Index (r = -0.498, P < 0.001), Insomnia Severity Index (r = -0.645, P < 0.001) and the Beck Depression Inventory-2 (r = -0.694, P < 0.001). Multiple regression showed a negative correlation between the Short Form 36-item Health Survey score and the Insomnia Severity Index (β = -1.100, P = 0.001) and Beck Depression Inventory-2 (β = -1.038, P < 0.001). idiopathic rapid eye movement sleep behaviour disorder had a significant negative impact on quality of life, although this effect was less than that of other chronic disorders. This negative effect might be related to a depressive mood associated with the disease. © 2016 European Sleep Research Society.

  8. Pregnancy and infant loss support: a new, feminist, American, patient movement?

    PubMed

    Layne, Linda L

    2006-02-01

    Using as examples three of the earliest pregnancy and infant loss organizations and multiple recent initiatives, I argue this is a unique patient movement, in part due to the particularities of pregnant patienthood. Although during the first 20 years of this distinctively US movement, pregnancy and infant loss support was hospital-based, there was remarkably little attention to the "medical" dimensions of these losses, e.g. etiology, diagnosis, prevention, and treatment. The thrust was instead on changing ideas and feelings. It is only since the turn of the century that bereaved parents have started to forge collaborations with physicians to work toward prevention. During the first phase (mid-1970s to mid-1990s), it was a women's movement, though it did not present itself as such, and although it was indebted to the feminist movement and included some feminist initiatives, the movement was dominated by a traditionally feminine ethos and included pro-life elements. During the second phase, as physicians and researchers have become more involved, leadership has become somewhat less female-centric while at the same time, more initiatives are explicitly feminist.

  9. Advocacy 201: Incorporating Advocacy Training in Health Education Professional Preparation Programs

    ERIC Educational Resources Information Center

    Thompson, Amy; Kerr, Dianne; Dowling, Jamie; Wagner, Laurie

    2012-01-01

    Involvement in advocacy is a responsibility of health educators, as identified by the National Commission on Health Education Credentialing. Of all the professional responsibilities, participation in advocacy-related activity is often neglected. This lack of participation may be due to the absence of advocacy and policy skills training in health…

  10. Introductory Guide to Advocacy: Working To Improve Advocacy for School Health Education and Services.

    ERIC Educational Resources Information Center

    Reynolds, Sherri T.; Reilly, Linda A.; Ballin, Scott; Wooley, Susan Frelick

    This guide was developed to help advocates who support school health programs, both as volunteers and staff. Four parts include: (1) "Introduction to Advocacy" (overview, American School Health Association and advocacy, lobbying laws and American School Health Association, and contract lobbyists); (2) "Advocacy Concepts"…

  11. Adaptive control with state-dependent modeling of patient impairment for robotic movement therapy.

    PubMed

    Bower, C; Taheri, H; Wolbrecht, E

    2013-06-01

    This paper presents an adaptive control approach for robotic movement therapy that learns a state-dependent model of patient impairment. Unlike previous work, this approach uses an unstructured inertial model that depends on both the position and direction of the desired motion in the robot's workspace. This method learns a patient impairment model that accounts for movement specific disability in neuro-muscular output (such as flexion vs. extension and slow vs. dynamic tasks). Combined with assist-as-needed force decay, this approach may promote further patient engagement and participation. Using the robotic therapy device, FINGER (Finger Individuating Grasp Exercise Robot), several experiments are presented to demonstrate the ability of the adaptive control to learn state-dependent abilities.

  12. Patient-Specific Model-Based Investigation of Speech Intelligibility and Movement during Deep Brain Stimulation

    PubMed Central

    Åström, Mattias; Tripoliti, Elina; Hariz, Marwan I.; Zrinzo, Ludvic U.; Martinez-Torres, Irene; Limousin, Patricia; Wårdell, Karin

    2010-01-01

    Background/Aims Deep brain stimulation (DBS) is widely used to treat motor symptoms in patients with advanced Parkinson's disease. The aim of this study was to investigate the anatomical aspects of the electric field in relation to effects on speech and movement during DBS in the subthalamic nucleus. Methods Patient-specific finite element models of DBS were developed for simulation of the electric field in 10 patients. In each patient, speech intelligibility and movement were assessed during 2 electrical settings, i.e. 4 V (high) and 2 V (low). The electric field was simulated for each electrical setting. Results Movement was improved in all patients for both high and low electrical settings. In general, high-amplitude stimulation was more consistent in improving the motor scores than low-amplitude stimulation. In 6 cases, speech intelligibility was impaired during high-amplitude electrical settings. Stimulation of part of the fasciculus cerebellothalamicus from electrodes positioned medial and/or posterior to the center of the subthalamic nucleus was recognized as a possible cause of the stimulation-induced dysarthria. Conclusion Special attention to stimulation-induced speech impairments should be taken in cases when active electrodes are positioned medial and/or posterior to the center of the subthalamic nucleus. PMID:20460952

  13. Do Bradykinesia and Tremor Interfere in Voluntary Movement of Essential Tremor Patients? Preliminary Findings

    PubMed Central

    Goubault, Etienne; Nguyen, Hung P.; Ayachi, Fouaz S.; Bogard, Sarah; Duval, Christian

    2017-01-01

    Background The aim of this study was to determine whether tremor and bradykinesia impacted a dexterous activity performed by patients with essential tremor (ET). Methods Core bradykinesia was assessed in 27 controls and 15 patients with ET using a rapid alternating movement (RAM) task. Then, participants performed a “counting money” counting tasks while equipped with inertial measurement units to detect and quantify tremor during movement. The time required to perform subsections of the tasks and the rate of failure (errors) were compared between groups using Mann–Whitney U tests and a chi-square test, respectively. Results Patients with ET presented with significant bradykinesia during the RAM task and had more tremor during the counting money task. However, the time required to perform the task and rate of failure were similar between groups. Discussion Results show that even though bradykinesia was detected during fast movements, and that tremor was present during a task requiring dexterity, both symptoms did not interfere with the performance of patients with ET. This pilot study suggests that there may be a threshold at which tremor will become problematic. Determining this threshold for a wide range of daily activities may help determine when it is appropriate to initiate treatment for patients with ET. PMID:28690920

  14. Patient-specific model-based investigation of speech intelligibility and movement during deep brain stimulation.

    PubMed

    Aström, Mattias; Tripoliti, Elina; Hariz, Marwan I; Zrinzo, Ludvic U; Martinez-Torres, Irene; Limousin, Patricia; Wårdell, Karin

    2010-01-01

    Deep brain stimulation (DBS) is widely used to treat motor symptoms in patients with advanced Parkinson's disease. The aim of this study was to investigate the anatomical aspects of the electric field in relation to effects on speech and movement during DBS in the subthalamic nucleus. Patient-specific finite element models of DBS were developed for simulation of the electric field in 10 patients. In each patient, speech intelligibility and movement were assessed during 2 electrical settings, i.e. 4 V (high) and 2 V (low). The electric field was simulated for each electrical setting. Movement was improved in all patients for both high and low electrical settings. In general, high-amplitude stimulation was more consistent in improving the motor scores than low-amplitude stimulation. In 6 cases, speech intelligibility was impaired during high-amplitude electrical settings. Stimulation of part of the fasciculus cerebellothalamicus from electrodes positioned medial and/or posterior to the center of the subthalamic nucleus was recognized as a possible cause of the stimulation-induced dysarthria. Special attention to stimulation-induced speech impairments should be taken in cases when active electrodes are positioned medial and/or posterior to the center of the subthalamic nucleus. 2010 S. Karger AG, Basel.

  15. Comparison of movement related cortical potential in healthy people and amyotrophic lateral sclerosis patients

    PubMed Central

    Gu, Ying; Farina, Dario; Murguialday, Ander R.; Dremstrup, Kim; Birbaumer, Niels

    2013-01-01

    Objective: To understand the brain motor functions and neurophysiological changes due to motor disorder by comparing electroencephalographic data between healthy people and amyotrophic lateral sclerosis (ALS) patients. Methods: The movement related cortical potential (MRCP) was recorded from seven healthy subjects and four ALS patients. They were asked to imagine right wrist extension at two speeds (fast and slow). The peak negativity (PN) and rebound rate (RR) were extracted from MRCP for comparison. Results: The statistical analysis has showed that there was no significant difference in PN between the healthy and the ALS subjects. However, the healthy subjects presented faster RR than ALS during both fast and slow movement imagination. Conclusions: The weaker RR of ALS patients might reflect the impairment of motor output pathways or the degree of motor degeneration. Significance: The comparison between healthy people and ALS patients provides a way to explain the movement disorder through brain electrical signal. In addition, the characteristics of MRCP could be used to monitor and guide brain plasticity in patients. PMID:23717256

  16. The patients' library movement: an overview of early efforts in the United States to establish organized libraries for hospital patients.

    PubMed

    Panella, N M

    1996-01-01

    The patients' library movement in the United States, a dynamic, cohesive drive begun and sustained by librarians and physicians, strove to promote placement of organized libraries for patients in hospitals. It took shape in the early years of this century, evolving from its proponents' deeply held conviction that books and reading foster the rehabilitation of sick people. The American Library Association's World War I service to hospitalized military personnel dramatically reinforced the conviction; the post-World War I institution of public library extension services to general hospitals explicitly reflected it. Enormous energy was infused into the patients' library movement. Throughout the first half of this century, there were sustained efforts not only to establish organized libraries for hospitalized people but also to expand and systematically study bibliotherapy and to shape patients' librarianship as a professional specialty. The movement's achievements include the establishment of patients' library committees within national and international associations; impetus for development of academic programs to train patients' librarians; and publication, from 1944 through 1970, of successive sets of standards for hospital patients' libraries. The first of these remain the first standards written and issued by a professional library association for a hospital library.

  17. The patients' library movement: an overview of early efforts in the United States to establish organized libraries for hospital patients.

    PubMed Central

    Panella, N M

    1996-01-01

    The patients' library movement in the United States, a dynamic, cohesive drive begun and sustained by librarians and physicians, strove to promote placement of organized libraries for patients in hospitals. It took shape in the early years of this century, evolving from its proponents' deeply held conviction that books and reading foster the rehabilitation of sick people. The American Library Association's World War I service to hospitalized military personnel dramatically reinforced the conviction; the post-World War I institution of public library extension services to general hospitals explicitly reflected it. Enormous energy was infused into the patients' library movement. Throughout the first half of this century, there were sustained efforts not only to establish organized libraries for hospitalized people but also to expand and systematically study bibliotherapy and to shape patients' librarianship as a professional specialty. The movement's achievements include the establishment of patients' library committees within national and international associations; impetus for development of academic programs to train patients' librarians; and publication, from 1944 through 1970, of successive sets of standards for hospital patients' libraries. The first of these remain the first standards written and issued by a professional library association for a hospital library. PMID:8938330

  18. Abnormal movement related potentials in patients with lesions of basal ganglia and anterior thalamus.

    PubMed Central

    Fève, A; Bathien, N; Rondot, P

    1994-01-01

    Movement-related cortical potentials (MRCPs) were recorded from scalp electrodes during wrist flexion in 15 dystonic patients with bilateral (nine) or unilateral (six) circumscribed lesions in the striatum (eight), pallidum (six), or anterior thalamus (one). The results were compared with those of 10 age-matched healthy volunteers. The early (BP) and late (NS') MRCP components were assessed in terms of their gradients and distribution on the scalp in Cz, C3', and C4'. The gradients of both BP and NS' components were significantly flatter in the patients with bilateral lesions than in the control subjects. Also, the BP gradient was maximum at Cz, and the NS' component was contralaterally predominant in the control subjects but not in the patients. In patients with unilateral lesions, the gradients were flatter (p < 0.05) during movement of the dystonic wrist than during movement of the normal wrist. This difference was significant for BP and NS', regardless of the location of the electrodes. Also, the normal topographic predominance of BP at Cz and of contralateral NS' disappeared. The BP and NS' components of the MRCPs are thought to reflect preparatory activity in the supplementary motor area and the primary motor cortex before movement. Reduced BP and NS' gradients in patients with both bilateral and unilateral lesions of the basal ganglia, which project towards the supplementary motor area, are consistent with this hypothesis. The bilateral nature of these reductions suggests that both the ipsilateral and the contralateral motor cortex are involved in the genesis of the MRCPs and that the dystonia in these patients is associated with impaired motor preparation. PMID:8301287

  19. Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial

    PubMed Central

    2011-01-01

    Background Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises. Methods/Design In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices. Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home. The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity. Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP. Trial registration Current Controlled Trials ISRCTN80064281 PMID:21943318

  20. Short-interval leg movements during sleep entail greater cardiac activation than periodic leg movements during sleep in restless legs syndrome patients.

    PubMed

    Ferri, Raffaele; Rundo, Francesco; Silvani, Alessandro; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Lanuzza, Bartolo; Ferini-Strambi, Luigi; Manconi, Mauro

    2017-10-01

    Periodic leg movements during sleep (PLMS) are sequences of ≥4 motor events with intermovement intervals (IMI) of 10-90 s. PLMS are a supportive diagnostic criterion for restless legs syndrome (RLS) and entail cardiac activation, particularly when associated with arousal. RLS patients also over-express short-interval leg movements during sleep (SILMS), which have IMI <10 s and are organized mainly in sequences of two movements (doublets). We tested whether the cardiac activation associated with SILMS doublets differs from that associated with PLMS in a sample of 25 RLS patients. We analysed time-series of R-R intervals synchronized to the onset of SILMS doublets or PLMS that entailed an arousal during non-rapid eye movement (NREM) sleep. We assessed cardiac activation based on the R-R interval decrease with respect to baseline during NREM sleep without leg movements. We found that the duration of the R-R interval decrease with SILMS doublets was significantly longer than that with PLMS, whereas the maximal decrease in R-R interval was similar. Scoring SILMS in RLS patients may therefore be relevant from a cardiac autonomic perspective. © 2017 European Sleep Research Society.

  1. The effect of video-guidance on passive movement in patients with cerebral palsy: fMRI study.

    PubMed

    Dinomais, Mickael; Chinier, Eva; Lignon, Gregoire; Richard, Isabelle; Ter Minassian, Aram; Tich, Sylvie Nguyen The

    2013-10-01

    In patients with cerebral palsy (CP), neuroimaging studies have demonstrated that passive movement and action-observation tasks have in common to share neuronal activation in all or part of areas involved in motor system. Action observation with simultaneous congruent passive movements may have additional effects in the recruitment of brain motor areas. The aim of this functional magnetic resonance imaging (fMRI) study was to examine brain activation in patients with unilateral CP during passive movement with and without simultaneous observation of simple hand movement. Eighteen patients with unilateral CP (fourteen male, mean age 14 years and 2 months) participated in the study. Using fMRI block design, brain activation following passive simple opening-closing hand movement of either the paretic or nonparetic hand with and without simultaneous observation of a similar movement performed by either the left or right hand of an actor was compared. Passive movement of the paretic hand performed simultaneously to the observation of congruent movement activated more "higher motor areas" including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than nonvideo-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the nonparetic hand. Our study showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Validation of the Policy Advocacy Engagement Scale for frontline healthcare professionals.

    PubMed

    Jansson, Bruce S; Nyamathi, Adeline; Heidemann, Gretchen; Duan, Lei; Kaplan, Charles

    2017-05-01

    Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy. To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals' engagement in policy advocacy with respect to a broad range of issues, including patients' ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care. Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test-retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals. Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale's test-retest stability. Cronbach's α of .93 indicated strong internal consistency. The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study's limitations, which include a low response rate and limited geographic scope. The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals' engagement in policy

  3. Measuring changes of movement dynamics during robot-aided neurorehabilitation of stroke patients.

    PubMed

    Colombo, Roberto; Sterpi, Irma; Mazzone, Alessandra; Delconte, Carmen; Minuco, Giuseppe; Pisano, Fabrizio

    2010-02-01

    The aim of this study was to describe in detail a new method, called normalized force control parameter (nFCP), to measure changes in movement dynamics obtained during robot-aided neurorehabilitation, and to evaluate its ability to estimate the clinical scales. The study was conducted in a group of 18 subjects after chronic stroke who underwent robot therapy of the upper limb. We used two different measures of movement dynamics to assess patients' performance during each session of training: the nFCP and force directional error (FDE), both measuring the directional error of the patient-exerted force applied to the end-effector of the robot device. Both metrics exhibited significant changes over the three-week course of treatment. The comparison between nFCP and FDE slopes showed a significant and high correlation ( r = 0.79; p < 0.001), indicating that the two parameters are closely correlated. The FDE informed on the direction of the force error, while the nFCP showed a better performance in predicting the clinical scale values. Assessment of the time course of recovery showed that nFCP, FDE and the movement smoothness improved quickly at first and then plateaued, while steady gains in mean velocity of movement took place over a longer time course. These data may be helpful to the therapist in developing more effective robot-based therapy protocols.

  4. Neural control of movement stability: Lessons from studies of neurological patients

    PubMed Central

    Latash, Mark L.; Huang, Xuemei

    2015-01-01

    The concept of synergy provides a theoretical framework for movement stability resulting from the neural organization of multiple elements (digits, muscles, etc.) that all contribute to salient performance variables. Although stability of performance is obviously important for steady-state tasks leading to high synergy indices, a feed-forward drop in synergy indices is seen in preparation to a quick action (i.e., anticipatory synergy adjustments, ASAs). We review recent studies of multi-finger and multi-muscle synergies that show decreased indices of synergies and ASAs in patients with Parkinson’s disease (PD) or multisystem atrophy. In PD, the impairments in synergies and ASAs are partially reversed by dopaminergic drugs, and changes in synergy indices are present even in PD patients at earliest diagnosis. Taken together, these results point at subcortical structures that are crucial for proper control of movement stability. It is timely to introduce the concept of impaired control of stability as an objective, quantifiable, and theory-based clinical descriptor of movement disorders that can increase our understanding of the neural control of movement with all of its implications for clinical practice. PMID:26047732

  5. Dysfunctional putamen modulation during bimanual finger-to-thumb movement in patients with Parkinson's disease

    PubMed Central

    Yan, Li-rong; Wu, Yi-bo; Zeng, Xiao-hua; Gao, Li-chen

    2015-01-01

    Parkinson's disease (PD) is a neurodegenerative disorder affecting middle-aged and elderly people. PD can be viewed as “circuit disorder,” indicating that large scale cortico-subcortical pathways were involved in its pathophysiology. The brain network in an experimental context is emerging as an important biomarker in disease diagnosis and prognosis prediction. This context-dependent network for PD and the underling functional mechanism remains unclear. In this paper, the brain network profiles in 11 PD patients without dementia were studied and compared with 12 healthy controls. The functional magnetic resonance imaging (fMRI) data were acquired when the subjects were performing a pseudorandomized unimanual or bimanual finger-to-thumb movement task. The activation was detected and the network profiles were analyzed by psychophysiological interaction (PPI) toolbox. For the controls and PD patients, the motor areas including the primary motor and premotor areas, supplementary motor area, the cerebellum and parts of the frontal, temporal and parietal gyrus were activated. The right putamen exhibited significant control > PD activation and weaker activity during the bimanual movement relative to the unimanual movement in the control group. The decreased putamen modulation on some nucleus in basal ganglia, such as putamen, thalamus and caudate, and some cortical areas, such as cingulate, parietal, angular, frontal, temporal and occipital gyrus was detected in the bimanual movement condition relative to the unimanual movement condition. Between-group PPI difference was detected in cingulate gyrus, angular gyrus and precuneus (control > PD) and inferior frontal gyrus (PD > control). The deficient putamen activation and its enhanced connectivity with the frontal gyrus could be a correlate of impaired basal ganglia inhibition and frontal gyrus compensation to maintain the task performance during the motor programs of PD patients. PMID:26483652

  6. Dysfunctional putamen modulation during bimanual finger-to-thumb movement in patients with Parkinson's disease.

    PubMed

    Yan, Li-Rong; Wu, Yi-Bo; Zeng, Xiao-Hua; Gao, Li-Chen

    2015-01-01

    Parkinson's disease (PD) is a neurodegenerative disorder affecting middle-aged and elderly people. PD can be viewed as "circuit disorder," indicating that large scale cortico-subcortical pathways were involved in its pathophysiology. The brain network in an experimental context is emerging as an important biomarker in disease diagnosis and prognosis prediction. This context-dependent network for PD and the underling functional mechanism remains unclear. In this paper, the brain network profiles in 11 PD patients without dementia were studied and compared with 12 healthy controls. The functional magnetic resonance imaging (fMRI) data were acquired when the subjects were performing a pseudorandomized unimanual or bimanual finger-to-thumb movement task. The activation was detected and the network profiles were analyzed by psychophysiological interaction (PPI) toolbox. For the controls and PD patients, the motor areas including the primary motor and premotor areas, supplementary motor area, the cerebellum and parts of the frontal, temporal and parietal gyrus were activated. The right putamen exhibited significant control > PD activation and weaker activity during the bimanual movement relative to the unimanual movement in the control group. The decreased putamen modulation on some nucleus in basal ganglia, such as putamen, thalamus and caudate, and some cortical areas, such as cingulate, parietal, angular, frontal, temporal and occipital gyrus was detected in the bimanual movement condition relative to the unimanual movement condition. Between-group PPI difference was detected in cingulate gyrus, angular gyrus and precuneus (control > PD) and inferior frontal gyrus (PD > control). The deficient putamen activation and its enhanced connectivity with the frontal gyrus could be a correlate of impaired basal ganglia inhibition and frontal gyrus compensation to maintain the task performance during the motor programs of PD patients.

  7. Machine learning classification of medication adherence in patients with movement disorders using non-wearable sensors.

    PubMed

    Tucker, Conrad S; Behoora, Ishan; Nembhard, Harriet Black; Lewis, Mechelle; Sterling, Nicholas W; Huang, Xuemei

    2015-11-01

    Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Effects of eye movement with functional electrical stimulation on balance in stroke patients with neglect syndrome

    PubMed Central

    Park, Si-Eun

    2016-01-01

    [Purpose] The aim of the present study was to determine whether eye movement in conjunction with functional electrical stimulation (FES) could improve balance ability in stroke patients with neglect syndrome. [Subjects and Methods] The subjects consisted of 15 stroke patients with neglect syndrome. The intervention was eye movement in conjunction with FES. The program was conducted 5 times per week, for 6 weeks. Static balance (eyes-open and eyes-closed) and dynamic balance were measured before and after testing. [Results] In measurement of static balance, subjects showed significant differences in sway length and sway area when examined in the eyes-open condition, but not the eyes-closed condition. In measurement of dynamic balance, the subjects showed significant differences in limit of stability (forward/backward and left/right). [Conclusion] These results indicate that eye movement in conjunction with FES had a positive effect on the static and dynamic balance in the eyes-open condition, but not in the eyes-closed condition of stroke patients with neglect syndrome. Further studies should therefore investigate various interventions in stroke patients with neglect syndrome. PMID:27313375

  9. Movement-related desynchronization-synchronization (ERD/ERS) in patients with Unverricht-Lundborg disease.

    PubMed

    Visani, E; Agazzi, P; Canafoglia, L; Panzica, F; Ciano, C; Scaioli, V; Avanzini, G; Franceschetti, S

    2006-10-15

    We studied changes in event-related desynchronization/synchronization (ERD/ERS) patterns in patients with Unverricht-Lundborg disease (ULD), presenting with prominent action myoclonus. We analyzed the movement-related ERD/ERS in alpha and beta frequency bands in 15 patients using self-paced finger extension as a motor paradigm and we compared the results with those obtained in 12 healthy volunteers. In all ULD patients, alpha- and beta-ERD regularly occurred with onset and location similar to that found in healthy controls, but the desynchronization of alpha activity was significantly greater than in controls (C3: -64.4+/-9.8% vs. -49.7+/-14.8%; p=0.004). Moreover, in the patients, both alpha- and beta-ERD spread toward frontal electrodes. In controls, the post-movement beta-ERS regularly occurred; it was absent in eight patients with severe action myoclonus, while, in seven patients with mild or moderate myoclonus, the beta-peak was significantly smaller with respect to that measured in controls (55.6+/-15.1% vs. 153.9+/-99.8%, p=0.006). The failure of beta-ERS well-correlated with motor impairment resulting from action myoclonus, whereas SSEPs and long-loop reflexes performed to detect signs of cortical hyperexcitability showed inconsistent changes. In ULD patients, ERD/ERS changes indicate an increased activation of motor cortex during movement planning and a great reduction of post-excitatory inhibition of motor cortex. The changes involving beta-ERS had a significant relationship with the functional disability in individual patients and might play a pathogenic role in the motor dysfunction.

  10. Correlation between automated writing movements and striatal dopaminergic innervation in patients with Wilson's disease.

    PubMed

    Hermann, Wieland; Eggers, Birk; Barthel, Henryk; Clark, Daniel; Villmann, Thomas; Hesse, Swen; Grahmann, Friedrich; Kühn, Hans-Jürgen; Sabri, Osama; Wagner, Armin

    2002-08-01

    Handwriting defects are an early sign of motor impairment in patients with Wilson's disease. The basal ganglia being the primary site of copper accumulation in the brain suggests a correlation with lesions in the nigrostiatal dopaminergic system. We have analysed and correlated striatal dopaminergic innervation using [(123)I]beta-CIT-SPECT and automated handwriting movements in 37 patients with Wilson's disease. There was a significant correlation of putaminal dopaminergic innervation with fine motor ability (p < 0,05 for NIV [number of inversion in velocity], NIA [number of inversion in acceleration], frequency). These data suggest that loss of dorsolateral striatal dopaminergic innervation has a pathophysiological function for decreased automated motor control in Wilson's disease. Furthermore analysis of automated handwriting movements could be useful for therapy monitoring and evaluation of striatal dopaminergic innervation.

  11. Effects of sertraline on kinematic aspects of hand movements in patients with obsessive-compulsive disorder.

    PubMed

    Mergl, Roland; Mavrogiorgou, Paraskevi; Juckel, Georg; Zaudig, Michael; Hegerl, Ulrich

    2004-01-01

    Movement disorders such as disturbances of fine motor co-ordination are a frequent phenomenon in patients with obsessive-compulsive disorder (OCD). Our aim was to investigate changes of hand-motor dysfunction in OCD patients under the influence of 10-week treatment with sertraline and behaviour therapy. We examined the performance of 40 patients satisfying DSM-IV criteria for OCD before and under this therapy using a digitising tablet and kinematic analysis of handwriting and drawing movements. Forty healthy controls were also tested (test-retest interval: 10 weeks). The speed of drawing was significantly lower in OCD patients than in controls (mean+/-standard deviation=197.03+/-113.26 mm/s for patients and 182.48+/-189.61 mm/s for controls; P=0.01). After 10 weeks of therapy, this parameter normalised in patients (from 197.03+/-113.26 mm/s to 163.66+/-101.92 mm/s; P=0.001). Hand-motor dysfunction (especially bradykinesia) improves with a serotonin-enhancing therapy in OCD patients.

  12. [Changes in movement-related cortical potentials in Parkinson's patients before and after treatment with levodopa].

    PubMed

    Feve, A P; Bathien, N; Rondot, P

    1991-05-01

    Cortical potentials associated with voluntary, self-paced wrist flexion (MRPs) were recorded from 3 scalp locations (Cz and psi contralateral hand motor area) in patients with Parkinson's disease (9 de novo patients and 30 L-Dopa treated patients). The analysis concerned 3 components of the MRPs: the 2 slow negative shifts (NS1 and N1) before the movement onset and the motor potential (MP). The NSI amplitude was measured at Cz, the peak negativity N1 and MP from contralateral hand motor area location. The potential distribution was also studied. The amplitude of the MRPs components was the same as in the normals. But in de novo patients, the potential distribution of the NS1 component was different; a Cz preponderance of the NS1 amplitude was not found. In patients treated with L-Dopa, there is a negative correlation between the changes in amplitude and the changes in clinical rating for NS1, N1 and MP components. The decrease in the MRPs components was significant from stage III and IV of the Hoehn and Yahr scales. After L-Dopa therapy, the NS1 component from de novo patients was increased in amplitude. The amplitude of the MRPs components from patients with L-Dopa induced clinical fluctuations was reduced during "off" period in comparison to "on" period. The findings suggest that the NS1 potential and the N1 and MP components share 2 distinct systems for the control of voluntary movement. Their mechanism in Parkinson's disease is discussed.

  13. Prevalence of periodical leg movements in patients with narcolepsy in an outpatient facility in São Paulo.

    PubMed

    Pereira, Danielle; Lopes, Eduardo; da Silva Behrens, Nilce Sanny Costa; de Almeida Fonseca, Hassana; Sguillar, Danilo Anunciatto; de Araújo Lima, Taís Figueiredo; Pradella-Hallinan, Marcia; Castro, Juliana; Tufik, Sergio; Santos Coelho, Fernando Morgadinho

    2014-03-01

    Studies have pointed out that approximately 50-60% of narcolepsy patients may demonstrate higher prevalence of periodical leg movements. However, we highlight that the prevalence studies and the effects of periodical leg movements in patients with narcolepsy are limited and with conflicting results. The objective of this study was that of describing and discussing the prevalence of periodical leg movements in patients with narcolepsy in the outpatient facility of diurnal excessive sleepiness of the Federal University of São Paulo, Brazil. We revised 59 files of patients with the clinical and electrophysiological diagnosis of narcolepsy according to the American Academy of Sleep Medicine. Of these 59 cases of patients with narcolepsy, 12 (20.3%) demonstrated periodical leg movements. Thirty five patients (59.3%) had history of cataplexy and 38 patients (64.4%) had the presence of the allele HLA-DQB1⁎0602. There was a higher prevalence of periodical leg movements in patients with cataplexy (p<0.0001) and in patients with the presence of the allele HLA-DQB1⁎0602 (p<0.0001). Our study characterized the higher prevalence of periodical leg movement in patients with narcolepsy, mainly in patients with cataplexy and with the presence of the allele HLA-DQB1⁎0602.

  14. Prevalence of periodical leg movements in patients with narcolepsy in an outpatient facility in São Paulo☆

    PubMed Central

    Pereira, Danielle; Lopes, Eduardo; da Silva Behrens, Nilce Sanny Costa; de Almeida Fonseca, Hassana; Sguillar, Danilo Anunciatto; de Araújo Lima, Taís Figueiredo; Pradella-Hallinan, Marcia; Castro, Juliana; Tufik, Sergio; Santos Coelho, Fernando Morgadinho

    2014-01-01

    Studies have pointed out that approximately 50–60% of narcolepsy patients may demonstrate higher prevalence of periodical leg movements. However, we highlight that the prevalence studies and the effects of periodical leg movements in patients with narcolepsy are limited and with conflicting results. The objective of this study was that of describing and discussing the prevalence of periodical leg movements in patients with narcolepsy in the outpatient facility of diurnal excessive sleepiness of the Federal University of São Paulo, Brazil. We revised 59 files of patients with the clinical and electrophysiological diagnosis of narcolepsy according to the American Academy of Sleep Medicine. Of these 59 cases of patients with narcolepsy, 12 (20.3%) demonstrated periodical leg movements. Thirty five patients (59.3%) had history of cataplexy and 38 patients (64.4%) had the presence of the allele HLA-DQB1⁎0602. There was a higher prevalence of periodical leg movements in patients with cataplexy (p<0.0001) and in patients with the presence of the allele HLA-DQB1⁎0602 (p<0.0001). Our study characterized the higher prevalence of periodical leg movement in patients with narcolepsy, mainly in patients with cataplexy and with the presence of the allele HLA-DQB1⁎0602. PMID:26483906

  15. From Classroom to Capitol: Building Advocacy Capacity Through State-Level Advocacy Experiences.

    PubMed

    Rivera, Lydia; Starry, Bethany; Gangi, Catherine; Lube, Lauren M; Cedergren, Anders; Whitney, Emily; Rees, Keely

    2016-11-01

    This commentary provides insight from Community Health Education and Master of Public Health students on the benefits of participating in a state-level Advocacy Experience and provides a theoretical framework for increased advocacy intention among students as a result of participating in a state-level Advocacy Experience. Providing students the opportunity to translate what they learn about advocacy in the classroom into advocacy in action with policy makers is vital to the career development of our future health education professionals and is key to increasing advocacy capacity within our profession. This article builds on previous work from emerging public health professionals highlighting the role of policy advocacy in professional development and provides additional perspectives from the next generation of health education specialists.

  16. Professor Brand Advocacy: Do Brand Relationships Matter?

    ERIC Educational Resources Information Center

    Jillapalli, Ravi K.; Wilcox, James B.

    2010-01-01

    The trend among students to advocate their professors online continues to generate interest within marketing academia. Brand advocacy in products and services has played a vital role in marketing. However, no known research to date has embraced the idea of brand advocacy in marketing education. This research builds on the recent human brand…

  17. Corporate Advocacy Advertising and Political Influence.

    ERIC Educational Resources Information Center

    Waltzer, Herbert

    1988-01-01

    Offers an operational definition and typology of advocacy and image advertising as complementary forms of institutional advertising. Examines two of the more important forms of advocacy advertising--paid print editorials appearing on the "op-ed" page of the "New York Times" and the "advertorials" in two principal…

  18. Advocacy in School Psychology: Problems and Procedures.

    ERIC Educational Resources Information Center

    Mcloughlin, Caven S.

    Inherent in the many roles of a school psychologist is a primary responsibility to act as a child advocate. Child advocacy carries with it a variety of definitions, all of which are concerned with aligning oneself with the cause of either an individual child or a group. Child advocacy involves asserting and defending those rights of an individual…

  19. New Advocacy Groups Shaking up Education Field

    ERIC Educational Resources Information Center

    Sawchuk, Stephen

    2012-01-01

    A new generation of education advocacy groups has emerged to play a formidable political role in states and communities across the country. Those groups are shaping policy through aggressive lobbying and campaign activity--an evolution in advocacy that is primed to continue in the 2012 elections and beyond. Though the record of their electoral…

  20. Health Advocacy--Counting the Costs

    ERIC Educational Resources Information Center

    Dyall, Lorna; Marama, Maria

    2010-01-01

    Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

  1. Autism Advocacy: A Network Striving for Equity

    ERIC Educational Resources Information Center

    Itkonen, Tiina; Ream, Robert

    2013-01-01

    In this exploratory case study, we examine the rise of autism on the policy agenda and the new generation of autism advocacy. We focus especially on interconnections between the rhetoric about autism in the media and the emergence and political effectiveness of Autism Speaks, the nation's largest autism advocacy group. We portray how…

  2. Advocacy: AASL Puts the Puzzle Together

    ERIC Educational Resources Information Center

    Johns, Sara Kelly

    2007-01-01

    School librarians work with people of all ages, abilities, and personalities; those people are the puzzle pieces that make advocacy for libraries effective. School librarians contribute to and use the resources of their state and national organizations' advocacy efforts. The completed picture of the puzzle is an excellent program with…

  3. Advocacy, a Role for DD Councils.

    ERIC Educational Resources Information Center

    Paul, James, L., Ed.; And Others

    The advocacy role of state developmental disabilities councils is examined in the monograph. It is explained that the material was gathered from a 1974 conference in Winter Park, Colorado. Topics addressed include the potential for advocacy, a personal perspective on developmental disabilities from a cerebral palsied adult, planning and evaluating…

  4. Building Evidence for Music Education Advocacy

    ERIC Educational Resources Information Center

    Shorner-Johnson, Kevin

    2013-01-01

    The economic challenges facing public schools and music education are immense. In this context, music teachers and supporters will need to engage in persuasive advocacy to protect resource allocations to music programs. It is worthwhile to consider the model of music education advocacy that allowed music to be adopted into the Boston Public…

  5. Building Evidence for Music Education Advocacy

    ERIC Educational Resources Information Center

    Shorner-Johnson, Kevin

    2013-01-01

    The economic challenges facing public schools and music education are immense. In this context, music teachers and supporters will need to engage in persuasive advocacy to protect resource allocations to music programs. It is worthwhile to consider the model of music education advocacy that allowed music to be adopted into the Boston Public…

  6. Advocacy in Counseling: Counselors, Clients, & Community.

    ERIC Educational Resources Information Center

    Lewis, Judy, Ed.; Bradley, Loretta, Ed.

    The sixteen chapters in this volume were selected from advocacy theme papers written by members of the American Counseling Association. They examine the role of the counselor as advocate for different groups of people, as follows: (1) "Developing a Common Language and Framework for Understanding Advocacy in Counseling," (R. L. Toporek);…

  7. The Dangerous Waters of Advocacy Oral History.

    ERIC Educational Resources Information Center

    Lang, William L.

    1987-01-01

    Describes the author's use of advocacy oral history in interviews of people devoted to Montana's wilderness preservation. Discusses the use of questions to elicit broad humanistic responses as opposed to striking journalistic quotations. Examines the differences between traditional and advocacy oral history and the benefits of the latter. (GEA)

  8. Professor Brand Advocacy: Do Brand Relationships Matter?

    ERIC Educational Resources Information Center

    Jillapalli, Ravi K.; Wilcox, James B.

    2010-01-01

    The trend among students to advocate their professors online continues to generate interest within marketing academia. Brand advocacy in products and services has played a vital role in marketing. However, no known research to date has embraced the idea of brand advocacy in marketing education. This research builds on the recent human brand…

  9. Advocacy Competencies for Professional School Counselors

    ERIC Educational Resources Information Center

    Trusty, Jerry; Brown, Duane

    2005-01-01

    Although advocacy has a long tradition in the counseling profession (Kiselica & Robinson, 2001), school counselors' roles as advocates have only recently received widespread attention (Baker & Gerler, 2004). The American School Counselor Association National Model describes advocacy as a key role for professional school counselors, and numerous…

  10. Effective Advocacy and Communication with Legislators.

    ERIC Educational Resources Information Center

    American Counseling Association, Office of Public Policy and Information, Alexandria, VA.

    This pamphlet attempts to make communicating with legislators easy. Each section includes a brief paragraph and several bullet points that present techniques or advice for simplifying communication. It begins with "Rules for Effective Advocacy," which presents a core set of basic advocacy principles, followed by "What Makes…

  11. New Advocacy Groups Shaking up Education Field

    ERIC Educational Resources Information Center

    Sawchuk, Stephen

    2012-01-01

    A new generation of education advocacy groups has emerged to play a formidable political role in states and communities across the country. Those groups are shaping policy through aggressive lobbying and campaign activity--an evolution in advocacy that is primed to continue in the 2012 elections and beyond. Though the record of their electoral…

  12. Political Advocacy Handbook: Activating Grassroots Involvement.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.; Warger, Cynthia L.

    This handbook is designed to assist special education advocates in developing the capacity to mount an effective advocacy campaign at the state and federal levels. It is divided into the following four separate training modules: (1) "Introduction to Advocacy"; (2) "Understanding the Governmental Process"; (3) "Changing Public Policy"; and (4)…

  13. University-Based Planning: Faculty Advocacy Roles.

    ERIC Educational Resources Information Center

    Harris, William M.; Thagard, Aubrey

    2001-01-01

    Supports the involvement of university planning faculty in advocacy roles as change agents in urban inner city communities, discussing several roles for urban design professionals in the academic context as advocates or contractors (i.e., planner advocacy in community development, in environmental affairs, and in urban design). (SM)

  14. Health Advocacy--Counting the Costs

    ERIC Educational Resources Information Center

    Dyall, Lorna; Marama, Maria

    2010-01-01

    Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

  15. Handwriting Movement Kinematics for Quantifying EPS in Patients Treated with Atypical Antipsychotics

    PubMed Central

    Caligiuri, Michael P.; Teulings, Hans-Leo; Dean, Charles E.; Niculescu, Alexander B.; Lohr, James B.

    2009-01-01

    Ongoing monitoring of neuroleptic-induced extrapyramidal side effects (EPS) is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization. Traditional approaches for assessing EPS such as parkinsonism, tardive akathisia, or dyskinesia rely upon clinical ratings. However, these observer-based EPS severity ratings can be unreliable and are subject to examiner bias. In contrast, quantitative instrumental methods are less subject to bias. Most instrumental methods have only limited clinical utility because of their complexity and costs. This paper describes an easy-to-use instrumental approach based on handwriting movements for quantifying EPS. Here, we present findings from psychiatric patients treated with atypical (second generation) antipsychotics. The handwriting task consisted of a sentence written several times within a 2 cm vertical boundary at a comfortable speed using an inkless pen and digitizing tablet. Kinematic variables including movement duration, peak vertical velocity and the number of acceleration peaks, and average normalized jerk (a measure of smoothness) for each up or down stroke and their submovements were analyzed. Results from 59 psychosis patients and 46 healthy comparison subjects revealed significant slowing and dysfluency in patients compared to controls. We observed differences across medications and daily dose. These findings support the ecological validity of handwriting movement analysis as an objective behavioral biomarker for quantifying the effects of antipsychotic medication and dose on the motor system. PMID:20381875

  16. Handwriting movement kinematics for quantifying extrapyramidal side effects in patients treated with atypical antipsychotics.

    PubMed

    Caligiuri, Michael P; Teulings, Hans-Leo; Dean, Charles E; Niculescu, Alexander B; Lohr, James B

    2010-05-15

    Ongoing monitoring of neuroleptic-induced extrapyramidal side effects (EPS) is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization. Traditional approaches for assessing EPS such as Parkinsonism, tardive akathisia, or dyskinesia rely upon clinical ratings. However, these observer-based EPS severity ratings can be unreliable and are subject to examiner bias. In contrast, quantitative instrumental methods are less subject to bias. Most instrumental methods have only limited clinical utility because of their complexity and costs. This paper describes an easy-to-use instrumental approach based on handwriting movements for quantifying EPS. Here, we present findings from psychiatric patients treated with atypical (second generation) antipsychotics. The handwriting task consisted of a sentence written several times within a 2 cm vertical boundary at a comfortable speed using an inkless pen and digitizing tablet. Kinematic variables including movement duration, peak vertical velocity and the number of acceleration peaks, and average normalized jerk (a measure of smoothness) for each up or down stroke and their submovements were analyzed. Results from 59 psychosis patients and 46 healthy comparison subjects revealed significant slowing and dysfluency in patients compared to controls. We observed differences across medications and daily dose. These findings support the ecological validity of handwriting movement analysis as an objective behavioral biomarker for quantifying the effects of antipsychotic medication and dose on the motor system.

  17. Effects of emotionally charged sounds in schizophrenia patients using exploratory eye movements: comparison with healthy subjects.

    PubMed

    Ishii, Youhei; Morita, Kiichiro; Shouji, Yoshihisa; Nakashima, Youko; Uchimura, Naohisa

    2010-02-01

    Emotion-associated sounds have been suggested to exert important effects upon human personal relationships. The present study was aimed to characterize the effects of the sounds of crying or laughing on visual cognitive function in schizophrenia patients. We recorded exploratory eye movements in 24 schizophrenia patients (mean age, 27.0 +/- 6.1 years; 14 male, 10 female) and age-matched controls. The total eye scanning length (TESL) and total number of gaze points in the left (left TNGP) and right (right TNGP) visual fields of the screen and the number of researching areas (NRA) were determined using eye-mark recording in the presence/absence of emotionally charged sounds. Controls' TESL for smiling pictures was longer than that for crying pictures irrespective of sounds. Patients' TESL for smiling pictures, however, was shorter than for crying pictures irrespective of the sounds. The left TNGP for smiling pictures was lower in patients than controls independent of sound. Importantly, the right TNGP was significantly larger with laughing sounds than in the absence of sound. In controls, the NRA for smiling pictures was significantly greater than for crying pictures irrespective of sound. Patient NRA did not significantly differ between smiling and crying pictures irrespective of sound. Eye movements in schizophrenia patients' left field for smiling pictures associated with laughing sounds particularly differed from those in controls, suggesting impaired visual cognitive function associated with positive emotion, also involving pleasure-related sounds, in schizophrenia.

  18. [A complex study of the movement biomechanics in patients with post-stroke hemiparesis].

    PubMed

    Skvortsov, D V; Bulatova, M A; Kovrazhkina, E A; Suvorov, A Iu; Ivanova, G E; Skvortsova, V I

    2012-01-01

    The authors present results of a pilot study on biomechanics of non-cyclic movements of the human consequent verticalization in the ontogenesis of patients with post-stroke hemiparesis (10 patients in the acute stage of cerebral stroke) and 10 healthy volunteers without neurologic and orthopedic pathology. Some movements of therapeutic exercises Balance (a model of ontogenetic kinesitherapy) have been selected for the study. Cinematic parameters have been recorded using a system of motion 3D video analysis, a kinematic model was build in accordance to standard protocols. The skin (native and straightened) electromyogram (EMG) was recorded synchronously with kinematic data using 16-channel electromyography from the following pairs of muscles: mm. sternocleido-mastoideus, trapezius (горизонтальная порция), biceps brachii, triceps brachii, rectus femoris, adductor magnus. Major differences in the EMG picture between patients and controls were: 1) the EMG "monotony" with the involvement of multiple additional muscles in locomotions with the prevalence of the peculiar "tonic" muscle activity (low amplitudes without distinct peaks), stretching along the whole cycle of movement. In controls, EMG demonstrated variability and had mostly "phasic" character with distinct 1 or 2 peaks; 2) the asymmetry of EMG profile in symmetric movements. i.e. when performed simultaneously from the right and from the left sides. The latter feature may be considered as predictive because it was never found in healthy people. It allows to identify objectively weak muscles even in the absence of visible parethis during the routine neurological examination.

  19. Pulp-dentine complex changes and root resorption during intrusive orthodontic tooth movement in patients prescribed nabumetone.

    PubMed

    Villa, Paula A; Oberti, Giovanni; Moncada, Cesar A; Vasseur, Olga; Jaramillo, Alejandro; Tobón, Diego; Agudelo, Jaime A

    2005-01-01

    Pulpitis, external root resorption, and pain may be experienced during orthodontic movement. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been suggested to control these changes. The purpose of this study was to observe pulp-dentinal reactions, root resorption, tooth pain, and tooth movement after the application of a 4-ounce intrusive orthodontic force to human maxillary first premolars in patients given the NSAID nabumetone. Thirty-four maxillary first premolars were evaluated. A placebo was prescribed to 17 patients after an intrusive force was activated and reactivated for an 8-week period on the right side. The same procedure was repeated on the left side after patients were given nabumetone. Pulp-dentinal reactions and external root resorption were evaluated by histology. Pain and movement were also evaluated. Nabumetone was found to be useful in reducing pulpitis, external root resorption, and pain caused by intrusive orthodontic movement, without altering tooth movement in response to the application of orthodontic force.

  20. Improving patient access at a movement disorder clinic by participating in a Process Improvement Program

    PubMed Central

    Goodridge, Alan; Woodhouse, Douglas; Barbour, Janet

    2013-01-01

    Our multi-disciplinary neurology team were dissatisfied with long access times for consultation for new referrals. We participated in a rapid process improvement workshop and a structured improvement process. Over a six-month period we were able to reduce our access time for initial appointment for patients with suspected movement disorders from 133 to 20 days. We implemented a ‘carousel’ multi-disciplinary appointment and a standardised clinic form that improved the flow of patients and that we estimate will save 150 hours of physician time and 320 hours of administrative time per year. PMID:26734164

  1. Dance/movement therapy for improving psychological and physical outcomes in cancer patients.

    PubMed

    Bradt, Joke; Shim, Minjung; Goodill, Sherry W

    2015-01-07

    Current cancer care increasingly incorporates psychosocial interventions. Cancer patients use dance/movement therapy to learn to accept and reconnect with their bodies, build new self-confidence, enhance self-expression, address feelings of isolation, depression, anger and fear and to strengthen personal resources. To update the previously published review that examined the effects of dance/movement therapy and standard care versus standard care alone or standard care and other interventions on psychological and physical outcomes in patients with cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 6), MEDLINE (OvidSP, 1950 to June week 4, 2014), EMBASE (OvidSP, 1980 to 2014 week 26), CINAHL (EBSCOhost, 1982 to July 15 2014), PsycINFO (EBSCOhost, 1806 to July 15 2014), LILACS (Virual Health Library, 1982 to July 15 2014), Science Citation Index (ISI, 1974 to July 15 2014), CancerLit (1983 to 2003), International Bibliography of Theatre and Dance (1989 to July 15 2014), the National Research Register (2000 to September 2007), Proquest Digital Dissertations, ClinicalTrials.gov, and Current Controlled Trials (all to July 15 2014). We handsearched dance/movement therapy and related topics journals, reviewed reference lists and contacted experts. There was no language restriction. We included all randomized and quasi-randomized controlled trials of dance/movement therapy interventions for improving psychological and physical outcomes in patients with cancer. We considered studies only if dance/movement therapy was provided by a formally trained dance/movement therapist or by trainees in a formal dance/movement therapy program. Two review authors independently extracted the data and assessed the methodological quality, seeking additional information from the trial researchers when necessary. Results were presented using standardized mean differences. We identified one new trial for inclusion in this update. In

  2. Movement related cortical source for elbow flexion in patients with branchial plexus injury after intercostal-musculocutaneous nerve crossing.

    PubMed

    Kanamaru, A; Homma, I; Hara, T

    1999-10-29

    Nine patients with brachial plexus injury whose transected musculo-cutaneous nerves had been sutured with intercostal nerves were examined and the relationship between flexion of the operated elbow and the respiratory movement were shown. Three out of nine patients showed independent control of movement from respiration after regeneration. The primary motor cortex for either flexion of the elbow to the operated side or brisk voluntary inspiration was estimated in the medial vertex region of the frontal cortex by the dipole-tracing method in these three patients. The present results suggest that patients contract the biceps muscle reinnervated by the intercostal nerve independently from respiratory movements using the same primary motor cortex with trunk movements. Functional plasticity may occur in the patients using the primary trunk motor cortex for elbow flexion.

  3. Classification of iRBD and Parkinson's disease patients based on eye movements during sleep.

    PubMed

    Christensen, Julie A E; Koch, Henriette; Frandsen, Rune; Kempfner, Jacob; Arvastson, Lars; Christensen, Soren R; Sorensen, Helge B D; Jennum, Poul

    2013-01-01

    Patients suffering from the sleep disorder idiopathic rapid-eye-movement sleep behavior disorder (iRBD) have been observed to be in high risk of developing Parkinson's disease (PD). This makes it essential to analyze them in the search for PD biomarkers. This study aims at classifying patients suffering from iRBD or PD based on features reflecting eye movements (EMs) during sleep. A Latent Dirichlet Allocation (LDA) topic model was developed based on features extracted from two electrooculographic (EOG) signals measured as parts in full night polysomnographic (PSG) recordings from ten control subjects. The trained model was tested on ten other control subjects, ten iRBD patients and ten PD patients, obtaining a EM topic mixture diagram for each subject in the test dataset. Three features were extracted from the topic mixture diagrams, reflecting "certainty", "fragmentation" and "stability" in the timely distribution of the EM topics. Using a Naive Bayes (NB) classifier and the features "certainty" and "stability" yielded the best classification result and the subjects were classified with a sensitivity of 95 %, a specificity of 80% and an accuracy of 90 %. This study demonstrates in a data-driven approach, that iRBD and PD patients may exhibit abnorm form and/or timely distribution of EMs during sleep.

  4. Subthalamic Neurons Encode Both Single- and Multi-Limb Movements in Parkinson’s Disease Patients

    PubMed Central

    Tankus, Ariel; Strauss, Ido; Gurevich, Tanya; Mirelman, Anat; Giladi, Nir; Fried, Itzhak; Hausdorff, Jeffrey M.

    2017-01-01

    The subthalamic nucleus (STN) is the main target for neurosurgical treatment of motor signs of Parkinson’s disease (PD). Despite the therapeutic effect on both upper and lower extremities, its role in motor control and coordination and its changes in Parkinson’s disease are not fully clear. We intraoperatively recorded single unit activity in ten patients with PD who performed repetitive feet or hand movements while undergoing implantation of a deep brain stimulator. We found both distinct and overlapping representations of upper and lower extremity movement kinematics in subthalamic units and observed evidence for re-routing to a multi-limb representation that participates in limb coordination. The well-known subthalamic somatotopy showed a large overlap of feet and hand representations in the PD patients. This overlap and excessive amounts of kinematics or coordination units may reflect pathophysiology or compensatory mechanisms. Our findings thus explain, at the single neuron level, the important subthalamic role in motor control and coordination and indicate the effect of PD on the neuronal representation of movement. PMID:28211850

  5. Body positions and movement patterns in female patients with congenital adrenal hyperplasia.

    PubMed

    Dittmann, R W

    1992-12-01

    Female patients with congenital adrenal hyperplasia (CAH; N = 33; 11-41 years), simple-virilizing (SV) patients (N = 19), salt-wasting (SW) patients (N = 13), and sister controls (N = 14) were compared with regard to their body positions and movement patterns. Data collection comprised both self assessments and mothers' assessments using 20 sex-dimorphic items with corresponding "more masculine" and "more feminine" versions for each variable, represented in photographs (forced-choice approach). Primarily based on mothers' assessments, single-item results suggested slightly more masculine positions and patterns for female CAH patients compared to sisters, for SW patients more distinct than for SV patients. Results from an 11-item scale ("motor behavior", alpha = 0.59) revealed differences between SW (more masculine) and SV patients for self assessments (P, one-tailed, < 0.09); sisters were in an intermediate position closer to the SV patients. According to mothers' assessments, the CAH patient group as a whole differed (more masculine) from sisters (P < 0.06); this finding was mainly accounted for by the SW group (P < 0.04). Complex analyses on the relationship of motor behavior and intervening variables (e.g., postnatal androgenization, onset of puberty, menarche, height, weight, sexual orientation) revealed very few significant results. Findings rather suggested organizational hormonal effects on body positions and movements prenatally; they are in line with main results from the interview section of the Hamburg CAH study (e.g., "Gender-related behavior"). An approach of this kind seems to be justified for investigating motor behavior in future psychoendocrine studies.

  6. Phasic activities of rapid eye movement sleep in vegetative state patients.

    PubMed

    Oksenberg, A; Gordon, C; Arons, E; Sazbon, L

    2001-09-15

    To assess the phasic components of rapid eye movement (REM) sleep in patients in vegetative state and to evaluate the possible relationship of these activities to patient outcome. Sleep disorders unit at a major rehabilitation hospital. Comparative control study. Eleven patients in vegetative state (10 males and 1 female) aged 17-53 years. Continuous 24-hour polysomnographic recording. All the patients had REM sleep periods during the 24-hr recording session. Mean total REM sleep time for the whole session was 66.5 +/- 34.9 min, and for the nocturnal hours only, 37.3 +/- 19.7 min. Comparison with the control group (79.2 +/- 11.5 min) yielded a significant difference only for nocturnal REM sleep time (p<0.0003). The duration of the REM sleep periods was significantly shorter in the patients than the controls for the whole 24-hr session (10.9 +/- 6.0 vs.19.6 +/- 4.9 min, p<0.008), but not for the nocturnal period alone. Compared to controls, the density of rapid eye movements (REMs) (p=0.001), chin twitches (p=0.002), and leg muscle twitches (p=0.023) was significantly lower in the patient group. The density of the sawtooth waves was also lower in the patients, but the difference did not reach significance (p=0.069). Similar results were obtained when the comparison was done only for the nocturnal period. There was no significant difference for any of the REM sleep characteristics or REM sleep phasic activities (24-hr, nocturnal and diurnal periods) between the patients who recovered consciousness and those who did not. The present study shows that patients in vegetative state have a significant reduction in the phasic activities of REM sleep. However, the amount of these activities is unrelated to recovery from the clinical condition. These findings may reflect possible damage to the pedunculopontine tegmentum cholinergic mechanisms in vegetative state.

  7. Left molar approach improves laryngeal view in patients with simulated limitation of cervical movements.

    PubMed

    Saini, S; Bala, R; Singh, R

    2008-07-01

    Immobilized cervical spine, because of either diseases or stabilizing devices, poses considerable difficulties with endotracheal intubation due to poor laryngoscopic view. The left molar (LM) approach has been shown to be useful in difficult sporadic intubation cases. We evaluated efficacy of this approach of laryngoscopy to improve laryngeal view in patients with simulated limitation of cervical movements. Thirty patients of American Society of Anesthesiologists grade I/II, who were scheduled to undergo routine surgical procedures under general anaesthesia and endotracheal intubation, were studied. A two-piece semi-rigid cervical collar was used to immobilize the cervical spine. Under standardized anaesthesia and neuromuscular blocking agent, conventional laryngoscopy using a curved Macintosh blade was performed and glottic view was recorded with and without optimal external laryngeal manipulation (OELM). Subsequently, in the same subjects the laryngoscope blade was withdrawn and re-inserted through the LM approach and glottic view was recorded with and without OELM followed by tracheal intubation. With the conventional approach, laryngeal view was recorded as grade II in five patients, grade III in 24 patients, and grade IV in one patient. However, with the LM approach, laryngeal view was grade I in 25 patients, grade II in five patients, and grade III or IV in none (P<0.001). Tracheal intubation with the LM approach required the use of a flexible stylet to guide the tube tip into the larynx. The laryngeal view is improved by the LM approach in patients with simulated limited cervical movements with a high success rate of tracheal intubation, but requires orientation for negotiation of the tube through the narrow oropharyngeal space available.

  8. Automated movement correction for dynamic PET/CT images: evaluation with phantom and patient data.

    PubMed

    Ye, Hu; Wong, Koon-Pong; Wardak, Mirwais; Dahlbom, Magnus; Kepe, Vladimir; Barrio, Jorge R; Nelson, Linda D; Small, Gary W; Huang, Sung-Cheng

    2014-01-01

    Head movement during a dynamic brain PET/CT imaging results in mismatch between CT and dynamic PET images. It can cause artifacts in CT-based attenuation corrected PET images, thus affecting both the qualitative and quantitative aspects of the dynamic PET images and the derived parametric images. In this study, we developed an automated retrospective image-based movement correction (MC) procedure. The MC method first registered the CT image to each dynamic PET frames, then re-reconstructed the PET frames with CT-based attenuation correction, and finally re-aligned all the PET frames to the same position. We evaluated the MC method's performance on the Hoffman phantom and dynamic FDDNP and FDG PET/CT images of patients with neurodegenerative disease or with poor compliance. Dynamic FDDNP PET/CT images (65 min) were obtained from 12 patients and dynamic FDG PET/CT images (60 min) were obtained from 6 patients. Logan analysis with cerebellum as the reference region was used to generate regional distribution volume ratio (DVR) for FDDNP scan before and after MC. For FDG studies, the image derived input function was used to generate parametric image of FDG uptake constant (Ki) before and after MC. Phantom study showed high accuracy of registration between PET and CT and improved PET images after MC. In patient study, head movement was observed in all subjects, especially in late PET frames with an average displacement of 6.92 mm. The z-direction translation (average maximum = 5.32 mm) and x-axis rotation (average maximum = 5.19 degrees) occurred most frequently. Image artifacts were significantly diminished after MC. There were significant differences (P<0.05) in the FDDNP DVR and FDG Ki values in the parietal and temporal regions after MC. In conclusion, MC applied to dynamic brain FDDNP and FDG PET/CT scans could improve the qualitative and quantitative aspects of images of both tracers.

  9. Automated Movement Correction for Dynamic PET/CT Images: Evaluation with Phantom and Patient Data

    PubMed Central

    Ye, Hu; Wong, Koon-Pong; Wardak, Mirwais; Dahlbom, Magnus; Kepe, Vladimir; Barrio, Jorge R.; Nelson, Linda D.; Small, Gary W.; Huang, Sung-Cheng

    2014-01-01

    Head movement during a dynamic brain PET/CT imaging results in mismatch between CT and dynamic PET images. It can cause artifacts in CT-based attenuation corrected PET images, thus affecting both the qualitative and quantitative aspects of the dynamic PET images and the derived parametric images. In this study, we developed an automated retrospective image-based movement correction (MC) procedure. The MC method first registered the CT image to each dynamic PET frames, then re-reconstructed the PET frames with CT-based attenuation correction, and finally re-aligned all the PET frames to the same position. We evaluated the MC method's performance on the Hoffman phantom and dynamic FDDNP and FDG PET/CT images of patients with neurodegenerative disease or with poor compliance. Dynamic FDDNP PET/CT images (65 min) were obtained from 12 patients and dynamic FDG PET/CT images (60 min) were obtained from 6 patients. Logan analysis with cerebellum as the reference region was used to generate regional distribution volume ratio (DVR) for FDDNP scan before and after MC. For FDG studies, the image derived input function was used to generate parametric image of FDG uptake constant (Ki) before and after MC. Phantom study showed high accuracy of registration between PET and CT and improved PET images after MC. In patient study, head movement was observed in all subjects, especially in late PET frames with an average displacement of 6.92 mm. The z-direction translation (average maximum = 5.32 mm) and x-axis rotation (average maximum = 5.19 degrees) occurred most frequently. Image artifacts were significantly diminished after MC. There were significant differences (P<0.05) in the FDDNP DVR and FDG Ki values in the parietal and temporal regions after MC. In conclusion, MC applied to dynamic brain FDDNP and FDG PET/CT scans could improve the qualitative and quantitative aspects of images of both tracers. PMID:25111700

  10. Movement disorders in Rett syndrome: an analysis of 60 patients with detected MECP2 mutation and correlation with mutation type.

    PubMed

    Temudo, Teresa; Ramos, Elisabete; Dias, Karin; Barbot, Clara; Vieira, Jose P; Moreira, Ana; Calado, Eulalia; Carrilho, Ines; Oliveira, Guiomar; Levy, Antonio; Fonseca, Maria; Cabral, Alexandra; Cabral, Pedro; Monteiro, Joao P; Borges, Luis; Gomes, Roseli; Santos, Manuela; Sequeiros, Jorge; Maciel, Patricia

    2008-07-30

    Rett syndrome (RS) is one of the best human models to study movement disorders. Patients evolve from a hyperkinetic to a hypokinetic state, and a large series of abnormal movements may be observed along their lives such as stereotypies, tremor, chorea, myoclonus, ataxia, dystonia, and rigidity. The aim of this work was to analyze movement disorders in RS patients with a detected MECP2 mutation, as well as their correlation with genotype, in a clinically and genetically well-characterized sample of patients, and thus contribute to redefine the clinical profile of this disease. In this study, we included 60 patients with detected MECP2 mutations. These were categorized and grouped for analysis, according to (1) type of change (missense or truncating, including nonsense and frameshift but also large deletions) and (2) location of the mutation. Differences were found concerning the frequency of independent gait, dystonia, type of tremor, and global score severity when comparing the group of patients with missense and truncating mutations. We also found differences in the presence, distribution, severity, or type of movement disorders in the two groups of patients according to the median duration of the disease (less than 60 months; 60 months or more). We conclude that movement disorders seem to reflect the severity and rate of progression of Rett disorder, patients with truncating mutations presenting a higher rate and more severe dystonia and rigid-akinetic syndrome, when comparing groups with similar time of disease evolution. Copyright 2008 Movement Disorder Society.

  11. Community health nursing advocacy: a concept analysis.

    PubMed

    Ezeonwu, Mabel C

    2015-01-01

    The purpose of this article is to present an in-depth analysis of the concept of community health nursing (CHN) advocacy. Walker and Avant's (2010) 8-step concept analysis methodology was used. A broad inquiry into the literature between 1994 and 2014 resulted in the identification of the uses, defining attributes, empirical referents, antecedents, and consequences, as well as the articulation of an operational definition of CHN advocacy. Model and contrary cases were identified to demonstrate the concept's application and to clarify its meaning. This analysis contributes to the advancement of knowledge of CHN advocacy and provides nurse clinicians, educators, and researchers with some conceptual clarity to help improve community health outcomes.

  12. High Incidence and Prevalence of Drug-Related Movement Disorders in Young Patients With Psychotic Disorders.

    PubMed

    Mentzel, Thierry Q; Lieverse, Ritsaert; Bloemen, Oswald; Viechtbauer, Wolfgang; van Harten, Peter N

    2017-04-01

    Drug-related movement disorders (DRMDs) reduce quality of life and contribute to medication noncompliance of patients with psychotic disorders. Little is known about the epidemiology of DRMDs in relatively young patients a few years after onset of psychosis. This is an important period to study, as the impact of the antipsychotic treatment on the long-term potentiation of the neural pathways associated with psychotic disorders and DRMDs is still minimal. This study investigated the prevalence, incidence, persistence, and clinical correlates of DRMDs in patients during their first years after disease onset. The Genetic Risk and Outcome of Psychosis study is a longitudinal study of 1120 relatively young patients with nonaffective psychosis and a mean age and illness duration of 27 and 4 years, respectively. The following drug-related movement disorders were assessed at baseline and at the 3-year follow-up: parkinsonism, akathisia, tardive dyskinesia, and tardive dystonia. We determined prevalence, incidence, and persistence and investigated clinical correlates at and over the baseline and follow-up assessment. Patients' mean age and illness duration at baseline were 27.1 and 4.3 years, respectively. In 4 patients, 1 developed a DRMD over the 3-year study period. Prevalence, incidence, and persistence rates were highest for parkinsonism (32%, 21%, and 53%) followed by akathisia (9%, 5%, and 17%) and tardive dyskinesia (4%, 3%, and 20%). Significant associations were found between DRMDs and the patients' age, IQ, and psychopathology. The prevalence, persistence, and incidence of DRMDs in this sample were high despite the relatively young age, recent onset of the disorder, and treatment primarily with second-generation antipsychotics. These findings emphasize that screening, diagnosis, and treatment of DRMDs are still important.

  13. Comparison of neck movement smoothness between patients with mechanical neck disorder and healthy volunteers using the spectral entropy method.

    PubMed

    Yang, Chia-Chi; Su, Fong-Chin; Guo, Lan-Yuen

    2014-08-01

    Mechanical neck disorder is one of the most common health issues. No related observations have applied spectral entropy to explore the smoothness of cervical movement. Therefore, the objectives were to ascertain whether the spectral entropy of time-series linear acceleration could extend to estimate the smoothness of cervical movement and compare the characteristics of the smoothness of cervical movement in patients with mechanical neck pain (MND) with healthy volunteers. The smoothness of cervical movement during cervical circumduction from 36 subjects (MND: n = 18, asymptomatic: n = 18) was quantified by the spectral entropy of time-series linear acceleration and other speed-dependent parameters, respectively. Patients with MND showed significantly longer movement time, higher value in the spectral entropy and wider band response in frequency spectrum than healthy volunteers (P = 0.01). The spectral entropy would be suitable to discriminate the smoothness of cervical movement between patients with MND with healthy volunteers and demonstrated patients with MND had significantly less smooth cervical movement.

  14. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?

    PubMed Central

    Heenen, Sarah; De Backer, Daniel; Vincent, Jean-Louis

    2006-01-01

    Introduction The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements. Methods The subjects were 21 critically ill patients with spontaneous breathing movements receiving mechanical ventilation with pressure support mode (n = 9) or breathing through a face mask (n = 12), and who required a fluid challenge. Complete hemodynamic measurements, including pulmonary artery occluded pressure (PAOP), right atrial pressure (RAP), pulse pressure variation (ΔPP) and inspiratory variation in RAP were obtained before and after fluid challenge. Fluid challenge consisted of boluses of either crystalloid or colloid until cardiac output reached a plateau. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive value of the indices to the response to fluids, as defined by an increase in cardiac index of 15% or more. Results Cardiac index increased from 3.0 (2.3 to 3.5) to 3.5 (3.0 to 3.9) l minute-1 m-2 (medians and 25th and 75th centiles), p < 0.05. At baseline, ΔPP varied between 0% and 49%. There were no significant differences in ΔPP, PAOP, RAP and inspiratory variation in RAP between fluid responders and non-responders. Fluid responsiveness was predicted better with static indices (ROC curve area ± SD: 0.73 ± 0.13 for PAOP, p < 0.05 vs ΔPP and 0.69 ± 0.12 for RAP, p = 0.054 compared with ΔPP) than with dynamic indices of preload (0.40 ± 0.13 for ΔPP and 0.53 ± 0.13 for inspiratory changes in RAP, p not significant compared with ΔPP). Conclusion In patients with spontaneous respiratory movements, ΔPP and inspiratory changes in RAP failed to predict the response to volume expansion. PMID:16846530

  15. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects.

    PubMed

    Ko, Min-Joo; Noh, Kyung-Hee; Kang, Min-Hyeok; Oh, Jae-Seop

    2016-07-01

    [Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stability). The Mann-Whitney test was used to analyze differences in Functional Movement Screen scores between the two groups. [Results] Chronic lower back pain patients scored lower on the Functional Movement Screen total composite compared with healthy control subjects. Chronic lower back pain patients scored lower on Functional Movement Screen subtests including the deep squat, hurdle step, active straight leg raise, and rotary stability tests. [Conclusion] The deep squat, hurdle step, active straight leg raise, and rotary stability tasks of the Functional Movement Screen can be recommended as a functional assessment tools to identify functional deficits in chronic lower back pain patients.

  16. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects

    PubMed Central

    Ko, Min-Joo; Noh, Kyung-Hee; Kang, Min-Hyeok; Oh, Jae-Seop

    2016-01-01

    [Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stability). The Mann-Whitney test was used to analyze differences in Functional Movement Screen scores between the two groups. [Results] Chronic lower back pain patients scored lower on the Functional Movement Screen total composite compared with healthy control subjects. Chronic lower back pain patients scored lower on Functional Movement Screen subtests including the deep squat, hurdle step, active straight leg raise, and rotary stability tests. [Conclusion] The deep squat, hurdle step, active straight leg raise, and rotary stability tasks of the Functional Movement Screen can be recommended as a functional assessment tools to identify functional deficits in chronic lower back pain patients. PMID:27512272

  17. EEG Event-Related Desynchronization of patients with stroke during motor imagery of hand movement

    NASA Astrophysics Data System (ADS)

    Tabernig, Carolina B.; Carrere, Lucía C.; Lopez, Camila A.; Ballario, Carlos

    2016-04-01

    Brain Computer Interfaces (BCI) can be used for therapeutic purposes to improve voluntary motor control that has been affected post stroke. For this purpose, desynchronization of sensorimotor rhythms of the electroencephalographic signal (EEG) can be used. But it is necessary to study what happens in the affected motor cortex of this people. In this article, we analyse EEG recordings of hemiplegic stroke patients to determine if it is possible to detect desynchronization in the affected motor cortex during the imagination of movements of the affected hand. Six patients were included in the study; four evidenced desynchronization in the affected hemisphere, one of them showed no results and the EEG recordings of the last patient presented high noise level. These results suggest that we could use the desynchronization of sensorimotor rhythms of the EEG signal as a BCI paradigm in a rehabilitation programme.

  18. Movement disorder, memory, psychiatric symptoms and serum DHEA levels in schizophrenic and schizoaffective patients.

    PubMed

    Harris, D S; Wolkowitz, O M; Reus, V I

    2001-04-01

    Reports of low levels of dehydroepiandrosterone (DHEA) or its sulphate (DHEA-S) in some schizophrenic patients and in some persons with poorer motoric and cognitive functioning led us to examine clinical correlates of serum DHEA and DHEA-S levels in schizophrenic patients. Ratings of abnormal movements, memory and psychiatric symptoms in 17 medicated chronic schizophrenic or schizoaffective inpatients at a state hospital were correlated with serum DHEA and DHEA-S levels, and their ratios with serum cortisol. Controlling for age, higher DHEA levels and/or higher DHEA/cortisol ratios were significantly correlated with lower symptom ratings on the Brief Psychiatric Rating Scale, better performance on some measures of memory, and lower ratings of parkinsonian symptoms. Relatively low DHEA levels or DHEA/cortisol ratios may identify a particularly impaired subgroup of medicated patients with chronic schizophrenia. Potential implications are discussed.

  19. Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury.

    PubMed

    Kearns, William D; Fozard, James L; Ray, Roger D; Scott, Steven; Jasiewicz, Jan M; Craighead, Jeffrey D; Pagano, Craig V

    2016-01-01

    Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victim's ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury. Clinical polytrauma center. Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years. Small group correlational study without random assignment. Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time. Fractal dimension was significantly inversely related to overall prompt compliance (r = -0.603, n = 10, P = .032; 1-tailed). The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.

  20. The effects of a program of systematic movement on COPD patients.

    PubMed

    Gift, A G; Austin, D J

    1992-01-01

    The intent of the study described in this article was to determine (a) if patients with chronic obstructive pulmonary disease (COPD) who regularly participate in less vigorous exercise programs, such as the program of systematic movement sponsored by the American Lung Association, differ from those who do not participate; and (b) whether these differences, if they exist, persist over time. Two convenience samples of COPD patients--those who practice systematic movement by participating in a pulmonary exercise program (PEP) and those who do not--were obtained through the American Lung Association of Maryland. Demographic information and health history were obtained from the participants and their physicians. They all completed the vertical visual analogue dyspnea scale (VADS) and the Beck Depression Inventory (BDI) on two occasions 8 weeks apart and described the strategies they used in dealing with their illness. Differences were found between the groups on the BDI and VADS at both measurement times. Those who participated in the program had lower depression (5.9 versus 17.75) and lower dyspnea (58.9 versus 78.8). These findings persisted 8 weeks later, with exercisers having depression levels of 5.5 versus 19 for the nonexercisers and dyspnea levels of 55.2 versus 79.4 for the nonexercisers. Exercisers used fewer emotion-focused coping strategies than nonexercisers. These findings have implications for the rehabilitation of COPD patients.

  1. Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

    PubMed Central

    2009-01-01

    Background In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life). Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion) of the different DoFs (degrees of Freedom). Methods The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE), Abduction/Adduction (AA) and Pronation/Supination (PS). Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns. Results Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the beginning and at the end

  2. Topographical Organization of Mu and Beta Band Activity Associated with Hand and Foot Movements in Patients with Perirolandic Lesions

    PubMed Central

    Willemse, Ronald B; de Munck, Jan C; Verbunt, Jeroen P.A; van ’t Ent, Dennis; Ris, Peterjan; Baayen, Johannes C; Stam, Cornelis J; Vandertop, W. Peter

    2010-01-01

    To study the topographical organization of mu and beta band event-related desynchronization (ERD) associated with voluntary hand and foot movements, we used magnetoencephalographic (MEG) recordings from 19 patients with perirolandic lesions. Synthetic aperture magnetometry (SAM) was used to detect and localize changes in the mu (7 - 11 Hz) and beta (13 - 30 Hz) frequency bands associated with repetitive movements of the hand and foot and overlaid on individual coregistered magnetic resonance (MR) images. Hand movements showed homotopic and contralateral ERD at the sensorimotor (S/M) cortex in the majority of cases for mu and to a lesser extent for beta rhythms. Foot movements showed an increased heterotopic distribution with bilateral and ipsilateral ERD compared to hand movements. No systematic topographical segregation between mu and beta ERD could be observed. In patients with perirolandic lesions, the mu and beta band spatial characteristics associated with hand movements retain the expected functional-anatomical boundaries to a large extent. Foot movements have altered patterns of mu and beta band ERD, which may give more insight into the differential functional role of oscillatory activity in different voluntary movements. PMID:21347203

  3. Topographical organization of mu and Beta band activity associated with hand and foot movements in patients with perirolandic lesions.

    PubMed

    Willemse, Ronald B; de Munck, Jan C; Verbunt, Jeroen P A; van 't Ent, Dennis; Ris, Peterjan; Baayen, Johannes C; Stam, Cornelis J; Vandertop, W Peter

    2010-08-02

    To study the topographical organization of mu and beta band event-related desynchronization (ERD) associated with voluntary hand and foot movements, we used magnetoencephalographic (MEG) recordings from 19 patients with perirolandic lesions. Synthetic aperture magnetometry (SAM) was used to detect and localize changes in the mu (7 - 11 Hz) and beta (13 - 30 Hz) frequency bands associated with repetitive movements of the hand and foot and overlaid on individual coregistered magnetic resonance (MR) images. Hand movements showed homotopic and contralateral ERD at the sensorimotor (S/M) cortex in the majority of cases for mu and to a lesser extent for beta rhythms. Foot movements showed an increased heterotopic distribution with bilateral and ipsilateral ERD compared to hand movements. No systematic topographical segregation between mu and beta ERD could be observed. In patients with perirolandic lesions, the mu and beta band spatial characteristics associated with hand movements retain the expected functional-anatomical boundaries to a large extent. Foot movements have altered patterns of mu and beta band ERD, which may give more insight into the differential functional role of oscillatory activity in different voluntary movements.

  4. Functional magnetic resonance imaging evaluation of brain function reorganization in cerebral stroke patients after constraint-induced movement therapy.

    PubMed

    Zhao, Jun; Zhang, Tong; Xu, Jianmin; Wang, Mingli; Zhao, Shengjie

    2012-05-25

    In this study, stroke patients received constraint-induced movement therapy for 3 weeks. Before and after constraint-induced movement therapy, the flexibility of their upper limbs on the affected side was assessed using the Wolf motor function test, and daily use of their affected limbs was assessed using the movement activities log, and cerebral functional reorganization was assessed by functional magnetic resonance imaging. The Wolf motor function test score and the movement activities log quantity and quality scores were significantly increased, while action performance time in the Wolf motor function test was significantly decreased after constraint-induced movement therapy. By functional magnetic resonance imaging examination, only scattered activation points were visible on the affected side before therapy. In contrast, the volume of the activated area was increased after therapy. The activation volume in the sensorimotor area was significantly different before and after therapy, and the activation area increased and appeared adjusted. In addition to the activated area around the lesions being decreased, there were also some new activated areas, including the supplementary movement area, premotor area and the ipsilateral sensorimotor area. Our findings indicate that constraint-induced movement therapy significantly improves the movement ability and daily use of the affected upper limbs in stroke patients and promotes cerebral functional reorganization.

  5. Eye movements during saccadic and fixation tasks in patients with homonymous hemianopia.

    PubMed

    Reinhard, Jens I; Damm, Ingelene; Ivanov, Iliya V; Trauzettel-Klosinski, Susanne

    2014-12-01

    The aim of our study was to quantify ocular motor performance in patients with homonymous hemianopia and in healthy controls during saccadic and fixation tasks and to detect potential spontaneous adaptive mechanisms in the hemianopic patients. Eye movements were recorded in 33 hemianopic patients (15 right, 18 left; disease duration, 0.2-29 years) and 14 healthy subjects by scanning laser ophthalmoscope allowing determination of the absolute fovea position relative to the stimulus without calibration. Landing accuracy of saccades was determined for 5° saccades, indicated by the number of dysmetric saccades (DS), and fixation stability (FS) after landing. In addition, during continuous fixation of a central cross, FS, and distribution of fixational eye movements (FEMs) were measured. Size of macular sparing was determined using custom microperimetry software (stimulus grid, 0.5°). Compared with controls, landing accuracy was decreased in hemianopic patients, indicated by significantly more DS (hypometric and hypermetric) to the blind side compared with the seeing side. The number of DS was greater in patients with macular sparing of <4°. DS were not correlated with age and disease duration. FS after landing was lower after saccades to the blind side. Distribution of FEM during continuous fixation was asymmetrically shifted to the blind side, especially in cases of macular sparing of <4°. Number of DS was not correlated with disease duration indicating insufficient spontaneous long-term adaptation. Increased number of DS and decreased FS after landing in patients with small or absent macular sparing stresses the importance of intact parafoveal vision. Asymmetric FEMs during continuous fixation indicate an advantageous adaptive mechanism to shift the visual field border towards the hemianopic side.

  6. [Therapeutic effects of the Feldenkrais method "awareness through movement" in patients with eating disorders].

    PubMed

    Laumer, U; Bauer, M; Fichter, M; Milz, H

    1997-05-01

    Based on the movement-pedagogical concept of Feldenkrais and the findings-of disturbed body perception by eating disordered patients this research aimed at studying the therapeutical effects of the Feldenkrais Method "Awareness through Movement" with eating disorder patients, 15 eating disordered patients treated at the Roseneck hospital for behavioural medicine rated-by means of a questionnaire consisting of scales of the Body Cathexis Scale (BCS), the Body Parts Satisfaction Scale (BPSS), the questionnaire for body perception (Fragebogen zum Körpererleben; FKE), the Emotion inventory (Emotionalitätsinventar; EMI-B), the Anorexia-Nervosa-Inventory for Self-rating (ANIS) and the Eating Disorder Inventory-2 (EDI)-various aspects of their eating disorder before and after participating in a nine hour course of the Feldenkrais Method. The data of these patients were compared to those of the members of a control group, also consisting of 15 eating disordered patients who did not participate in a Feldenkrais course. The participants of the Feldenkrais-course showed increasing contentment with regard to problematic zones of their body and their own health as well as concerning acceptance and familiarity with their own body. Other results were a more spontaneous, open and self-confident behaviour, the decrease of feelings of helplessness and decrease of the wish to return to the security of the early childhood, which indicates the development of felt sense of self, self-confidence and a general process of maturation of the whole personality. The outcome points to the therapeutical effectiveness of the Feldenkrais Method with eating-disorder patients within a multimodal treatment program.

  7. Deep brain stimulation suppresses pallidal low frequency activity in patients with phasic dystonic movements.

    PubMed

    Barow, Ewgenia; Neumann, Wolf-Julian; Brücke, Christof; Huebl, Julius; Horn, Andreas; Brown, Peter; Krauss, Joachim K; Schneider, Gerd-Helge; Kühn, Andrea A

    2014-11-01

    Deep brain stimulation of the globus pallidus internus alleviates involuntary movements in patients with dystonia. However, the mechanism is still not entirely understood. One hypothesis is that deep brain stimulation suppresses abnormally enhanced synchronized oscillatory activity within the motor cortico-basal ganglia network. Here, we explore deep brain stimulation-induced modulation of pathological low frequency (4-12 Hz) pallidal activity that has been described in local field potential recordings in patients with dystonia. Therefore, local field potentials were recorded from 16 hemispheres in 12 patients undergoing deep brain stimulation for severe dystonia using a specially designed amplifier allowing simultaneous high frequency stimulation at therapeutic parameter settings and local field potential recordings. For coherence analysis electroencephalographic activity (EEG) over motor areas and electromyographic activity (EMG) from affected neck muscles were recorded before and immediately after cessation of high frequency stimulation. High frequency stimulation led to a significant reduction of mean power in the 4-12 Hz band by 24.8 ± 7.0% in patients with predominantly phasic dystonia. A significant decrease of coherence between cortical EEG and pallidal local field potential activity in the 4-12 Hz range was revealed for the time period of 30 s after switching off high frequency stimulation. Coherence between EMG activity and pallidal activity was mainly found in patients with phasic dystonic movements where it was suppressed after high frequency stimulation. Our findings suggest that high frequency stimulation may suppress pathologically enhanced low frequency activity in patients with phasic dystonia. These dystonic features are the quickest to respond to high frequency stimulation and may thus directly relate to modulation of pathological basal ganglia activity, whereas improvement in tonic features may depend on long-term plastic changes within the

  8. NAMI in our own voice and NAMI smarts for advocacy: self-narrative as advocacy tool.

    PubMed

    Pandya, Anand

    2012-11-01

    In his first Advocacy column for the Journal of Psychiatric Practice, the author discusses the importance and relevance of advocacy for all mental health professionals and researchers in whatever setting they work. Advocacy efforts can and have influenced a range of issues that are important to hospital-based and community psychiatrists, private practitioners, and researchers. The author then discusses the importance of personal self-narrative as a tool for decreasing stigma and increasing understanding of serious mental illness, with a focus on two programs developed by the National Alliance on Mental Illness: NAMI In Our Own Voice and NAMI Smarts for Advocacy.

  9. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke

    PubMed Central

    Kal, E. C.; van der Kamp, J.; Houdijk, H.; Groet, E.; van Bennekom, C. A. M.; Scherder, E. J. A.

    2015-01-01

    Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p’s ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients’ attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients’ strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor

  10. How disease advocacy organizations participate in clinical research: a survey of genetic organizations.

    PubMed

    Landy, David C; Brinich, Margaret A; Colten, Mary Ellen; Horn, Elizabeth J; Terry, Sharon F; Sharp, Richard R

    2012-02-01

    Disease advocacy organizations may assist in the conduct of research in a variety of ways. We sought to characterize how disease advocacy organizations participate in clinical research and perceive their contributions. Postal and electronic surveys administered to leaders of disease advocacy organizations for genetic conditions identified through the Genetic Alliance's Disease InfoSearch. Of the 201 disease advocacy organizations approached, 124 (62%) responded. In the past 2 years, 91% of these organizations had assisted in participant recruitment, 75% collected data, 60% provided a researcher with financial support, and 56% assisted with study design. Forty-five percent of these organizations also supported a research registry or biobank. Few disease advocacy organization leaders (12%) reported regrets about research studies they had supported. Most (68%) felt their involvement in clinical research had increased the amount of research on their condition and that researchers should consult organizations like theirs in deciding how to recruit participants (58%) and in selecting research topics (56%). In addition to providing financial support, disease advocacy organizations participate directly in multiple aspects of research, ranging from study design and patient recruitment to data collection and analysis. Leaders of these organizations feel strongly that scientists and research sponsors should engage them as partners in the conduct of clinical research.

  11. Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms.

    PubMed

    Molina, Yamile; Hempstead, Bridgette H; Thompson-Dodd, Jacci; Weatherby, Shauna Rae; Dunbar, Claire; Hohl, Sarah D; Malen, Rachel C; Ceballos, Rachel M

    2015-09-01

    African-American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African-American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30-74-year-old women who self-identified as African-American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African-Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized that staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.

  12. Medical Advocacy and Supportive Environments for African Americans following Abnormal Mammograms

    PubMed Central

    Molina, Yamile; Hempstead, Bridgette H.; Thompson-Dodd, Jacci; Weatherby, Shauna Rae; Dunbar, Claire; Hohl, Sarah D.; Malen, Rachel C.; Ceballos, Rachel M.

    2014-01-01

    African American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30–74 year old women who self-identified as African American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram. PMID:25270556

  13. Nursing staff's movement awareness, attitudes and reported behaviour in patient transfer before and after an educational intervention.

    PubMed

    Kindblom-Rising, Kristina; Wahlström, Rolf; Nilsson-Wikmar, Lena; Buer, Nina

    2011-03-01

    The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staff's movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staff's self-awareness of movements and body, and their communication competence, with the intention to promote the patient's independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff's movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.

  14. Participatory advocacy: a counter to media imperialism.

    PubMed

    Brown, M

    1996-01-01

    Western media have a history of defining news worldwide, presenting news from a Western perspective which distorts and denies the truth as perceived from developing countries. Western news coverage of developing countries seems to emphasize countries' fragility, instability, and corruption, leading people to believe that the economic problems of developing countries are due to internal failures. That view is then transferred back to indigenous peoples and communities through major Western news agencies and mass media. Participatory communication is based upon the notion that people have the right to decide how they want themselves and their situations to be portrayed, to decide what information is useful to them and their community, and to be integral players in the communication process. With regard to media imperialism, the author discusses implications for advocacy activities, participatory communication approaches, participatory advocacy, participatory advocacy in South Asia, girl child drama in Nepal, drug abuse television drama in Nepal, and the advocacy challenge.

  15. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities. (a...

  16. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities. (a...

  17. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities. (a...

  18. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities. (a...

  19. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities. (a...

  20. Factors for success in mental health advocacy

    PubMed Central

    Hann, Katrina; Pearson, Heather; Campbell, Doris; Sesay, Daniel; Eaton, Julian

    2015-01-01

    Background Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition – Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. Design The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Results Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. Conclusions The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings. PMID:26689456

  1. Factors for success in mental health advocacy.

    PubMed

    Hann, Katrina; Pearson, Heather; Campbell, Doris; Sesay, Daniel; Eaton, Julian

    2015-01-01

    Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition - Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings.

  2. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

    PubMed Central

    Chun, Eun Mi; Han, Soo Jeong; Modi, Hitesh N

    2015-01-01

    Background The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray. Patients and methods Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds. Results There were significant improvements (2,022.8±1,548.3 mm2 to 3,010.7±1,495.6 mm2 and 2,382.4±1,475.9 mm2 to 3,315.9±1,883.5 mm2; right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation. Conclusion The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging. PMID:25670895

  3. Exploring the scope for advocacy by paediatricians

    PubMed Central

    Rudolf, M; Bundle, A; Damman, A; Garner, M; Kaur, V; Khan, M; Robinson, G; Ruge, S; Waterston, T; BELL, R

    1999-01-01

    AIMS—To ascertain the type and extent of problems requiring advocacy in paediatrics. To develop an approach for analysing problems according to their root causes and the level of society at which advocacy is needed.
METHODS—Nine paediatricians kept detailed clinical diaries for two weeks to identify problems. Classifications were developed to categorise problems by cause and the level of society at which they needed to be addressed. The press was surveyed for one week for childhood issues attracting media attention.
RESULTS—60 problems requiring advocacy were identified. Root causes included failures within agencies, between agencies, and inadequate provision. In addition to advocacy required individually, "political" action was needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the press, these did not relate closely to issues identified by clinicians.
CONCLUSIONS—Many opportunities for advocacy arise in the course of daily work. A systematic way of analysing them has been developed for use in planning action. To optimise the health and health care of children, there is a need to train and support paediatricians in advocacy work for local as well as national issues. Ten issues were identified that might be prioritised by paediatricians working on an agenda for action.

 PMID:10569972

  4. Influence of attention alternation on movement-related cortical potentials in healthy individuals and stroke patients.

    PubMed

    Aliakbaryhosseinabadi, Susan; Kostic, Vladimir; Pavlovic, Aleksandra; Radovanovic, Sasa; Nlandu Kamavuako, Ernest; Jiang, Ning; Petrini, Laura; Dremstrup, Kim; Farina, Dario; Mrachacz-Kersting, Natalie

    2017-01-01

    In this study, we analyzed the influence of artificially imposed attention variations using the auditory oddball paradigm on the cortical activity associated to motor preparation/execution. EEG signals from Cz and its surrounding channels were recorded during three sets of ankle dorsiflexion movements. Each set was interspersed with either a complex or a simple auditory oddball task for healthy participants and a complex auditory oddball task for stroke patients. The amplitude of the movement-related cortical potentials (MRCPs) decreased with the complex oddball paradigm, while MRCP variability increased. Both oddball paradigms increased the detection latency significantly (p<0.05) and the complex paradigm decreased the true positive rate (TPR) (p=0.04). In patients, the negativity of the MRCP decreased while pre-phase variability increased, and the detection latency and accuracy deteriorated with attention diversion. Attention diversion has a significant influence on MRCP features and detection parameters, although these changes were counteracted by the application of the laplacian method. Brain-computer interfaces for neuromodulation that use the MRCP as the control signal are robust to changes in attention. However, attention must be monitored since it plays a key role in plasticity induction. Here we demonstrate that this can be achieved using the single channel Cz. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Movement disorders in patients with schizophrenia and a history of substance abuse.

    PubMed

    Hansen, Lars K; Nausheen, Bina; Hart, Deborah; Kingdon, David

    2013-03-01

    The movement disorders acute dystonia, akathisia, Parkinsonian symptoms and tardive dyskinesia [extrapyramidal side effects (EPSs)] are recognized adverse effects of antipsychotic medication. Previous studies have indicated that substance abuse in patients with schizophrenia can worsen EPS. This study therefore investigated the relationship between drug and alcohol use and EPS in a group of patients with schizophrenia. Seventy patients with schizophrenia assessed for drug and alcohol use, global functioning, EPS and suicidality. Chlorpromazine equivalents were correlated to levels of EPS and substance abuse. Current EPS were found in 65% of the sample despite three-quarters of the patients receiving second-generation antipsychotics. An even higher level of patients, 87%, was found to have a history of EPS. A long history of schizophrenia independently predicted presence of any EPS, particularly akathisia, controlling for history of substance abuse which was a non-significant predictor. History or current use of alcohol or drug abuse did not predict EPS, except for alcohol abuse at the time of diagnosis which was associated with current akathisia. Length of illness was correlated with EPS, whereas suicidality was not linked to akathisia. Neither chlorpromazine equivalent antipsychotic dose nor whether the patient received first-generation or second-generation antipsychotic medication was significantly associated with EPS or substance abuse. Copyright © 2013 John Wiley & Sons, Ltd.

  6. Plasma apelin level in patients with restless legs syndrome and its association with periodic leg movements.

    PubMed

    Korkmaz, Selda; Aksu, Murat; Baskol, Gulden

    2017-03-01

    Apelin is an antioxidant and anti-inflammatory molecule secreted by adipose tissue and has a protective effect on cardiac and neuronal tissue. Recent studies have reported that the risk of vascular disease is increased in restless legs syndrome (RLS). We aimed to measure plasma levels of apelin in patients with RLS. Additionally, we wanted to determine if there is any relationship between apelin levels and RLS disease severity and the periodic leg movement index (PLMI). A total of 14 RLS patients with moderate-to-severe symptoms and 14 age- and body mass index (BMI)-matched healthy controls participated in the study. All participants had no concomitant medical disorder nor took medications. The international RLS rating scale (IRLSS) was used to determine disease severity. Polysomnography (PSG) served to exclude other sleep disorders such as sleep-related breathing disorders and to measure sleep parameters. The mean plasma apelin level was significantly lower in the patient group compared to the control group independent of IRLSS score and PSG findings (p = 0.004). After comparison between the RLS patient group and control group, the patient group was divided into two subgroups based on a PLMI above or below 15 events per hour. A reduced mean apelin level was observed in the patient group having a PLMI above 15 compared to the patient group with PLMI below 15 and the control group (p = 0.003). There was no correlation between plasma apelin levels and disease severity and PLMI in the two patient subgroups. RLS patients especially those with a PLMI above 15 have low plasma apelin levels independent of disease severity and sleep parameters such as sleep duration and quality. Decreased apelin levels may explain the increased risk for vascular diseases in those patients.

  7. Impact of perception of socioeconomic burden on advocacy for patient autonomy in end-of-life decision making: a study of societal attitudes.

    PubMed

    Kwon, Y C; Shin, D W; Lee, J H; Heo, D S; Hong, Y S; Kim, S-Y; Yun, Y H

    2009-01-01

    We investigated the impact of perception of socioeconomic burden on beliefs regarding a patient's autonomy in end-of-life (EOL) decision making. We also sought to identify the characteristics of individuals who advocate patient autonomy and their attitudes toward other EOL issues. A total of 1055 individuals from the Korean general population were interviewed through a telephone survey using a structured questionnaire that was designed to investigate public attitudes toward various EOL issues. Of 1019 individuals included in the analysis, 635 (62.3%) specified the patient and 221 (21.7%) the family, when asked who is the appropriate decision maker in terms of EOL decisions in the absence of perception of socioeconomic burden. In contrast, the numbers were 458 (44.9%) and 500 (49.1%), respectively, if substantial burden was assumed. Respondents who favoured the patient's right to make decisions regardless of perception of socioeconomic burden numbered only 312 (30.6%) and were likely to be younger and have knowledge of hospice than who favoured family decision. Former group also favoured the disclosure of terminal illness to patients, withholding life-sustaining treatment, and preparation of advanced directives. Societal attitudes toward patient autonomy were significantly influenced by perception of socioeconomic burden. Open and balanced discussion about burden to family and adequate welfare support are thus suggested.

  8. Measuring nursing advocacy in procedural pain care--development and validation of an instrument.

    PubMed

    Vaartio, Heli; Leino-Kilpi, Helena; Suominen, Tarja; Puukka, Pauli

    2009-12-01

    Nursing advocacy has been defined in several ways, but its structure has not been operationalized. Therefore, different theoretical aspects of advocacy have not been able to be verified empirically. Our aim was to validate the content and structure of the concept of nursing advocacy within procedural pain care from the point of view of both patients and nurses. The concept of nursing advocacy was outlined first by integrative literature review and then delineated with data of semi-structured interviews among adult internal medicine and surgical patients and nurses (phases I-II). Then, the instrument was developed with facet-design approach, and the content and construct validity of it established in two subsamples within otolaryngeal surgical care (phases III-V). These descriptive and explorative studies were conducted from 2003 to 2007 in a total of 12 Finnish hospitals. The findings supported the validity of both the concept and the instrument. Pearson correlations and Cronbach alphas supported the conceptual dimensions of advocacy operationalized in this instrument. Internal consistency validity of the instrument scales were supported by subscale CVI, which ranged from 0.97 to 0.99, and item CVI, which ranged from 0.93 to 1.00. The instrument structure was strengthened with exploratory factor analysis, which explained 65% (sample of patients) or 57% (sample of nurses) of the variance in antecedents, 75% or 74% of the variance in activities, and 60% or 56% of the variance in the consequences of advocacy. This four-part 56-item (58-item for nurses) instrument promises to measure the dimensions of nursing advocacy. However, the instrument needs further validation in different settings.

  9. Bobath Concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: a randomized controlled trial.

    PubMed

    Huseyinsinoglu, Burcu Ersoz; Ozdincler, Arzu Razak; Krespi, Yakup

    2012-08-01

    To compare the effects of the Bobath Concept and constraint-induced movement therapy on arm functional recovery among stroke patients with a high level of function on the affected side. A single-blinded, randomized controlled trial. Outpatient physiotherapy department of a stroke unit. A total of 24 patients were randomized to constraint-induced movement therapy or Bobath Concept group. The Bobath Concept group was treated for 1 hour whereas the constraint-induced movement therapy group received training for 3 hours per day during 10 consecutive weekdays. Main measures were the Motor Activity Log-28, the Wolf Motor Function Test, the Motor Evaluation Scale for Arm in Stroke Patients and the Functional Independence Measure. The two groups were found to be homogeneous based on demographic variables and baseline measurements. Significant improvements were seen after treatment only in the 'Amount of use' and 'Quality of movement' subscales of the Motor Activity Log-28 in the constraint-induced movement therapy group over the the Bobath Concept group (P = 0.003; P = 0.01 respectively). There were no significant differences in Wolf Motor Function Test 'Functional ability' (P = 0.137) and 'Performance time' (P = 0.922), Motor Evaluation Scale for Arm in Stroke Patients (P = 0.947) and Functional Independence Measure scores (P = 0.259) between the two intervention groups. Constraint-induced movement therapy and the Bobath Concept have similar efficiencies in improving functional ability, speed and quality of movement in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving the amount and quality of affected arm use.

  10. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD.

    PubMed

    Chun, Eun Mi; Han, Soo Jeong; Modi, Hitesh N

    2015-01-01

    The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray. Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds. There were significant improvements (2,022.8±1,548.3 mm(2) to 3,010.7±1,495.6 mm(2) and 2,382.4±1,475.9 mm(2) to 3,315.9±1,883.5 mm(2); right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation. The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging.

  11. Actigraphic assessment of periodic leg movements in patients with restless legs syndrome.

    PubMed

    Cippà, Maria A T; Baumann, Christian R; Siccoli, Massimiliano M; Bassetti, Claudio L; Poryazova, Rositsa; Werth, Esther

    2013-10-01

    The diagnosis of restless legs syndrome (RLS) relies upon diagnostic criteria which are based on history only, and dopaminergic treatment is not normally the first choice of treatment for all patients. It would be worthwhile to identify patients non-responsive to dopaminergic treatment beforehand, because they may suffer from a restless legs-like syndrome and may require alternative treatment. We included retrospectively 24 adult patients fulfilling the four essential criteria for restless legs and 12 age-matched healthy controls. They were investigated by ambulatory actigraphy from both legs over three nights, and patients started treatment with dopamine agonists after this diagnostic work-up. We examined 12 responders to dopaminergic treatment and 12 non-responders and studied the association between response to dopaminergic treatment and the periodic limb movement index (PLMI) as assessed with actigraphy. Demographic characteristics, excessive daytime sleepiness and fatigue at baseline were similar in all three groups. Baseline RLS severity was similar between responders and non-responders [International Restless Legs Severity Scale (IRLS): 25 ± 9 and 24 ± 8]. Group comparisons of PLMI before treatment initiation showed significant differences between the three groups. Post-hoc pairwise comparisons revealed that healthy controls had significantly lower PLMI (4.9 ± 4.5) than responders (29.3 ± 22.7) and non-responders (13.3 ± 11.2). Similarly, the PLMI in responders was lower than in non-responders. PLMI day-to-day variability did not differ between responders and non-responders and there was no correlation between treatment effect, as assessed by the decrease of the IRLS and baseline PLMI. Our retrospective study indicates that actigraphy to assess periodic limb movements may contribute to a better diagnosis of dopamine-responsive restless legs syndrome.

  12. Anti-aging medicine: a patient/practitioner movement to redefine aging.

    PubMed

    Mykytyn, Courtney Everts

    2006-02-01

    Having enjoyed tremendous growth for the past 5 years, the anti-aging medicine movement is redefining aging so that it becomes a target for biomedical intervention. Targeting aging for intervention dislodges popular understandings of aging: for anti-aging practitioners it no longer matters if aging is natural since it can be itself the target of therapy. So-called "age-associated" diseases like cancer are, in this framework, conceived of as symptoms of aging. Anti-aging medicine is a broad term that may comprise groups selling remedies over the Internet, companies touting the "anti-aging"ness of their products, practitioners who work outside of scientific medicine, and practitioners of anti-aging medicine in clinics who believe that their work is strictly scientific. This article, drawing from more than 3 years of ethnographic interviews, participant observation in clinics and conferences, and a review of the literature, considers the last group. It examines the involvement stories of anti-aging medicine practitioners in two Western United States metropolitan cities. These stories reflect the practices of anti-aging medicine practitioners and the accompanying rationale for involvement. Often originally patients themselves, practitioners frame their involvement with the anti-aging movement in three ways. First, they describe aging as it is currently experienced as a time of decline, suffering, and weakness. This anguish is not inevitable, they argue, and their work toward treating aging biomedically is situated as clearly moral. Secondly, intense frustration with the current biomedical environment has motivated practitioners to look for other ways in which to practice: anti-aging medicine is their chosen alternative. Finally, with dramatic expectations of future biotechnologies and disdain for current medical treatments of old age, anti-aging practitioners embrace a scientific revolutionary identity. These stories of migrations from patient to practitioner reveal

  13. A qualitative analysis of identity and goals in patients with deformities: preparation for an evidence-based advocacy for a vulnerable population.

    PubMed

    Tapia, Viridiana J; Chang, David C; Ramirez, Michelle; Gosman, Amanda

    2013-04-01

    Economically and socially vulnerable patients with deformities are likely to live a marginalized life, reducing their quality of life and societal participation. An evidence-based approach is needed for these patients who may not be able to advocate for themselves. The objective of this study is to identify important aspects of the perceived identity of adult patients with deformities. This retrospective qualitative analysis is of applicant responses to an intake questionnaire for Fresh Start Surgical Gifts, a charitable reconstructive surgery organization serving children and adults with deformities. Five open-ended questions were analyzed and grouped into 2 broad categories: Identity and Goals. Keywords were identified by an online survey website and subjective judgment of the investigators. Keywords were then combined into broader themes. Seventy respondents with a mean age of 24.79 (median 23) between 1992 and 2011 were analyzed. Social and professional issues were the most frequently occurring themes among Identity and Goals questions. The current identity of patients with deformities centers on social aspects of their lives, rather than a career or profession, yet they do hold both professional and social aspirations. This research will guide the development of an objective tool to measure patient-reported impact and outcomes of reconstructive plastic surgery.

  14. Cherenkoscopy based patient positioning validation and movement tracking during post-lumpectomy whole breast radiation therapy

    NASA Astrophysics Data System (ADS)

    Zhang, Rongxiao; Andreozzi, Jacqueline M.; Gladstone, David J.; Hitchcock, Whitney L.; Glaser, Adam K.; Jiang, Shudong; Pogue, Brian W.; Jarvis, Lesley A.

    2015-01-01

    To investigate Cherenkov imaging (Cherenkoscopy) based patient positioning and movement tracking during external beam radiation therapy (EBRT). In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the LINAC pulse output, during different fractions of the treatment. Patients were positioned with the aid of the AlignRT system in the beginning of each treatment session. Inter-fraction setup variation was studied by rigid image registrations between images acquired at individual treatments to the average image from all imaged treatment fractions. The amplitude of respiratory motion was calculated from the registration of each frame of Cherenkov images to the reference. A Canny edge detection algorithm was utilized to highlight the beam field edges and biological features provided by major blood vessels apparent in the images. Real-time Cherenkoscopy can monitor the treatment delivery, patient motion and alignment of the beam edge to the treatment region simultaneously. For all the imaged fractions, the patient positioning discrepancies were within our clinical tolerances (3 mm in shifts and 3 degree in pitch angle rotation), with 4.6% exceeding 3 mm but still within 4 mm in shifts. The average discrepancy of repetitive patient positioning was 1.22 mm in linear shift and 0.34 degrees in rotational pitch, consistent with the accuracy reported by the AlignRT system. The edge detection algorithm enhanced features such as field edges and blood vessels. Patient positioning discrepancies and respiratory motion retrieved from rigid image registration were consistent with the edge enhanced images. Besides positioning discrepancies caused by globally inaccurate setups, edge enhanced blood vessels indicate the existence of deformations within the treatment region, especially for large patients. Real-time Cherenkoscopy imaging during EBRT is a

  15. Advocacy for Health Equity: A Synthesis Review

    PubMed Central

    Farrer, Linden; Marinetti, Claudia; Cavaco, Yoline Kuipers; Costongs, Caroline

    2015-01-01

    Context Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short

  16. Opiate sensitivity test in patients with stereotypic movement disorder and trichotillomania.

    PubMed

    Frecska, Ede; Arato, Mihaly

    2002-06-01

    Preliminary data about the therapeutic effect of opiate receptor manipulation in self-injurious behavior (SIB) suggest that endogenous opioid mechanisms may have a pathophysiological role in that condition and their involvement may be dependent on the severity of the SIB. The aim of this study was to use fentanyl-induced prolactin response as an opiate receptor sensitivity test in patients with stereotypic movement disorder (SMD) manifesting SIB (skin picking). Healthy volunteers and trichotillomanic patients were enrolled as comparison subjects. Individuals with trichotillomania (TTM) manifest repetitive, less serious self-mutilation (hair pulling) and are classified under different DSM-IV category than SMD. Therefore, they were considered as patient controls. Ten healthy subjects received 0.05 mg/70 kg and another 10 were given 0.1 mg/70 kg dose of fentanyl intravenously in the AM hours. Five of them had placebo trials. A dose of 0.05 mg/70 kg fentanyl was administered to patients with SMD (n = 10) and TTM (n = 12). Serial blood sampling was performed for prolactin measurements. Fentanyl elevated plasma prolactin in a dose-dependent manner. Patients with skin picking, but not with hair pulling, showed significantly increased responses. This finding supports the involvement of endogenous opioids in the pathomechanism of serious SIB.

  17. Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study

    PubMed Central

    Ibáñez, Jaime; Monge-Pereira, Esther; Molina-Rueda, Francisco; Serrano, J. I.; del Castillo, Maria D.; Cuesta-Gómez, Alicia; Carratalá-Tejada, María; Cano-de-la-Cuerda, Roberto; Alguacil-Diego, Isabel M.; Miangolarra-Page, Juan C.; Pons, Jose L.

    2017-01-01

    Background: The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke. Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention. Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol. Conclusions: According to results obtained here

  18. Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study.

    PubMed

    Ibáñez, Jaime; Monge-Pereira, Esther; Molina-Rueda, Francisco; Serrano, J I; Del Castillo, Maria D; Cuesta-Gómez, Alicia; Carratalá-Tejada, María; Cano-de-la-Cuerda, Roberto; Alguacil-Diego, Isabel M; Miangolarra-Page, Juan C; Pons, Jose L

    2017-01-01

    Background: The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke. Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention. Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol. Conclusions: According to results obtained here

  19. ACA Advocacy Competencies: Social Justice Advocacy at the Client/Student Level

    ERIC Educational Resources Information Center

    Ratts, Manivong J.; Hutchins, A. Michael

    2009-01-01

    There is a rise in calls for counselors to be advocates for social justice. Counselors can meet the growing need to expand their roles to include advocacy by using the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). This article operationalizes the client/student level of…

  20. ACA Advocacy Competencies: Social Justice Advocacy at the Client/Student Level

    ERIC Educational Resources Information Center

    Ratts, Manivong J.; Hutchins, A. Michael

    2009-01-01

    There is a rise in calls for counselors to be advocates for social justice. Counselors can meet the growing need to expand their roles to include advocacy by using the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). This article operationalizes the client/student level of…

  1. Sepsis of the hip due to pressure sore in spinal cord injured patients: advocacy for a one-stage surgical procedure.

    PubMed

    Le Fort, M; Rome-Saulnier, J; Lejeune, F; Bellier-Waast, F; Touchais, S; Kieny, P; Duteille, F; Perrouin-Verbe, B

    2014-11-04

    Study design:Retrospective study reporting characteristics and management of septic arthritis of the hip due to pressure sores in spinal cord-injured patients.Objectives:To describe clinical and biological data of septic arthritis of the hip and its treating management.Setting:The database of the regional SCI referral center, Nantes, France.Methods:We retrospectively collected data from 33 cases of septic arthritis of the hip in the medical files of 26 patients.Results:We analyzed 33 cases of septic arthritis of the hip treated in one French referent center for spinal cord-injured patients from January 1988 to December 2009. Most patients had a thoracic complete paraplegia and nearly two-third (17 out of 26) had no systematic follow-up. In 25 out of 33 cases, the septic arthritis of the hip was due to a trochanteric pressure sore. The causal pressure sore was most frequently associated with a persistent drainage. The standard radiological examination led to the diagnosis in 30 cases and, in 7 questionable cases, magnetic resonance imaging was more contributory. Surgery always consisted of a wide carcinological-like excision and of a subtrochanteric proximal femoral resection including both greater and lesser trochanters. A musculocutaneous flap was realized for all cases and the choice of the muscle depended on the localization of the causal pressure sore but also of the remaining choices, as most of the patients had already undergone a prior surgery. An antibiotic treatment was adapted to multiple samples during surgery.Conclusion:We do advocate for a one-stage procedure including a subtrochanteric proximal femoral resection and a musculocutaneous flap.Spinal Cord advance online publication, 4 November 2014; doi:10.1038/sc.2014.170.

  2. A proposal for patient-tailored supervision of movement performance during end-effector-based robot-assisted rehabilitation of the upper extremities.

    PubMed

    Hennes, Michael; Bollue, Kai; Arenbeck, Henry; Disselhorst-Klug, Catherine

    2015-06-01

    Millions of people worldwide suffer from stroke each year. One way to assist patients cost-effectively during their rehabilitation process is using end-effector-based robot-assisted rehabilitation. Such systems allow patients to use their own movement strategies to perform a movement task, which encourages them to do self-motivated training but also allow compensation movements if they have problems executing the movement tasks. Therefore, a patient supervision system was developed on the basis of inertial measurement units and a patient-tailored movement interpretation system. Very light and small inertial measurement units were developed to record the patients' movements during a teaching phase in which the desired movement is shown to the patient by a physiotherapist. During a following exercise phase, the patient is training the previously shown movement alone with the help of an end-effector-based robot-assisted rehabilitation system, and the patient's movement is recorded again. The data from the teaching and exercise phases are compared with each other and evaluated by using fuzzy logic tailored to each patient. Experimental tests with one healthy subject and one stroke patient showed the capability of the system to supervise patient movements during the robot-assisted end-effector-based rehabilitation.

  3. Cortical Reorganization in Patients Recovered from Bell's Palsy: An Orofacial and Finger Movements Task-State fMRI Study

    PubMed Central

    Lee, Jaeyoun; Yuan, Aihong; Wu, Hongli; Wang, Anqin; Xue, Qiuju; Wang, Tao; Wang, Linying; Gao, Ting

    2016-01-01

    Objective. To explore cortical reorganization of patients recovered from Bell's palsy (BP) by task-state functional magnetic resonance imaging (fMRI) during finger and orofacial movements and provide more evidence for acupuncture clinical treatment of BP. Methods. We collected 17 BP patients with complete clinical recovery (BP group) and 20 healthy volunteers (control group) accepted the task-state fMRI scans with lip pursing movements and finger movements, respectively. Results. It was found that there were significant differences of brain functional status between the two groups. Conclusions. The results showed that there was cortical reorganization in the brain of patients recovered from BP after acupuncture treatment, which also suggested the relationship between the hand motor areas and facial motor areas of BP patients. PMID:28116170

  4. Gaze position corrective eye movements in normal subjects and in patients with vestibular deficits.

    PubMed

    Peng, Grace C Y; Minor, Lloyd B; Zee, David S

    2005-04-01

    Eye movements in response to high-acceleration head rotations (thrusts) in the horizontal plane from patients with unilateral (UVD) or bilateral vestibular loss (BVD) were recorded. The rapid, gaze-position corrections (GPCs) that appeared when vestibulo-ocular reflex (VOR) slow phases were undercompensatory were characterized. For comparison, eye movements from normal subjects who were asked to generate saccades in the direction opposite head rotation (in the same direction as slow phases) were recorded. This normal-subject model produced responses with spatial and temporal characteristics similar to those from GPCs in patients as follows: When head rotations were generated actively, compared with passively, gaze-position errors and corresponding GPCs were smaller and occurred earlier. During passively generated head thrusts, GPCs still occurred when head rotations were made in total darkness, though their accuracy decreased as the requirement for maintaining gaze on a specific location in space was relaxed. Time of onset of GPCs was not rigidly tied to head kinematics (peak velocity or peak acceleration). Speeds of GPCs, however, were lower than speeds of similar-sized, head-fixed saccades. Finally, during passive and active head thrusts in patients, sustained, high-frequency (20 to 30 Hz) oscillations that appeared as tiny saccades were occasionally observed, one immediately following the other, resembling a compensatory slow-phase response. Taken together, the results suggest that one strategy for overcoming a VOR deficit is to enlist the saccadic system to produce an oculomotor response that is required to compensate for head rotation. This response may come in the form of high-velocity GPCs or smaller-amplitude oscillations.

  5. Movement disorders and sleep.

    PubMed

    Driver-Dunckley, Erika D; Adler, Charles H

    2012-11-01

    This article summarizes what is currently known about sleep disturbances in several movement disorders including Parkinson disease, essential tremor, parkinsonism, dystonia, Huntington disease, myoclonus, and ataxias. There is an association between movement disorders and sleep. In some cases the prevalence of sleep disorders is much higher in patients with movement disorder, such as rapid eye movement sleep behavior disorder in Parkinson disease. In other cases, sleep difficulties worsen the involuntary movements. In many cases the medications used to treat patients with movement disorder disturb sleep or cause daytime sleepiness. The importance of discussing sleep issues in patients with movement disorders cannot be underestimated.

  6. Patient movement in the Pacific theater: changing the strategic focus from airplane to patient.

    PubMed

    Olsen, J C

    2001-05-01

    The U.S. military health care system forms a vast network across thousands of miles to serve patients in the Pacific theater. The medical treatment facilities in the Pacific, however, act independently and do not effectively track patients in the air evacuation system. The patients and the tracking systems are so disconnected that patients' whereabouts are unknown to both the command structure and the medical treatment facilities as soon as the plane leaves the ground. Furthermore, the databases cannot analyze treatment trends, and the cost of transport--a major part of the cost of health care in the Pacific--is hidden inside the air evacuation system. To ensure that managed care works effectively in the Pacific, Tricare Pacific has created an Internet-based database that will support a new network of case managers and effectively track patients. The Lead Agency's analysis of aeromedical evacuation also concluded that the wartime method of routine patient transport is not efficient in peacetime and, in fact, delays treatment. The recommendations from this financial analysis will reduce patient delays, enhance access, and save millions of health care dollars.

  7. Advancing Your Citizenship: An Annotated Bibliography on Consumerism/Advocacy for Persons with Disabilities. Advancing Your Citizenship Series Number 2.

    ERIC Educational Resources Information Center

    Browning, Philip; And Others

    The annotated bibliography lists 289 references which relate to the advocacy consumer movement for disabled people. Initial sections contain a listing of the periodicals, books and monographs/reports/proceedings from which the annotated references are derived; an author index; and a subject index. Among the subjects covered are the following:…

  8. Increased Saccadic Rate during Smooth Pursuit Eye Movements in Patients at Ultra High Risk for Developing a Psychosis

    ERIC Educational Resources Information Center

    van Tricht, M. J.; Nieman, D. H.; Bour, L. J.; Boeree, T.; Koelman, J. H. T. M.; de Haan, L.; Linszen, D. H.

    2010-01-01

    Abnormalities in eye tracking are consistently observed in schizophrenia patients and their relatives and have been proposed as an endophenotype of the disease. The aim of this study was to investigate the performance of patients at Ultra High Risk (UHR) for developing psychosis on a task of smooth pursuit eye movement (SPEM). Forty-six UHR…

  9. Increased Saccadic Rate during Smooth Pursuit Eye Movements in Patients at Ultra High Risk for Developing a Psychosis

    ERIC Educational Resources Information Center

    van Tricht, M. J.; Nieman, D. H.; Bour, L. J.; Boeree, T.; Koelman, J. H. T. M.; de Haan, L.; Linszen, D. H.

    2010-01-01

    Abnormalities in eye tracking are consistently observed in schizophrenia patients and their relatives and have been proposed as an endophenotype of the disease. The aim of this study was to investigate the performance of patients at Ultra High Risk (UHR) for developing psychosis on a task of smooth pursuit eye movement (SPEM). Forty-six UHR…

  10. Oral motor movements and swallowing in patients with myotonic dystrophy type 1.

    PubMed

    Ercolin, Beatriz; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Mendonça, Lucia Iracema Zanotto; Limongi, Suelly Cecilia Olivan; de Andrade, Claudia Regina Furquim

    2013-09-01

    Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1) using a standardized clinical protocol and surface electromyography (sEMG). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing.

  11. Mortality and Its Risk Factors in Patients with Rapid Eye Movement Sleep Behavior Disorder.

    PubMed

    Zhou, Junying; Zhang, Jihui; Lam, Siu Ping; Mok, Vincent; Chan, Anne; Li, Shirley Xin; Liu, Yaping; Tang, Xiangdong; Yung, Wing Ho; Wing, Yun Kwok

    2016-08-01

    To determine the mortality and its risk factors in patients with rapid eye movement (REM) sleep behavior disorder (RBD). A total of 205 consecutive patients with video-polysomnography confirmed RBD (mean age = 66.4 ± 10.0 y, 78.5% males) were recruited. Medical records and death status were systematically reviewed in the computerized records of the health care system. Standardized mortality ratio (SMR) was used to calculate the risk ratio of mortality in RBD with reference to the general population. Forty-three patients (21.0%) died over a mean follow-up period of 7.1 ± 4.5 y. The SMR was not increased in the overall sample, SMR (95% confidence interval [CI]) = 1.00 (0.73-1.33). However, SMR (95% CI) increased to 1.80 (1.21-2.58) and 1.75 (1.11-2.63) for RBD patients in whom neurodegenerative diseases and dementia, respectively, eventually developed. In the Cox regression model, mortality risk was significantly associated with age (hazard ratio [HR] = 1.05; 95% CI, 1.01-1.10), living alone (HR = 2.04; 95% CI, 1.39-2.99), chronic obstructive pulmonary disease (HR = 3.38; 95% CI, 1.21-9.46), cancer (HR = 10.09; 95% CI, 2.65-38.42), periodic limb movements during sleep (HR = 3.06; 95% CI, 1.50-6.24), and development of neurodegenerative diseases (HR = 2.84; 95% CI, 1.47-5.45) and dementia (HR = 2.66; 95% CI, 1.39-5.08). Patients with RBD have a higher mortality rate than the general population only if neurodegenerative diseases develop. Several risk factors on clinical and sleep aspects are associated with mortality in RBD patients. Our findings underscore the necessity of timely neuroprotective interventions in the early phase of RBD before the development of neurodegenerative diseases. © 2016 Associated Professional Sleep Societies, LLC.

  12. Effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients.

    PubMed

    Glasser, L

    1986-05-01

    The purpose of this study was to determine the effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients. Ten male and 10 female subjects, aged 40 to 75 years, participated in the study. The 20 hemiparetic subjects were assigned randomly to either a control group or an experimental group. All of the subjects participated in a conventional therapeutic exercise program and gait training. The experimental group also received isokinetic training on the Kinetron exercise machine as part of their program. Functional ambulation profile tests were administered to each subject before and after the five-week experimental period. All of the subjects showed improvement in the rate of ambulation and in overall ambulation performance. The differences in ambulation times and functional ambulation profile scores between the two groups were shown to be insignificant.

  13. Characteristics of left and right scanning in schizophrenia patients using exploratory eye movements: comparison with healthy subjects.

    PubMed

    Nishiura, Sachiko; Morita, Kiichiro; Kurakake, Kouji; Igimi, Hiroyasu; Maeda, Hisao

    2007-10-01

    To characterize the left and right scanning function and the effect of affection in schizophrenia patients exploratory eye movements as biologic markers were recorded in 44 schizophrenia patients and 72 age-matched healthy controls. The total eye scanning length (TESL) and total number of gaze points (TNGP) in the left and right visual fields were calculated as subjects viewed neutral or affectively charged pictures. TESL of patients was shorter than that of controls when viewing pictures of smiling babies and open circles. TESL of patients was shorter for smiling faces than for crying babies, but TESL of controls was longer for smiling faces than for crying babies. Left TNGP for smiling faces and circles was lower in patients than in controls. In patients, left TNGP for crying babies was higher than for either smiling babies or circles. In controls, left TNGP for smiling babies was higher than crying babies. In patients, left TNGP for smiling babies and circles was smaller than the right TNGP. In controls, left TNGP was larger for smiling than for crying babies. When viewing smiling babies, both TESL and TNGP were negatively correlated with negative symptom scores in patients. Patients' eye movements in the left visual field were clearly different from controls', suggesting that visual cognitive function is impaired in schizophrenia patients. Exploratory eye movements are a useful marker of visual cognitive function, and are a useful tool to evaluate the influence of affection in schizophrenia patients.

  14. Science, policy advocacy, and marine protected areas.

    PubMed

    Gray, Noella J; Campbell, Lisa M

    2009-04-01

    Much has been written in recent years regarding whether and to what extent scientists should engage in the policy process, and the focus has been primarily on the issue of advocacy. Despite extensive theoretical discussions, little has been done to study attitudes toward and consequences of such advocacy in particular cases. We assessed attitudes toward science and policy advocacy in the case of marine protected areas (MPAs) on the basis of a survey of delegates at the First International Marine Protected Areas Congress. Delegates were all members of the international marine conservation community and represented academic, government, and nongovernmental organizations. A majority of respondents believed science is objective but only a minority believed that values can be eliminated from science. Respondents showed only partial support of positivist principles of science. Almost all respondents supported scientists being integrated into MPA policy making, whereas half of the respondents agreed that scientists should actively advocate for particular MPA policies. Scientists with a positivist view of science supported a minimal role for scientists in policy, whereas government staff with positivist beliefs supported an advocacy or decision-making role for scientists. Policy-making processes for MPAs need to account for these divergent attitudes toward science and advocacy if science-driven and participatory approaches are to be reconciled.

  15. The Northland fluoridation advocacy programme: an evaluation.

    PubMed

    Gowda, Sunitha; Thomas, David R

    2008-12-01

    On 20 July 2006, the Far North District Council resolved to fluoridate Kaitaia and Kaikohe. This was the first such initiative by any Territorial Local Authority (TLA) in New Zealand for 23 years, and resulted from a fluoridation advocacy programme. This paper describes the programme implementation, assesses its consistency with the principles of the Treaty of Waitangi, and critically examines the collaboration between the fluoride advocate and the key stakeholders. Process evaluation identified three main categories of programme implementation: policy advocacy, community action projects, and media advocacy. The collaboration of iwi, Maori health providers and the community suggests that the programme was consistent with the principles (partnership, participation and protection) ofthe Treaty ofWaitangi. Media advocacy played an important role in reflecting and engaging community views on fluoridation, and it influenced decision-making by the Far North District Council. The simultaneous, combined 'top-down and bottom-up' approach was an effective and successful strategy for fluoridation advocacy in the community. Less integrated approaches implemented on their own (such as the 'top down' approach in Whangarei and the 'bottom-up' approach in Dargaville) were not effective.

  16. Gender and advocacy in Indonesia.

    PubMed

    Ray-ross, S

    1997-01-01

    The Centre for Development and Population Activities (CEDPA) and the Indonesian Midwives Association (IBI) have developed a two-phase training program regarding gender issues for the association's midwives. The first phase focuses on the leadership, management, and advocacy skills necessary to articulate program needs and to take part in making decisions regarding family planning and reproductive health. The second phase concerns the integration of gender into project design. Proposals developed by the midwives include the following: 1) to improve counseling services for women in a district where 70% of the women using contraception do not decide for themselves which methods to use; 2) to reduce maternal mortality in a district where it has increased by 20% and where women have died while waiting for husbands or fathers-in-law to make the decision to bring them to hospitals; 3) to develop gender-sensitive materials concerning HIV/AIDS; and 4) to expand gender training to all levels of IBI, to provide follow-up technical support, and to integrate gender into the mission statement of the organization. Dr. Nafsiah Mboi (member of Parliament and vice chair of the Global Commission on Women's Health), Dr. Widyastuti Wibisana (director of community participation in the Ministry of Health), Dr. Kokila Vaidya (WHO Medical Officer), Carla Bianpoen (gender specialist with the World Bank), and Titi Sumbung (director of the Melati Foundation) helped to develop and to conduct the program. IBI, which has 65,000 members, provides family planning, reproductive health, and maternal and child health services throughout Indonesia.

  17. Effects of discontinuing anticholinergic treatment on movement disorders, cognition and psychopathology in patients with schizophrenia

    PubMed Central

    Beauclair, Linda; Annable, Lawrence; Bélanger, Marie-Claire; Kolivakis, Theodore T.; Margolese, Howard C.

    2014-01-01

    Background: Physicians have prescribed anticholinergic agents such as benztropine, procyclidine, biperiden and trihexyphenidyl for treatment and prophylaxis of antipsychotic-induced extrapyramidal symptoms (EPS) for decades. Anticholinergic agents can however worsen tardive dyskinesia and cause many adverse effects, including cognitive impairment. Previous studies of anticholinergic discontinuation in patients with schizophrenia receiving antipsychotics have yielded a wide range of EPS relapse rates. Improvement in cognition after anticholinergic withdrawal was observed in some studies. Objective: This study evaluated the effect of anticholinergic discontinuation on movement disorders, cognition and general psychopathology after a 4-week taper in 20 outpatients with schizophrenia or schizoaffective disorder treated with antipsychotics. Results: Eighteen of twenty patients successfully discontinued their anticholinergic medication; two did not because of akathisia. Repeated measures analysis of variance did not show a significant effect of anticholinergic discontinuation on total Extrapyramidal Symptoms Rating Scale score or on the Parkinsonism, Akathisia, Dystonia or Tardive Dyskinesia subscales. However, significant improvement was found on the Brief Assessment of Cognition in Schizophrenia composite z score at weeks 6, 8 and 12 compared with baseline. Significant improvements were seen on the motor and the symbol-coding tasks. No significant effects were observed on the Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Clinical Global Impression – Improvement scales. Conclusion: In this 12-week study of anticholinergic discontinuation in 20 outpatients with schizophrenia or schizoaffective disorder, gradual decrease and discontinuation of anticholinergics led to a positive effect on cognition. There were no adverse consequences on general psychopathology and no significant differences for 18 of 20 subjects on movement disorders

  18. Bowel Sounds Are Not Associated With Flatus, Bowel Movement, or Tolerance of Oral Intake in Patients After Major Abdominal Surgery.

    PubMed

    Read, Thomas E; Brozovich, Marc; Andujar, Jose E; Ricciardi, Rocco; Caushaj, Philip F

    2017-06-01

    Auscultation for bowel sounds has been advocated by some clinicians as a method to determine the resolution of postoperative ileus. Our primary aim was to prospectively evaluate the relationships between bowel sounds and the ability to tolerate oral intake in patients after major abdominal surgery. Secondarily we aimed to evaluate relationships among bowel sounds, flatus and bowel movement, and oral intake. This was a prospective, blinded observational study. The study was conducted at Western Pennsylvania Hospital. A total of 124 adult patients undergoing major abdominal surgery were included. Data were collected by medical students blinded to the purpose of the study for 10 days postoperatively or until discharge, including the presence of bowel sounds (auscultation for 1 minute), flatus, bowel movement, and tolerance of oral intake (defined as ingestion of ≥1000 mL/24 h and each subsequent day without vomiting). Associations between paired variables were determined using ϕ coefficient testing. The study population consisted of 51 men and 73 women, with a mean age of 64 years (range, 20-92 y). The majority of patients (78/124 (63%)) underwent colorectal resection. The median length of hospital was 6 days. Bowel sounds were not associated with flatus, bowel movement, or tolerance of oral intake throughout the study period. The positive predictive value of bowel sounds in predicting flatus and bowel movement was low in the early postoperative period and remained <25% in predicting tolerance of oral intake throughout the study period. The analysis was repeated, including only those patients undergoing colorectal procedures, and was essentially unchanged. Flatus correlated with bowel movement in the first 6 days postoperation, but neither flatus nor bowel movement was associated with tolerance of oral intake. The rate of tolerance of oral intake was relatively modest throughout the study period. Bowel sounds are not associated with flatus, bowel movement, or

  19. Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease.

    PubMed

    Bäck, Maria; Jansson, Bengt; Cider, Asa; Herlitz, Johan; Lundberg, Mari

    2012-04-01

    To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease. Methodological research (cross-sectional study). A total of 332 patients, mean age 65 years (standard deviation 9.1) diagnosed with coronary artery disease at a university hospital were included in the study. The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face, content, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. In terms of reliability, the TSK-SV Heart was found to be stable over time (intra-class correlation coefficient 0.83) and internally consistent (Cronbach's alpha 0.78). Confirmatory factor analysis provided acceptable fit for a hypothesized 4-factor model with inclusion of a method factor. These results provide support for the reliability of the TSK-SV Heart. The questionnaire appears to be valid for use in patients with coronary artery disease. However, some items require further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future research concerning their implications for the target group.

  20. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke.

    PubMed

    Yoon, Jin A; Koo, Bon Il; Shin, Myung Jun; Shin, Yong Beom; Ko, Hyun-Yoon; Shin, Yong-Il

    2014-08-01

    To evaluate the effectiveness of constraint-induced movement therapy (CIMT) and combined mirror therapy for inpatient rehabilitation of the patients with subacute stroke. Twenty-six patients with subacute stroke were enrolled and randomly divided into three groups: CIMT combined with mirror therapy group, CIMT only group, and control group. Two weeks of CIMT for 6 hours a day with or without mirror therapy for 30 minutes a day were performed under supervision. All groups received conventional occupational therapy for 40 minutes a day for the same period. The CIMT only group and control group also received additional self-exercise to substitute for mirror therapy. The box and block test, 9-hole Pegboard test, grip strength, Brunnstrom stage, Wolf motor function test, Fugl-Meyer assessment, and the Korean version of Modified Barthel Index were performed prior to and two weeks after the treatment. After two weeks of treatment, the CIMT groups with and without mirror therapy showed higher improvement (p<0.05) than the control group, in most of functional assessments for hemiplegic upper extremity. The CIMT combined with mirror therapy group showed higher improvement than CIMT only group in box and block test, 9-hole Pegboard test, and grip strength, which represent fine motor functions of the upper extremity. The short-term CIMT combined with mirror therapy group showed more improvement compared to CIMT only group and control group, in the fine motor functions of hemiplegic upper extremity for the patients with subacute stroke.

  1. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial.

    PubMed

    Beselga, Carlos; Neto, Francisco; Alburquerque-Sendín, Francisco; Hall, Toby; Oliveira-Campelo, Natália

    2016-04-01

    Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA). To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA. Randomized controlled trial with immediate follow-up. Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. pain recorded by numerical rating scale (NRS). hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention. For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable. Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Validity of the lower extremity functional movement screen in patients with chronic ankle instability

    PubMed Central

    Choi, Ho-Suk; Shin, Won-Seob

    2015-01-01

    [Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI. PMID:26180349

  3. Rate-Dependent Impairments in Repetitive Finger Movements in Patients with Parkinson’s Disease are not Due to Peripheral Fatigue

    PubMed Central

    Stegemöller, Elizabeth L.; Allen, David P.; Simuni, Tanya; MacKinnon, Colum D.

    2010-01-01

    Performance of repetitive finger movements is an important clinical measure of disease severity in patients with Parkinson’s disease (PD) and is associated with a dramatic deterioration in performance at movement rates near 2 Hz and above. The mechanisms contributing to this rate-dependent movement impairment are poorly understood. Since clinical and experimental testing of these movements involve prolonged repetition of movement, a loss of force generating capacity due to peripheral fatigue may contribute to performance deterioration. This study examined the contribution of peripheral fatigue to the performance of unconstrained index finger flexion movements by measuring maximum voluntary contractions (MVC) immediately before and after repetitive finger movements in patients with PD (both off- and on-medication) and matched control subjects. Movement performance was quantified using finger kinematics, maximum force production, and electromyography (EMG). The principal finding was that peak force and EMG activity during the MVC did not significantly change from the pre- to post- movement task in patients with PD despite the marked deterioration in movement performance of repetitive finger movements. These findings show that the rate-dependent deterioration of repetitive finger movements in PD cannot be explained by a loss of force-generating capacity due to peripheral fatigue, and further suggest that mechanisms contributing to impaired isometric force production in PD are different from those that mediate impaired performance of high-rate repetitive movements. PMID:20599591

  4. Impact of Advocacy Initiatives on Nurses' Motivation to Sustain Momentum in Public Policy Advocacy.

    PubMed

    Taylor, Melissa R S

    2016-01-01

    The purpose of this study is to elicit insight from the public policy leaders of 2 regional professional nursing organizations on key qualities of their current advocacy initiatives that motivate nurses to sustain momentum in public policy advocacy beyond a single episode. The goal is to inform quality improvement in the development of future advocacy initiatives to increase sustained engagement of nurses. Social cognitive theory was used as the rationale for this qualitative, descriptive study. A purposive convenience sample of executive leadership and board committee members from 2 regional professional nursing organizations were recruited to complete an initial Web-based electronic survey, followed by separate semistructured interview focus groups. One organization was composed primarily of advanced practice registered nurses, and the other group composed of diverse, multispecialty nursing members with varied educational levels. Nine themes emerged, categorized as facilitators or challenges to the positive impact of advocacy initiatives on nurses' motivation. Highlighting and marketing facilitators to the positive impact of advocacy initiatives on nurses' motivation to sustain momentum in public policy advocacy, while designing and testing new initiatives that address the challenges, may increase the number of nurses who sustain engagement in the policy advocacy process. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Essentials of Advocacy in Case Management: Part 1: Ethical Underpinnings of Advocacy-Theories, Principles, and Concepts.

    PubMed

    Tahan, Hussein M

    2016-01-01

    This article describes the meaning and underpinnings of advocacy in the field of case management and shares essential principles and concepts for effective client advocacy. All practice settings across the continuum of health and human services and case managers of diverse professional backgrounds. Advocacy is vital to case management practice and a primary role of the professional case manager. It is rooted in ethical theory and principles. Successful case managers apply advocacy at every step of the case management process and in every action they take. Part I of this 2-part article explores the ethical theories and principles of advocacy, the perception of case management-related professional organizations of advocacy, and types of advocacy. Part II then presents a client advocacy model for case managers to apply in their practice, describes the role of advocacy in client engagement, and identifies important strategies and a set of essential competencies for effective case management advocacy. Acquiring foundational knowledge, skills, and competencies in what advocacy is equips case managers with the ability and confidence to enact advocacy-related behaviors in the provision of care to achieve desired outcomes for both the clients and health care agencies/providers alike. Case management leaders may use the knowledge shared in this article to develop advocacy training and competency programs for their case managers.

  6. Advocacy Evaluation: A Model for Internal Evaluation Offices.

    ERIC Educational Resources Information Center

    Sonnichsen, Richard C.

    1988-01-01

    As evaluations are more often implemented by internal staff, internal evaluators must begin to assume decision-making and advocacy tasks. This advocacy evaluation concept is described using the Federal Bureau of Investigation evaluation staff as a model. (TJH)

  7. Advocacy and Ombudswork for Children: Implications of the Israeli Experience.

    ERIC Educational Resources Information Center

    Rauche-Elnekave, Helen

    1989-01-01

    Discusses a network of child advocacy councils in Israel in relation to child advocacy efforts in the United States. Describes the Jerusalem Children's Council and the work of its Ombudsman for Children. (RJC)

  8. Advocacy and Ombudswork for Children: Implications of the Israeli Experience.

    ERIC Educational Resources Information Center

    Rauche-Elnekave, Helen

    1989-01-01

    Discusses a network of child advocacy councils in Israel in relation to child advocacy efforts in the United States. Describes the Jerusalem Children's Council and the work of its Ombudsman for Children. (RJC)

  9. Community stakeholder responses to advocacy advertising

    SciTech Connect

    Miller, B.; Sinclair, J.

    2009-07-01

    Focus group research was used to examine how community stakeholders, a group with local industry experience, responded to coal industry advocacy messages. The stakeholders expressed beliefs about both the advertiser and the coal industry, and while their knowledge led to critical consideration of the industry campaign, they also expressed a desire to identify with positive messages about their community. Applying a postpositivist research perspective, a new model is introduced to integrate these beliefs in terms of advertiser trust and industry accountability under the existing theoretical framework of persuasion knowledge. Agent and topic knowledge are combined in this model based on responses to the industry advocacy campaign. In doing so, this study integrates a priori theory within a new context, extending the current theoretical framework to include an understanding of how community stakeholders - a common target for marketplace advocacy - interpret industry messages.

  10. Tai-chi for residential patients with schizophrenia on movement coordination, negative symptoms, and functioning: a pilot randomized controlled trial.

    PubMed

    Ho, Rainbow T H; Au Yeung, Friendly S W; Lo, Phyllis H Y; Law, Kit Ying; Wong, Kelvin O K; Cheung, Irene K M; Ng, Siu Man

    2012-01-01

    Objective. Patients with schizophrenia residing at institutions often suffer from negative symptoms, motor, and functional impairments more severe than their noninstitutionalized counterparts. Tai-chi emphasizes body relaxation, alertness, and movement coordination with benefits to balance, focus, and stress relief. This pilot study explored the efficacy of Tai-chi on movement coordination, negative symptoms, and functioning disabilities towards schizophrenia. Methods. A randomized waitlist control design was adopted, where participants were randomized to receive either the 6-week Tai-chi program and standard residential care or only the latter. 30 Chinese patients with schizophrenia were recruited from a rehabilitation residency. All were assessed on movement coordination, negative symptoms, and functional disabilities at baseline, following intervention and 6 weeks after intervention. Results. Tai-chi buffered from deteriorations in movement coordination and interpersonal functioning, the latter with sustained effectiveness 6 weeks after the class was ended. Controls showed marked deteriorations in those areas. The Tai-chi group also experienced fewer disruptions to life activities at the 6-week maintenance. There was no significant improvement in negative symptoms after Tai-chi. Conclusions. This study demonstrated encouraging benefits of Tai-chi in preventing deteriorations in movement coordination and interpersonal functioning for residential patients with schizophrenia. The ease of implementation facilitates promotion at institutional psychiatric services.

  11. Tai-Chi for Residential Patients with Schizophrenia on Movement Coordination, Negative Symptoms, and Functioning: A Pilot Randomized Controlled Trial

    PubMed Central

    Ho, Rainbow T. H.; Au Yeung, Friendly S. W.; Lo, Phyllis H. Y.; Law, Kit Ying; Wong, Kelvin O. K.; Cheung, Irene K. M.; Ng, Siu Man

    2012-01-01

    Objective. Patients with schizophrenia residing at institutions often suffer from negative symptoms, motor, and functional impairments more severe than their noninstitutionalized counterparts. Tai-chi emphasizes body relaxation, alertness, and movement coordination with benefits to balance, focus, and stress relief. This pilot study explored the efficacy of Tai-chi on movement coordination, negative symptoms, and functioning disabilities towards schizophrenia. Methods. A randomized waitlist control design was adopted, where participants were randomized to receive either the 6-week Tai-chi program and standard residential care or only the latter. 30 Chinese patients with schizophrenia were recruited from a rehabilitation residency. All were assessed on movement coordination, negative symptoms, and functional disabilities at baseline, following intervention and 6 weeks after intervention. Results. Tai-chi buffered from deteriorations in movement coordination and interpersonal functioning, the latter with sustained effectiveness 6 weeks after the class was ended. Controls showed marked deteriorations in those areas. The Tai-chi group also experienced fewer disruptions to life activities at the 6-week maintenance. There was no significant improvement in negative symptoms after Tai-chi. Conclusions. This study demonstrated encouraging benefits of Tai-chi in preventing deteriorations in movement coordination and interpersonal functioning for residential patients with schizophrenia. The ease of implementation facilitates promotion at institutional psychiatric services. PMID:23304224

  12. Heightened beta EEG activity during nonrapid eye movement sleep in primary insomnia patients with reports of childhood maltreatment.

    PubMed

    Bader, Klaus; Schäfer, Valérie; Nissen, Lukas; Schenkel, Maya

    2013-04-01

    The present study explores the relationship between childhood maltreatment experiences and spectral power in high-frequency EEG activity during sleep in a sample of adults experiencing primary insomnia. Forty-five nontreated patients with primary insomnia spent three consecutive nights in the sleep laboratory, during which polysomnographic recordings were carried out. Nonrapid eye movement and rapid eye movement EEG data were analyzed using spectral analysis. In addition, each participant completed several self-report questionnaires assessing maltreatment in childhood and adolescence, current level of stress, and current depressivity. Insomnia patients with self-reported history of moderate to severe childhood maltreatment (MAL group; n = 25), as measured by the Childhood Trauma Questionnaire, were compared with insomnia patients without such a history (non-MAL group; n = 20). The MAL group exhibited more absolute and relative beta 1 and beta 2 power in nonrapid eye movement sleep and more absolute beta 1 and beta 2 activity in rapid eye movement sleep than the non-MAL group. Contrary to hypothesis, no group differences were found in gamma frequency band. The results suggest an association between history of childhood maltreatment and increased beta EEG activity particularly during nonrapid eye movement sleep in adult insomnia, what may reflect heightened psychophysiologic arousal during sleep.

  13. Measurement of three dimensional shoulder movement patterns with an electromagnetic tracking device in patients with a frozen shoulder

    PubMed Central

    Vermeulen, H; Stokdijk, M; Eilers, P; Meskers, C; Rozing, P; Vlieland, T

    2002-01-01

    Objective: To compare three dimensional movement patterns of the affected and non-affected shoulder in patients with a frozen shoulder before and after physical therapy. Methods: Patients with a unilateral frozen shoulder were assessed before and after three months of treatment. Three dimensional movement analysis was performed with the "Flock of Birds" electromagnetic tracking device while the patient raised their arms in three directions. Slopes of the regression lines of glenohumeral joint rotation versus scapular rotation, reflecting the scapulohumeral rhythm, were calculated. All assessments were made for both the affected and the unaffected side. Additional assessments included conventional range of motion (ROM) measurements and visual analogue scales (VAS) (0–100 mm) for shoulder pain at rest, during movement, and at night. Results: Ten patients with a unilateral frozen shoulder were included. The slopes of the curves of the forward flexion, scapular abduction, and abduction in the frontal plane of the affected and the unaffected side were significantly different in all three movement directions. Mean differences were 0.267, 0.215, and 0.464 (all p values <0.005), respectively. Mean changes of the slopes of the affected side after treatment were 0.063 (p=0.202), 0.048 (p=0.169), and 0.264 (p=0.008) in forward flexion, scapular abduction, and abduction in the frontal plane, respectively. All patients showed significant improvement in active ROM (all p<0.005), and the VAS for pain during movement and pain at night (p<0.05). Conclusions: With a three dimensional electromagnetic tracking system the abnormal movement pattern of a frozen shoulder, characterised by the relatively early laterorotation of the scapula in relation to glenohumeral rotation during shoulder elevation, can be described and quantified. Moreover, the system is sufficiently sensitive to detect clinical improvements. Its value in other shoulder disorders remains to be established. PMID

  14. Clinical usefulness and validity of robotic measures of reaching movement in hemiparetic stroke patients.

    PubMed

    Otaka, Eri; Otaka, Yohei; Kasuga, Shoko; Nishimoto, Atsuko; Yamazaki, Kotaro; Kawakami, Michiyuki; Ushiba, Junichi; Liu, Meigen

    2015-08-12

    Various robotic technologies have been developed recently for objective and quantitative assessment of movement. Among them, robotic measures derived from a reaching task in the KINARM Exoskeleton device are characterized by their potential to reveal underlying motor control in reaching movements. The aim of this study was to examine the clinical usefulness and validity of these robot-derived measures in hemiparetic stroke patients. Fifty-six participants with a hemiparetic arm due to chronic stroke were enrolled. The robotic assessment was performed using the Visually Guided Reaching (VGR) task in the KINARM Exoskeleton, which allows free arm movements in the horizontal plane. Twelve parameters were derived based on motor control theory. The following clinical assessments were also administered: the proximal upper limb section in the Fugl-Meyer Assessment (FMA-UE(A)), the proximal upper limb part in the Stroke Impairment Assessment Set (SIAS-KM), the Modified Ashworth Scale for the affected elbow flexor muscles (MAS elbow), and seven proximal upper limb tasks in the Wolf Motor Function Test (WMFT). To explore which robotic measures represent deficits of motor control in the affected arm, the VGR parameters in the paretic arm were compared with those in the non-paretic arm using the Wilcoxon signed rank test. Then, to explore which VGR parameters were related to overall motor control regardless of the paresis, correlations between the paretic and non-paretic arms were examined. Finally, to investigate the relationships between the robotic measures and the clinical scales, correlations between the VGR parameters and clinical scales were investigated. Spearman's rank correlation coefficients were used for all correlational analyses. Eleven VGR parameters on the paretic side were significantly different from those on the non-paretic side with large effect sizes (|effect size| = 0.76-0.87). Ten VGR parameters correlated significantly with FMA-UE(A) (|r| = 0

  15. Development and Assessment of the Social Issues Advocacy Scale

    ERIC Educational Resources Information Center

    Nilsson, Johanna E.; Marszalek, Jacob M.; Linnemeyer, Rachel M.; Bahner, Angela D.; Misialek, Leah Hanson

    2011-01-01

    This article describes the development and the initial psychometric evaluation of the Social Issues Advocacy Scale in two studies. In the first study, an exploratory factor analysis (n = 278) revealed a four-factor scale, accounting for 71.4% of the variance, measuring different aspects of social issue advocacy: Political and Social Advocacy,…

  16. Examining School Counselors' Commitments to Social Justice Advocacy

    ERIC Educational Resources Information Center

    Feldwisch, Rachel P.

    2016-01-01

    Many school counselors endorse using social justice advocacy to close achievement gaps. In this study, school counselors from a single state scored in the moderate to high range on the Social Issues Advocacy Scale. Results showed alignment between school counselors' self-endorsement of social justice advocacy and scores on the Advocacy…

  17. Examining School Counselors' Commitments to Social Justice Advocacy

    ERIC Educational Resources Information Center

    Feldwisch, Rachel P.

    2016-01-01

    Many school counselors endorse using social justice advocacy to close achievement gaps. In this study, school counselors from a single state scored in the moderate to high range on the Social Issues Advocacy Scale. Results showed alignment between school counselors' self-endorsement of social justice advocacy and scores on the Advocacy…

  18. Development and Assessment of the Social Issues Advocacy Scale

    ERIC Educational Resources Information Center

    Nilsson, Johanna E.; Marszalek, Jacob M.; Linnemeyer, Rachel M.; Bahner, Angela D.; Misialek, Leah Hanson

    2011-01-01

    This article describes the development and the initial psychometric evaluation of the Social Issues Advocacy Scale in two studies. In the first study, an exploratory factor analysis (n = 278) revealed a four-factor scale, accounting for 71.4% of the variance, measuring different aspects of social issue advocacy: Political and Social Advocacy,…

  19. Compensatory eye and head movements of patients with homonymous hemianopia in the naturalistic setting of a driving simulation.

    PubMed

    Bahnemann, Markus; Hamel, Johanna; De Beukelaer, Sophie; Ohl, Sven; Kehrer, Stefanie; Audebert, Heinrich; Kraft, Antje; Brandt, Stephan A

    2015-02-01

    Homonymous hemianopia (HH) is a frequent deficit resulting from lesions to post-chiasmal brain structures with a significant negative impact on activities of daily living. To address the question how patients with HH may compensate their visual field defect in a naturalistic environment, we performed a driving simulation experiment and quantitatively analyzed both eye and head movements using a head-mounted pupil camera. 14 patients with HH and 14 matched healthy control subjects participated in the study. Based on the detection performance of dynamically moving obstacles, which appeared unexpectedly along the sides of the road track, we divided the patient group into a high- and a low-performance group. Then, we compared parameters of eye and head movements between the two patient groups and the matched healthy control group to identify those which mediate successful detection of potentially hazardous objects. Differences in detection rates could not be explained by demographic variables or the extent of the visual field defect. Instead, high performance of patients with HH in the naturalistic setting of our driving simulation depended on an adapted visual exploratory behavior characterized by a relative increase in the amplitude and a corresponding increase in the peak velocity of saccades, widening horizontally the distribution of eye movements, and by a shift of the overall distribution of saccades into the blind hemifield. The result of the group comparison analyses was confirmed by a subsequent stepwise regression analysis which identified the horizontal spread of eye movements as single factor predicting the detection of hazardous objects.

  20. Rapid eye movement-sleep is reduced in patients with acute uncomplicated diverticulitis—an observational study

    PubMed Central

    Alamili, Mahdi; Nielsen, Claus Henrik; Rosenberg, Jacob; Gögenur, Ismail

    2015-01-01

    Introduction. Sleep disturbances are commonly found in patients in the postoperative period. Sleep disturbances may give rise to several complications including cardiopulmonary instability, transient cognitive dysfunction and prolonged convalescence. Many factors including host inflammatory responses are believed to cause postoperative sleep disturbances, as inflammatory responses can alter sleep architecture through cytokine-brain interactions. Our aim was to investigate alteration of sleep architecture during acute infection and its relationships to inflammation and clinical symptoms. Materials & Methods. In this observational study, we included patients with acute uncomplicated diverticulitis as a model to investigate the isolated effects of inflammatory responses on sleep. Eleven patients completed the study. Patients were admitted and treated with antibiotics for two nights, during which study endpoints were measured by polysomnography recordings, self-reported discomfort scores and blood samples of cytokines. One month later, the patients, who now were in complete remission, were readmitted and the endpoints were re-measured (the baseline values). Results. Total sleep time was reduced 4% and 7% the first (p = 0.006) and second (p = 0.014) nights of diverticulitis, compared to baseline, respectively. The rapid eye movement sleep was reduced 33% the first night (p = 0.016), compared to baseline. Moreover, plasma IL-6 levels were correlated to non-rapid eye movement sleep, rapid eye movement sleep and fatigue. Conclusion. Total sleep time and rapid eye movement sleep were reduced during nights with active diverticulitis and correlated with markers of inflammation. PMID:26290799

  1. Rapid eye movement-sleep is reduced in patients with acute uncomplicated diverticulitis-an observational study.

    PubMed

    Huang, Chenxi; Alamili, Mahdi; Nielsen, Claus Henrik; Rosenberg, Jacob; Gögenur, Ismail

    2015-01-01

    Introduction. Sleep disturbances are commonly found in patients in the postoperative period. Sleep disturbances may give rise to several complications including cardiopulmonary instability, transient cognitive dysfunction and prolonged convalescence. Many factors including host inflammatory responses are believed to cause postoperative sleep disturbances, as inflammatory responses can alter sleep architecture through cytokine-brain interactions. Our aim was to investigate alteration of sleep architecture during acute infection and its relationships to inflammation and clinical symptoms. Materials & Methods. In this observational study, we included patients with acute uncomplicated diverticulitis as a model to investigate the isolated effects of inflammatory responses on sleep. Eleven patients completed the study. Patients were admitted and treated with antibiotics for two nights, during which study endpoints were measured by polysomnography recordings, self-reported discomfort scores and blood samples of cytokines. One month later, the patients, who now were in complete remission, were readmitted and the endpoints were re-measured (the baseline values). Results. Total sleep time was reduced 4% and 7% the first (p = 0.006) and second (p = 0.014) nights of diverticulitis, compared to baseline, respectively. The rapid eye movement sleep was reduced 33% the first night (p = 0.016), compared to baseline. Moreover, plasma IL-6 levels were correlated to non-rapid eye movement sleep, rapid eye movement sleep and fatigue. Conclusion. Total sleep time and rapid eye movement sleep were reduced during nights with active diverticulitis and correlated with markers of inflammation.

  2. Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients

    PubMed Central

    Costa, Dirceu; Cancelliero, Karina Maria; IKE, Daniela; Laranjeira, Thais Lima; Pantoni, Camila Bianca Falasco; Borghi-Silva, Audrey

    2011-01-01

    INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL) movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time) and two shoulder abduction-adduction (same timing as above). Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p≤ 0.05). RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172%; PhREB: 131%; PhRTB: 142% and PhAng: 238%) as well as in shoulder horizontal abduction (PhRIB: 145%; PhREB: 109%; PhRTB: 130% and PhAng: 229%), differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients. PMID:21484050

  3. The effect of house design and environment on fungal movement in homes of bronchial asthma patients.

    PubMed

    Takatori, K; Saito, A; Yasueda, H; Akiyama, K

    2001-01-01

    The effect of house building design and environment on the fungal movement in the houses of 41 bronchial asthma (BA) patients has been investigated by examining house dust. The presence and composition of fungi were determined and compared in relation to building structure, house age, size of living room, main flooring material, presence of a living-room rug or air purifier, and frequency of vacuum cleaning. Among these elements, fungal CFU apparently varied only between building structure: wooden-board houses had significantly higher numbers of fungi than reinforced concrete houses (p < 0.01), and wooden mortar or iron-framed prefabricated houses had significantly higher numbers of fungi than reinforced concrete houses (p < 0.05). Classification of the types of fungi present in the house dust of BA patients showed that, regardless of the building designs, there were high levels of osmophilic fungi (group A) and fungi that survive at relatively dry conditions (group B), whereas fungi that survive in very wet conditions (group D) were present at low frequency.

  4. Nocturnal Rapid Eye Movement Sleep Latency for Identifying Patients With Narcolepsy/Hypocretin Deficiency

    PubMed Central

    Andlauer, Olivier; Moore, Hyatt; Jouhier, Laura; Drake, Christopher; Peppard, Paul E.; Han, Fang; Hong, Seung-Chul; Poli, Francesca; Plazzi, Giuseppe; O’Hara, Ruth; Haffen, Emmanuel; Roth, Thomas; Young, Terry; Mignot, Emmanuel

    2014-01-01

    IMPORTANCE Narcolepsy, a disorder associated with HLA-DQB1*06:02 and caused by hypocretin (orexin) deficiency, is diagnosed using the Multiple Sleep Latency Test (MSLT) following nocturnal polysomnography (NPSG). In many patients, a short rapid eye movement sleep latency (REML) during the NPSG is also observed but not used diagnostically. OBJECTIVE To determine diagnostic accuracy and clinical utility of nocturnal REML measures in narcolepsy/hypocretin deficiency. DESIGN, SETTING, AND PARTICIPANTS Observational study using receiver operating characteristic curves for NPSG REML and MSLT findings (sleep studies performed between May 1976 and September 2011 at university medical centers in the United States, China, Korea, and Europe) to determine optimal diagnostic cutoffs for narcolepsy/hypocretin deficiency compared with different samples: controls, patients with other sleep disorders, patients with other hypersomnias, and patients with narcolepsy with normal hypocretin levels. Increasingly stringent comparisons were made. In a first comparison, 516 age- and sex-matched patients with narcolepsy/hypocretin deficiency were selected from 1749 patients and compared with 516 controls. In a second comparison, 749 successive patients undergoing sleep evaluation for any sleep disorders (low pretest probability for narcolepsy) were compared within groups by final diagnosis of narcolepsy/hypocretin deficiency. In the third comparison, 254 patients with a high pretest probability of having narcolepsy were compared within group by their final diagnosis. Finally, 118 patients with narcolepsy/hypocretin deficiency were compared with 118 age- and sex-matched patients with a diagnosis of narcolepsy but with normal hypocretin levels. MAIN OUTCOME AND MEASURES Sensitivity and specificity of NPSG REML and MSLT as diagnostic tests for narcolepsy/hypocretin deficiency. This diagnosis was defined as narcolepsy associated with cataplexy plus HLA-DQB1*06:02 positivity (no cerebrospinal

  5. Motor-prediction improvements after virtual rehabilitation in geriatrics: frail patients reveal different learning curves for movement and postural control.

    PubMed

    Kubicki, A; Bonnetblanc, F; Petrement, G; Mourey, F

    2014-01-01

    Postural control associated with self-paced movement is critical for balance in frail older adults. The present work aimed to investigate the effects of a 2D virtual reality-based program on postural control associated with rapid arm movement in this population. Participants in an upright standing position performed rapid arm-raising movements towards a target. Practice-related changes were assessed by pre- and post-test comparisons of hand kinematics and centre-of-pressure (CoP) displacement parameters measured in a training group and a control group. During these pre- and post-test sessions, patients have to reach towards yellow balls appearing on the screen, form a standardized upright position (with 15cm between the two malleoli). Training group patients took part in six sessions of virtual game. In this, patients were asked to reach their arm towards yellow balls appearing on the screen, from an upright position. After training, we observed improvements in arm movements and in the initial phase of CoP displacement, especially in the anticipatory postural adjustments. Learning curves for these two types of motor improvements showed different rates. These were continuous for the control of the arm movement, and discontinuous for the control of the CoP during the anticipatory postural adjustments. These results suggest that some level of motor (re)-learning is maintained in frail patients with low functional reserves. They also suggest that re-learning of anticipatory postural control (i.e. motor prediction) is less robust than explicit motor learning involved for the arm reaching. This last point should encourage clinicians to extend the training course duration, even if reaching movement improvements seems acquired, in order to automate these anticipatory postural activities. However, other studies should be done to measure the retention of these two types of learning on a longer-term period. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. [Involuntary movements: video presentation].

    PubMed

    Ugawa, Yoshikazu

    2012-01-01

    What's involuntary movement? To define the involuntary movement, we should define the voluntary movement. It is, however, difficult to define the voluntariness. The involuntary movement usually indicates some abnormal movement occurring without any movement intention of the subject which excludes any reflex movements, such as tendon reflexes or normal startle response. How to see patients with involuntary movements Classification of involuntary movements entirely depends on clinical features of movements. The method to see the patients, therefore, follows how to describe the movements when explaining those to others. The three main points to care are as follows. Regularity in time or rhythmicity of the movement: regular, mostly regular, irregular or completely irregular. The most rhythmic one is tremor and most irregular one is myoclonus. Conditions inducing involuntary movement: resting, postural, during movement, emotional stress, sensory trick or others. These are important factor to see actual movements in clinical practice. To make an inducing condition in the clinic is sometimes required to see the symptoms. Pattern of involuntary movements: irregular, stereotypical, distribution of moving muscles, right-left difference and others. Several kinds of involuntary movements are presented in my talk.

  7. Automatic video detection of body movement during sleep based on optical flow in pediatric patients with epilepsy.

    PubMed

    Cuppens, Kris; Lagae, Lieven; Ceulemans, Berten; Van Huffel, Sabine; Vanrumste, Bart

    2010-09-01

    The aim of our work is to investigate whether the optical flow algorithm applied to video recordings can be used to detect movement during sleep in pediatric patients with epilepsy. The optical flow algorithm allocates intensities to pixels proportional to their involvement in movement of an object. The average of a percentage of the highest movement vectors was plotted as a function of time (R(t)). The used dataset contains video data acquired at the University Hospital of Leuven consisting of normal sleep movement and seizure movement. We investigated R(t), to make a distinction between movement and non-movement. We used the acquisition parameters (320 x 240 at 12.5 fps), derived from a previous study (Cuppens et al., Proceedings of the 4th European congress of the international federation for medical and biological engineering (MBEC 2008), ECIFBME 2008, Antwerp, Belgium, IFMBE Proceedings, vol 22, pp 784-789, 2008). Two experiments were concluded, one with global thresholds of R(t) in all datasets and one with a variable threshold in each dataset. The latter is obtained by inspecting a non-movement epoch and calculating the mean and standard deviations of R(t) over time. The variable threshold on R(t) was then obtained for each dataset by adding to the mean a fixed multiple of the standard deviation. Optimal thresholds were derived based on a three-fold cross-validation. The best result was achieved when using a variable threshold, which resulted in a sensitivity of one in all the test sets and a PPV of 1, 0.821, and 1, respectively, for the three test sets.

  8. Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy

    PubMed Central

    Ryu, Kwangmin; Ali, Asif; Kwon, Minji; Lee, Changyoung; Kim, Yujin; Lee, Gyusung; Kim, Jingu

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. [Subjects and Methods] Thirty-two right-handed patients with cerebral palsy (18 male, 14 female) whose ages ranged from 8 to 48 years participated in this experiment. Their cerebral palsy levels ranged from 1 to 3. The participants were assigned to one of three groups according to the experimental conditions: an assisted aquatic movement therapy group, a horseback riding therapy group, or a control group. Electroencephalograms, the Feeling Scale and the Felt Arousal Scale were examined as dependent variables. [Results] Analysis of self-reported data demonstrated a significant positive improvement in the emotions of participants in the assisted aquatic movement therapy group in comparison with the control group. With regard to the electroencephalogram analysis, the results of this study showed increased alpha power in the assisted aquatic movement therapy group compared with the horseback riding and control groups. [Conclusion] The results of this study suggest that professionals can consider assisted aquatic movement therapy as an effective therapeutic intervention for the improvement of mental health and brain activation. PMID:28174435

  9. Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy.

    PubMed

    Ryu, Kwangmin; Ali, Asif; Kwon, Minji; Lee, Changyoung; Kim, Yujin; Lee, Gyusung; Kim, Jingu

    2016-12-01

    [Purpose] The purpose of this study was to determine the effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. [Subjects and Methods] Thirty-two right-handed patients with cerebral palsy (18 male, 14 female) whose ages ranged from 8 to 48 years participated in this experiment. Their cerebral palsy levels ranged from 1 to 3. The participants were assigned to one of three groups according to the experimental conditions: an assisted aquatic movement therapy group, a horseback riding therapy group, or a control group. Electroencephalograms, the Feeling Scale and the Felt Arousal Scale were examined as dependent variables. [Results] Analysis of self-reported data demonstrated a significant positive improvement in the emotions of participants in the assisted aquatic movement therapy group in comparison with the control group. With regard to the electroencephalogram analysis, the results of this study showed increased alpha power in the assisted aquatic movement therapy group compared with the horseback riding and control groups. [Conclusion] The results of this study suggest that professionals can consider assisted aquatic movement therapy as an effective therapeutic intervention for the improvement of mental health and brain activation.

  10. Health and human rights advocacy: perspectives from a Rwandan refugee camp.

    PubMed

    Pavlish, Carol; Ho, Anita; Rounkle, Ann-Marie

    2012-07-01

    Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals' health and well-being. However, the International Council of Nurses' Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is paramount. This article applies the results of an ethnographic human rights study with displaced populations in Rwanda to argue for a rights-based social advocacy role for nurses. Human rights advocacy strategies include sensitization, participation, protection, good governance, and accountability. By adopting a rights-based approach to advocacy, nurses contribute to health agendas that include more just social relationships, equitable access to opportunities, and health-positive living situations for all persons.

  11. Eye Movement Dysfunction in First-Degree Relatives of Patients with Schizophrenia: A Meta-Analytic Evaluation of Candidate Endophenotypes

    ERIC Educational Resources Information Center

    Calkins, Monica E.; Iacono, William G.; Ones, Deniz S.

    2008-01-01

    Several forms of eye movement dysfunction (EMD) are regarded as promising candidate endophenotypes of schizophrenia. Discrepancies in individual study results have led to inconsistent conclusions regarding particular aspects of EMD in relatives of schizophrenia patients. To quantitatively evaluate and compare the candidacy of smooth pursuit,…

  12. Correlation of attention deficit, rapid eye movement latency and slow wave sleep in schizophrenia patients.

    PubMed

    Chang, Yu-San; Hsu, Chung-Yao; Tang, Shu-Hui; Lin, Ching-Yu; Chen, Ming-Chao

    2009-04-01

    Schizophrenia patients present both reduced slow wave sleep (SWS) and shortened rapid eye movement latency (REML) in polysomnographic (PSG) profiles, which have been linked to dopaminergic and muscarinic impairment, respectively. Two main selective attentional systems involve different anatomical structures. The first system is the parietal cortical areas and thalamic areas, which are linked to cholinergic neurotransmission. This is responsible for automatic attention response. The second system is the frontal regions, which are linked to dopaminergic neurotransmission. This is responsible for voluntary control of attentional resources. It was hypothesized that low attentional performance in schizophrenia patients is associated with shortened REML and reduced SWS. The PSG profile was correlated with the continuous performance test (CPT) in 15 schizophrenia inpatients under treatment with risperidone. Schizophrenia was diagnosed according to DSM-IV criteria, and clinical symptoms were evaluated on the Brief Psychiatric Rating Scale. REML was negatively correlated with errors of omission (P < 0.05), reaction time (RT; P < 0.05) and positively correlated with hit rate (HR; P < 0.05). No association was found between SWS and CPT performance. The significant indicators of CPT represent different attention processes. Errors of omission, which are linked to the problems with automatic attention processing, RT, which represent the speed of automatic processing, and HR, are involved in the integration of autonomic and voluntary attention control. The present results suggest that REML is associated with thalamus-related automatic attention response. Due to study limitations, however, confirmation of these findings in a large-scale controlled study of drug-naïve patients is needed.

  13. A Queer Theorist's Critique of Online Domestic Violence Advocacy: Critically Responding to the National Coalition Against Domestic Violence Web Site.

    PubMed

    Shelton, Samuel Z

    2017-08-30

    Since the foundations of the contemporary anti-violence movement in the 1960s and 1970s, advocates have sought to establish a critical understanding of domestic violence that we can use to direct our efforts for social change. Yet many advocates and advocacy organizations continue to rely on a problematic narrative of sameness that marginalizes and erases diverse victims' experiences and needs. In this article, I conduct a critical discourse analysis of the National Coalition Against Domestic Violence Web site to identify outcomes of this narrative for the inclusivity of advocacy efforts. I argue that despite the organization's numerous claims to represent diverse victims' experiences, Web site content reveals that its purportedly general account of domestic violence normalizes the experiences of a small group of victims-namely, heterosexual, cisgender women. Further, the Web site's content greatly limits the potential for thinking about and discussing violence across difference. I conclude with recommendations for changes in advocacy practices.

  14. Obama Team's Advocacy Boosts Charter Momentum

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2009-01-01

    President Barack Obama and U.S. Secretary of Education Arne Duncan have been championing charter schools for months, creating what some advocates believe is the most forceful national momentum to expand the largely independent public schools since the first charter opened nearly 20 years ago. That high-profile advocacy is being matched, moreover,…

  15. Parental Advocacy for Students with Autism

    ERIC Educational Resources Information Center

    Barclift, Coriann

    2010-01-01

    Students attending schools in the United States who have autism would benefit from increased parental involvement to enhance their learning. There is a lack of research regarding parental advocacy on behalf of students with autism. The purpose of this phenomenological study was to examine the lived experiences and perceptions of parents who have…

  16. Taking Our Seat at the Advocacy Table

    ERIC Educational Resources Information Center

    Laverdure, Patricia

    2017-01-01

    The Policy-Advocacy-Leadership (PAL) column is developed to initiate and facilitate important dialogue about health care and educational policy, and develop and share the knowledge, tools, and resources that enable all of us to be effective advocates for our clients and our practice and leaders in our practice settings and profession. In this…

  17. The state of advocacy in cancer.

    PubMed

    Maxwell, G Larry

    2015-12-01

    Non-profit advocacy organizations have been important in raising public awareness, promoting education, and enhancing political activism for issues related to cancer. Grassroots efforts aimed at fund-raising have substantially augmented federal funding for community outreach and research. The objective of this review was to evaluate successful accomplishments of several major non-profit organizations that are focused on cancer. A review of news media, medical literature, and financial records (using GuideStar) was performed to access the organizational structure and productivity of several successful cancer advocacy organizations. Compared to other cancer advocacy groups, the American Cancer Society is the oldest (>100years old) and worth the most with net assets of over $1.25 billion dollars and an annual total revenue of over $900 million dollars. The ACS also has the highest overhead at 41%. Most of the gynecologic cancer advocacy groups are approximately 20years old and have collective total annual revenue of over $17M dollars. The Ovarian Cancer Research Fund has been the most successful at raising funds and building net assets to date while maintaining an overhead of <10%. The most active and financially successful cancer organizations tend to be older, have higher overhead, spend less on total administration, spend more on fund-raising, have more events (rather than a limited number), and use aggressive social media strategies.

  18. Higher Education Alumni Associations and Political Advocacy

    ERIC Educational Resources Information Center

    Buchli, Richard N.

    2015-01-01

    Political advocacy is comprised of speaking on the behalf of a cause or participating as part of a political action group (Weerts, Cabrera, & Sanford, 2010). Because state financial support for public higher education has not been maintained at previous levels, higher education (HE) institutions have been recruiting alumni in an attempt to win…

  19. Educational Expertise, Advocacy, and Media Influence

    ERIC Educational Resources Information Center

    Malin, Joel R.; Lubienski, Christopher

    2015-01-01

    The efforts of many advocacy organizations to advance their preferred policies despite conflicting evidence of the effectiveness of these policies raise questions about factors that shape successful policy promotion. While many may like to think that expertise on an issue in question is an essential prerequisite for influence in public policy…

  20. Science Advocacy in a Shifting Policy Landscape

    NASA Astrophysics Data System (ADS)

    Bickford, E. E.

    2013-12-01

    In the last 50 years, federal investment in research as a share of total spending has declined from a little more than 10% in 1963 to less than 4% in 2013 (AAAS, 2013). In an era of sequestration and shrinking budgets, more and more scientists are advocating directly to policymakers (and their staff) to gain support for research programs and funding. The best advocates understand the political and policy processes, and anticipate policy shifts that may affect them. While scientists are trained with the technical skills to conduct their science, teach it to others, and market their work in order to win grants and publish papers, the policy advocacy arena is unfamiliar territory to many. Acquiring yet another area of expertise mid-career can be daunting, but science advocacy need not require another academic degree. Connecting with policymakers is the first step, and then an understanding of each policymaker's issue history and top priorities will inform the sales pitch. Here, I present some experiences on both the pitching and receiving ends of science advocacy from my year in the US Senate as an AGU/AAAS Congressional Science Fellow, and some guidance for meeting with policymakers and successful science advocacy.

  1. Enhancing Advocacy Skills of Teacher Candidates

    ERIC Educational Resources Information Center

    Holmes, Melissa A.; Herrera, Socorro G.

    2009-01-01

    This case study explores the dynamics of enhancing the capacities of teacher candidates in the Bilingual/Bicultural Education Students Interacting to Obtain Success (BESITOS) recruitment and retention program to advocate for culturally and linguistically diverse (CLD) students. Herrera and Murry's advocacy framework provides the theoretical…

  2. Organizing Your Parents for Effective Advocacy

    ERIC Educational Resources Information Center

    Elpus, Kenneth

    2008-01-01

    In today's world of restrictive school budgets and increasing property taxes, it is an unfortunate reality that many school districts will be faced with a budget crunch crisis that unenlightened school boards may try to solve by cutting or eliminating funds for music. At the crisis stage, it is often only the effective advocacy of an organized…

  3. Youth Advocacy: The Florida Tobacco Prevention Model.

    ERIC Educational Resources Information Center

    Foulk, David F.; Rollin, Stephen A.

    1999-01-01

    Describes the Florida Tobacco Pilot Program, a focused anti-tobacco initiative that uses youth advocacy training to accomplish its goals. The paper examines several of the Florida Tobacco Pilot Program's youth-related activities, which are designed to empower participating teens to be successful in resisting tobacco products. (SM)

  4. Health care advocacy turns into political activism.

    PubMed Central

    Spears, T

    1995-01-01

    Some advocacy groups are becoming more willing to engage in political activism. One is the Ontario Lung Association, which has been calling attention to government inaction on air-pollution issues such as controlling smog and improving indoor air quality. These lobbying efforts are supported by some physicians, who believe that environmental factors are behind the increased incidence of respiratory illness. PMID:7743456

  5. Strengthening Music Programs While Avoiding Advocacy Pitfalls

    ERIC Educational Resources Information Center

    West, Chad; Clauhs, Matthew

    2015-01-01

    This article examines ways in which music education advocacy efforts have become disconnected from the unified visions and declarations of music educators espoused in the Tanglewood and Housewright declarations and are thus reifying the disconnect between what we value and what we say we value. We first analyze the policies posited by the recently…

  6. Electronic Advocacy and Social Welfare Policy Education

    ERIC Educational Resources Information Center

    Moon, Sung Seek; DeWeaver, Kevin L.

    2005-01-01

    The rapid increase in the number of low-cost computers, the proliferation of user-friendly software, and the development of electronic networks have created the "informatics era." The Internet is a rapidly growing communication resource that is becoming mainstream in the American society. Computer-based electronic political advocacy by social…

  7. Higher Education Alumni Associations and Political Advocacy

    ERIC Educational Resources Information Center

    Buchli, Richard N.

    2015-01-01

    Political advocacy is comprised of speaking on the behalf of a cause or participating as part of a political action group (Weerts, Cabrera, & Sanford, 2010). Because state financial support for public higher education has not been maintained at previous levels, higher education (HE) institutions have been recruiting alumni in an attempt to win…

  8. Inclusion & Parent Advocacy: A Resource Guide.

    ERIC Educational Resources Information Center

    Klauber, Julie; Klauber, Avery

    This resource guide for public libraries provides an annotated listing of books, pamphlets, and multimedia materials about inclusion and parent advocacy. The introductory material explains inclusion, summarizes legal rights and inclusion terminology for librarians, describes the guide, and identifies some related resources for library collections.…

  9. Minnesota Youth Advocacy Corps: An Evaluation.

    ERIC Educational Resources Information Center

    Higgins, Paul S.

    The Minnesota Youth Advocacy Corps is an attempt to bridge the gap between institution and community for delinquent youth. The Corps was planned jointly by the Minnesota Departments of Education and Corrections, was funded by HEW (through the Youth Delinquency Prevention Administration) for initial organizational purposes and continued by funds…

  10. Child Advocacy: Implications for Child Welfare.

    ERIC Educational Resources Information Center

    McGowan, Brenda G.

    The purpose of this study was to evaluate the many diverse activities going on under the child advocacy label in order to determine if there was anything new or different about this phenomenon and to attempt some conceptual ordering of the field. Interviews were conducted with a number of people knowledgeable in children's service, and an attempt…

  11. CEC Handbook for Strengthening Grassroots Advocacy.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.

    This handbook is designed: (1) to empower individuals working with people who have disabilities to be a force for meeting the policy challenges in the communities in which they live and work; and (2) to help them to channel their strength, commitment, and knowledge of the special education field into effective advocacy efforts. The handbook…

  12. Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients.

    PubMed

    Kim, Nan-Hyang; Cha, Yong-Jun

    2015-03-01

    [Purpose] The purpose of the present study was to examine the effect of intensive gait training using a constrained induced movement therapy (CIMT) technique applied to the non-paretic upper extremity on the balance ability of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group or a control group. The experimental group received gait training with CIMT for 30 minutes per session, three sessions per week for four weeks, and the control group received gait training alone. [Results] The experimental group showed improvements in dynamic balance and the degree of improvement in this group was greater than that observed in the control group. Furthermore, the experimental group showed improvements in movement distances to the paretic side. On the other hand, the control group showed no significant improvements in balance indices after the intervention. [Conclusion] Gait training of stroke patients using CIMT techniques should be regarded as a treatment that can improve the balance of stroke patients.

  13. The African cancer advocacy consortium: shaping the path for advocacy in Africa

    PubMed Central

    2013-01-01

    Although there is significant evidence of a cancer epidemic in Africa, there is limited awareness about cancer in most African countries. By partnering with international organizations and institutions such as the University of Florida and the Prostate Net, the African Organisation for Research and Training in Cancer (AORTIC) is committed to improving cancer advocacy in Africa. This paper presents some of the recent efforts on cancer advocacy in Africa, including the results of a SWOT analysis conducted for the cancer advocacy workshop and the guidelines developed by cancer advocates on best practices for cancer advocacy in Africa. One of the outcomes of these efforts is the African Cancer Advocates Consortium (ACAC) founded by cancer advocates in Africa to, “Make Cancer a Top Priority in Africa”. While we have started the work to strengthen cancer advocacy in Africa, we still have a long way to go. Our goal of making cancer a priority in Africa can mainly be achieved by: (1) increasing the manpower for cancer advocacy through education and training; and (2) strengthening the network of cancer advocates across the continent. PMID:23902674

  14. How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information.

    PubMed

    Ploderer, Bernd; Fong, Justin; Klaic, Marlena; Nair, Siddharth; Vetere, Frank; Cofré Lizama, L Eduardo; Galea, Mary Pauline

    2016-10-05

    Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30% to 60% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients' adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient's arm movement and a Web-based dashboard to visualize this information for therapists. The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients' activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and

  15. Prehension Movements in a Patient (AC) with Posterior Parietal Cortex Damage and Posterior Callosal Section

    ERIC Educational Resources Information Center

    Frak, Victor; Paulignan, Yves; Jeannerod, Marc; Michel, Francois; Cohen, Henri

    2006-01-01

    Prehension movements of the right hand were recorded in a right-handed man (AC), with an injury to the left posterior parietal cortex (PPC) and with a section of the left half of the splenium. The kinematic analysis of AC's grasping movements in direct and perturbed conditions was compared to that of five control subjects. A novel effect in…

  16. Diagnosis and treatment of impulse control disorders in patients with movement disorders

    PubMed Central

    Mestre, Tiago A.; Strafella, Antonio P.; Thomsen, Teri; Voon, Valerie

    2013-01-01

    Impulse control disorders are a psychiatric condition characterized by the failure to resist an impulsive act or behavior that may be harmful to self or others. In movement disorders, impulse control disorders are associated with dopaminergic treatment, notably dopamine agonists (DAs). Impulse control disorders have been studied extensively in Parkinson’s disease, but are also recognized in restless leg syndrome and atypical Parkinsonian syndromes. Epidemiological studies suggest younger age, male sex, greater novelty seeking, impulsivity, depression and premorbid impulse control disorders as the most consistent risk factors. Such patients may warrant special monitoring after starting treatment with a DA. Various individual screening tools are available for people without Parkinson’s disease. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease has been developed specifically for Parkinson’s disease. The best treatment for impulse control disorders is prevention. However, after the development of impulse control disorders, the mainstay intervention is to reduce or discontinue the offending anti-Parkinsonian medication. In refractory cases, other pharmacological interventions are available, including neuroleptics, antiepileptics, amantadine, antiandrogens, lithium and opioid antagonists. Unfortunately, their use is only supported by case reports, small case series or open-label clinical studies. Prospective, controlled studies are warranted. Ongoing investigations include naltrexone and nicotine. PMID:23634190

  17. Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy

    PubMed Central

    Haddad, Cinira Assad Simão; Saad, Marcelo; Perez, Maria del Carmen Janeiro; Miranda, Fausto

    2013-01-01

    ABSTRACT Objective: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. Methods: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. Results: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. Conclusion: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist. PMID:24488379

  18. Calcitonin gingival crevicular fluid levels and pain discomfort during early orthodontic tooth movement in young patients.

    PubMed

    Alarcón, José Antonio; Linde, Dolores; Barbieri, Germán; Solano, Patricia; Caba, Octavio; Rios-Lugo, María Judith; Sanz, Mariano; Martin, Conchita

    2013-06-01

    To investigate the previously unreported presence of calcitonin (CT) levels in gingival crevicular fluid (GCF), its variations during initial orthodontic tooth movement in both tension and compression sites, and its possible association with the experienced dental pain. Fifteen children (mean age: 12.6 years) requiring orthodontic closure of the upper midline diastema were included. We collected GCF from the compression and tension sites of the upper right central incisor (experimental) and first bicuspid (control), before and after (1h, 24h, 7d, 15d) beginning of treatment. Calcitonin levels were determined by Western blot. Pain intensity was assessed using a visual analogue scale. Calcitonin levels were higher in the compression site versus the control site at 7d (p=0.014). Intragroup comparisons showed an increment of CT between 1h and 7d (680.81±1672.60pg/30s, p=0.010) in the compression site. No significant changes were found in the tension and control sites. Calcitonin levels and pain intensity were negatively associated during the period from 24h to 15d (r=-0.54, p=0.05). CT levels in the GCF significantly increased in the compression site after the short term after application of orthodontic forces. These changes were negatively associated with the perceived patient's dental pain during the period from 24h to 15d. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. The movement of patients across borders: challenges and opportunities for public health

    PubMed Central

    2011-01-01

    Abstract In a globalizing world, public health is no longer confined to national borders. In recent years we have observed an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data are sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, we still have little empirical evidence on its impact on public health, especially on health systems. This paper summarizes the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. This paper also offers guidance on how to define medical travel and how to improve data collection. It advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel. PMID:21346893

  20. Community HIV Treatment Advocacy Programs May Support Treatment Adherence

    PubMed Central

    Bogart, Laura M.; Wagner, Glenn J.; Mutchler, Matt G.; Risley, Brian; McDavitt, Bryce W.; McKay, Tara; Klein, David J.

    2011-01-01

    Treatment advocacy (TA) programs, based in AIDS service organizations and clinics, aim to engage clients into care and support antiretroviral treatment (ART) adherence through client-centered counseling; advocate for patients with providers; and provide social service referrals. Systematic evaluations of TA are lacking. We conducted a non-randomized evaluation examining relationships of TA participation to adherence, care engagement, social services utilization, unmet needs, patient self-advocacy, and adherence self-efficacy among 121 HIV-positive clients (36 in TA, 85 not in TA; 87% male, 34% African American, 31% White, 19% Latino). In multivariate models, TA participants (vs. non-TA participants) showed higher electronically monitored [85.3% vs. 70.7% of doses taken; b(SE)=13.16(5.55), p<.05] and self-reported [91.1% vs. 75.0%; b(SE)=11.60(5.65), p<.05] adherence; utilized more social service programs [Ms = 5.2 vs. 3.4; b(SE)=1.97(0.48), p<.0001]; and had fewer unmet social-service needs [Ms = 1.8 vs. 2.7; b(SE)=−1.06(0.48), p<.05]. Findings suggest the need for a randomized controlled trial of TA. PMID:22339141

  1. Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients.

    PubMed

    Kim, Kyoung; Lee, Dong-Kyu; Jung, Sang-In

    2015-12-01

    [Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.

  2. Relationship between Physical Impairments and Movement Patterns During Gait in Patients With End-stage Hip Osteoarthritis

    PubMed Central

    Zeni, Joseph; Pozzi, Federico; Abujaber, Sumayah; Miller, Laura

    2014-01-01

    Patients with hip osteoarthritis demonstrate limited range of motion, muscle weakness and altered biomechanics; however, few studies have evaluated the relationships between physical impairments and movement asymmetries. The purpose of this study was to identify the physical impairments related to movement abnormalities in patients awaiting total hip arthroplasty. We hypothesized that muscle weakness and pain would be related to greater movement asymmetries. Fifty-six subjects who were awaiting total hip arthroplasty were enrolled. Pain was assessed using a 0 to 10 scale, range of motion was assessed with the Harris Hip Score and isometric hip abductor strength was tested using a hand-held dynamometer. Trunk, pelvis and hip angles and moments in the frontal and sagittal planes were measured during walking using three dimensional motion analysis. During gait, subjects had 3.49 degrees less peak hip flexion and 8.82 degrees less extension angles (p<0.001) and had 0.03 Nm/k*m less hip abduction moment on the affected side (p=0.043). Weaker hip muscles were related to greater pelvis (r=−0.291) and trunk (r=−0.332) rotations in the frontal plane. These findings suggest that hip weakness drives abnormal movement patterns at the pelvis and trunk in patients with hip osteoarthritis to a greater degree than hip pain. PMID:25492583

  3. Restoration of Central Programmed Movement Pattern by Temporal Electrical Stimulation-Assisted Training in Patients with Spinal Cerebellar Atrophy.

    PubMed

    Huang, Ying-Zu; Chang, Yao-Shun; Hsu, Miao-Ju; Wong, Alice M K; Chang, Ya-Ju

    2015-01-01

    Disrupted triphasic electromyography (EMG) patterns of agonist and antagonist muscle pairs during fast goal-directed movements have been found in patients with hypermetria. Since peripheral electrical stimulation (ES) and motor training may modulate motor cortical excitability through plasticity mechanisms, we aimed to investigate whether temporal ES-assisted movement training could influence premovement cortical excitability and alleviate hypermetria in patients with spinal cerebellar ataxia (SCA). The EMG of the agonist extensor carpi radialis muscle and antagonist flexor carpi radialis muscle, premovement motor evoked potentials (MEPs) of the flexor carpi radialis muscle, and the constant and variable errors of movements were assessed before and after 4 weeks of ES-assisted fast goal-directed wrist extension training in the training group and of general health education in the control group. After training, the premovement MEPs of the antagonist muscle were facilitated at 50 ms before the onset of movement. In addition, the EMG onset latency of the antagonist muscle shifted earlier and the constant error decreased significantly. In summary, temporal ES-assisted training alleviated hypermetria by restoring antagonist premovement and temporal triphasic EMG patterns in SCA patients. This technique may be applied to treat hypermetria in cerebellar disorders. (This trial is registered with NCT01983670.).

  4. Movement and Other Neurodegenerative Syndromes in Patients with Systemic Rheumatic Diseases: A Case Series of 8 Patients and Review of the Literature.

    PubMed

    Menezes, Rikitha; Pantelyat, Alexander; Izbudak, Izlem; Birnbaum, Julius

    2015-08-01

    Patients with rheumatic diseases can present with movement and other neurodegenerative disorders. It may be underappreciated that movement and other neurodegenerative disorders can encompass a wide variety of disease entities. Such disorders are strikingly heterogeneous and lead to a wider spectrum of clinical injury than seen in Parkinson's disease. Therefore, we sought to stringently phenotype movement and other neurodegenerative disorders presenting in a case series of rheumatic disease patients. We integrated our findings with a review of the literature to understand mechanisms which may account for such a ubiquitous pattern of clinical injury.Seven rheumatic disease patients (5 Sjögren's syndrome patients, 2 undifferentiated connective tissue disease patients) were referred and could be misdiagnosed as having Parkinson's disease. However, all of these patients were ultimately diagnosed as having other movement or neurodegenerative disorders. Findings inconsistent with and more expansive than Parkinson's disease included cerebellar degeneration, dystonia with an alien-limb phenomenon, and nonfluent aphasias.A notable finding was that individual patients could be affected by cooccurring movement and other neurodegenerative disorders, each of which could be exceptionally rare (ie, prevalence of ∼1:1000), and therefore with the collective probability that such disorders were merely coincidental and causally unrelated being as low as ∼1-per-billion. Whereas our review of the literature revealed that ubiquitous patterns of clinical injury were frequently associated with magnetic resonance imaging (MRI) findings suggestive of a widespread vasculopathy, our patients did not have such neuroimaging findings. Instead, our patients could have syndromes which phenotypically resembled paraneoplastic and other inflammatory disorders which are known to be associated with antineuronal antibodies. We similarly identified immune-mediated and inflammatory markers of injury

  5. Gait profile score and movement analysis profile in patients with Parkinson's disease during concurrent cognitive load

    PubMed Central

    Speciali, Danielli S.; Oliveira, Elaine M.; Cardoso, Jefferson R.; Correa, João C. F.; Baker, Richard; Lucareli, Paulo R. G.

    2014-01-01

    Background: Gait disorders are common in individuals with Parkinson's Disease (PD) and the concurrent performance of motor and cognitive tasks can have marked effects on gait. The Gait Profile Score (GPS) and the Movement Analysis Profile (MAP) were developed in order to summarize the data of kinematics and facilitate understanding of the results of gait analysis. Objective: To investigate the effectiveness of the GPS and MAP in the quantification of changes in gait during a concurrent cognitive load while walking in adults with and without PD. Method: Fourteen patients with idiopathic PD and nine healthy subjects participated in the study. All subjects performed single and dual walking tasks. The GPS/MAP was computed from three-dimensional gait analysis data. Results: Differences were found between tasks for GPS (P<0.05) and Gait Variable Score (GVS) (pelvic rotation, knee flexion-extension and ankle dorsiflexion-plantarflexion) (P<0.05) in the PD group. An interaction between task and group was observed for GPS (P<0.01) for the right side (Cohen's ¯d=0.99), left side (Cohen's ¯d=0.91), and overall (Cohen's ¯d=0.88). No interaction was observed only for hip internal-external rotation and foot internal-external progression GVS variables in the PD group. Conclusions: The results showed gait impairment during the dual task and suggest that GPS/MAP may be used to evaluate the effects of concurrent cognitive load while walking in patients with PD. PMID:25054382

  6. Prevalence and Characteristics of Periodic Limb Movements during Sleep in Korean Adult Patients with Restless Legs Syndrome

    PubMed Central

    Shin, Jung-won; Koo, Yong Seo; Lee, Byeong Uk; Shin, Won Chul; Lee, Sang Kun; Cho, Yong Won; Jung, Ki-Young

    2016-01-01

    Study Objectives: The aim of this study was to investigate the prevalence and characteristics of periodic limb movements during sleep (PLMS) in Korean patients with restless legs syndrome (RLS). Methods: Unmedicated adult patients with idiopathic RLS (n = 354) who underwent polysomnography at three major sleep centers in tertiary hospitals were included. Characteristics of PLMS in RLS were analyzed using the time structure of polysomnographically recorded leg movements and periodicity indices (PIs). RLS severity and subjective sleep quality were assessed. Results: Out of 354 patients with idiopathic RLS (mean age: 52.9 ± 12.0 years), 150 patients (42.3%) had RLS with a PLMS index greater than 15 events/h, and 204 (57.9%) had a PLMS index greater than 5 events/h. The distribution of inter-LM intervals was bimodal, and high PIs (0.86 ± 0.10) were observed in patients with RLS and PLMS (PLMS index > 15 events/h). The PLMS index was positively correlated with age (r = 0.228; p < 0.001), the periodic limb movements in wakefulness index (r = 0.455, p < 0.001) and arousal index (r = 0.174, p = 0.014), but not with RLS severity and parameters of sleep quality. In multivariate analysis, age and male gender were independently associated with PLMS > 15 events/h. Conclusions: The prevalence of PLMS in Korean patients with RLS was lower than that observed in Western countries, but the characteristics of PLMS were not different. Ethnic differences and/or different genetic backgrounds may contribute to the varying prevalence of PLMS in RLS. Citation: Shin JW, Koo YS, Lee BU, Shin WC, Lee SK, Cho YW, Jung KY. Prevalence and characteristics of periodic limb movements during sleep in Korean adult patients with restless legs syndrome. J Clin Sleep Med 2016;12(8):1089–1097. PMID:27306390

  7. Mandibular Range of Movement and Pain Intensity in Patients with Anterior Disc Displacement without Reduction

    PubMed Central

    Alajbeg, Iva Z.; Gikić, Marijana; Valentić-Peruzović, Melita

    2015-01-01

    Objective Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional occlusal splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction. Materials and Methods Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS). Results At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy. Conclusion This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc

  8. Can music-based movement therapy improve motor dysfunction in patients with Parkinson's disease? Systematic review and meta-analysis.

    PubMed

    Zhang, Shuai; Liu, Dong; Ye, Dan; Li, Haiyu; Chen, Feng

    2017-06-21

    This study aimed to quantify whether there is association between music-based movement therapy and motor dysfunction in patients with Parkinson's disease, and, if so, whether music-based movement therapy can be used as first-line non-pharmacological treatment. To conduct a systematic review and meta-analysis of clinical trials that examined the effect of music-based movement therapy on patient-relevant and disease-specific outcomes. Comprehensive literature was searched of PubMed, EMbase, and the Cochrane Library from inception to November 2016. Randomized controlled trial of patients with Parkinson's disease was searched to identify trials comparing music-based movement therapy with no music care. A total of 8 studies (11 analyses, 241 subjects) were included; all of them had acceptable quality by PEDro scale score. Studies based on any type of Parkinson's disease patients were combined and subgroup analyzed. Compared with the control group, the SMD of Berg Balance Scale score was 0.85(0.46 to 1.25), -0.60 (-0.98 to -0.22) in Parkinson Disease Questionnaire-39 summary index, -0.90s (-1.56 to -0.23) in Time Up and Go text, and -0.43 (-1.11 to 0.25) in Unified Parkinson's Disease Rating Scale Motor Subscale 3 as instrument methods for motor function. Secondary outcomes included cognitive function and quality of life. There was positive evidence to support the use of music-based movement therapy on treatment of motor function; there was neutral evidence to support the use of music for the treatment of cognitive function quality of life.

  9. Interpersonal violence as social construction: the potentially undermining role of claims making and advocacy statistics.

    PubMed

    Perrin, Robin D; Miller-Perrin, Cindy L

    2011-10-01

    The relationship between empirical research inquiry and advocacy efforts is complex and seldom addressed in the interpersonal violence literature. In this article, we first examine how social conditions come to be seen as social problems, using a social constructionist perspective. Next, we focus specifically on the problem of interpersonal violence as viewed through a social constructionist lens, highlighting the many ways in which advocacy has influenced public perceptions of interpersonal violence as a social problem. Finally, this article considers some of the consequences that may result from exaggerated or misleading claims, especially when they are made by social scientists who are presumably engaged in an objective discussion of a problem. These consequences include generating skepticism toward the social sciences, feeding a backlash movement, and diverting attention away from the most severe forms of interpersonal violence. Contrary to the goals of many advocates, some of these consequences may be detrimental to the very social problems they hope to alleviate.

  10. Integrating medical and environmental sociology with environmental health: crossing boundaries and building connections through advocacy.

    PubMed

    Brown, Phil

    2013-06-01

    This article reviews the personal and professional processes of developing an interdisciplinary approach to understanding the complex issues of environmental health in their community, political-economic, social science, and scientific contexts. This interdisciplinary approach includes a synthesis of research, policy work, and advocacy. To examine multiple forms of interdisciplinarity, I examine pathways of integrating medical and environmental sociology via three challenges to the boundaries of traditional research: (1) crossing the boundaries of medical and environmental sociology, (2) linking social science and environmental health science, and (3) crossing the boundary of research and advocacy. These boundary crossings are discussed in light of conceptual and theoretical developments of popular epidemiology, contested illnesses, and health social movements. This interdisciplinary work offers a more comprehensive sociological lens for understanding complex problems and a practical ability to join with scientists, activists, and officials to meet public health needs for amelioration and prevention of environmental health threats.

  11. Patient safety in the operating theatre: how A3 thinking can help reduce door movement.

    PubMed

    Simons, Frederique Elisabeth; Aij, Kjeld Harald; Widdershoven, Guy A M; Visse, Merel

    2014-08-01

    Research has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands. A digital counter recorded door movement during 8009 surgical procedures during 8 months. The number of door movements per surgical procedure ranged from 0 to 555, with a mean of 24 door movements per hour across 26 specialisms. We aimed to reduce door movement in one operating room for orthopedic surgery by a lean A3 intervention. This intervention was executed by means of an A3 report that promotes structured problem solving based on a Plan-Do-Check-Act cycle. The steps of the A3 report was followed and completed one-by-one by a multidisciplinary team. The effect of the changes was monitored over the course of 12 months. The use of a lean A3 intervention resulted in a sustainable decrease of door movements by 78%, from a mean of 24 to a mean of 4 door movements per hour during orthopedic surgery at one OR. This paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures-with, according to respondents, a sustainable result. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  12. Deficit in late-stage contingent negative variation provides evidence for disrupted movement preparation in patients with conversion paresis.

    PubMed

    Blakemore, Rebekah L; Hyland, Brian I; Hammond-Tooke, Graeme D; Anson, J Greg

    2015-07-01

    Conversion paresis is the presence of unexplained weakness without detectable neuropathology that is not feigned. To examine the 'abnormal preparation' and 'disrupted execution' hypotheses proposed to explain the movement deficits in conversion paresis, electroencephalographic, electromyographic and kinematic measures were recorded during motor preparation and execution. Six patients with unilateral upper limb conversion weakness, 24 participants feigning weakness and 12 control participants performed a 2-choice precued reaction time task. Precues provided advance information about the responding hand or finger. Patients and feigners demonstrated similar diminished force, longer movement time and extended duration of muscle activity in their symptomatic limb. Patients showed significantly suppressed contingent negative variation (CNV) amplitudes, but only when the symptomatic limb was precued. Despite the similarity in performance measures, this CNV suppression was not seen in feigners. Diminished CNV for symptomatic hand precues may reflect engagement of an inhibitory mechanism suppressing cortical activity related to preparatory processes. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. An Investigation of Horizontal Combined Eye-Head Tracking in Patients with Abnormal Vestibular and Smooth Pursuit Eye Movements

    NASA Technical Reports Server (NTRS)

    Huebner, William P.; Leigh, R. John; Seidman, Scott H.; Billian, Carl

    1993-01-01

    We investigated the interaction of smooth ocular pursuit (SP) and the vestibulo-ocular reflex (VOR) during horizontal, combined eye-head tracking (CEHT) in patients with abnormalities of either the VOR or SP movements. Our strategy was to apply transient stimuli that capitalized on the different latencies to onset of SP and the VOR. During CEHT of a target moving at 15 deg/sec, normal subjects and patients with VOR deficits all tracked the target with a gain close to 1.O. When the heads of normal subjects were suddenly and unexpectedly braked to a halt during CEHT, the eye promptly began to move in the orbit to track the target, but eye-in-orbit velocity transiently fell to about 60-70% of target velocity. In patients with deficient labyrinthine function, following the onset of the head brake, eye movements to track the target were absent, and SP movements were not generated until about 100 msec later. In patients with deficient SP, CEHT was superior to SP tracking with the head stationary; after the onset of the head brake, tracking eye movements were initiated promptly, but eye velocity was less than 50% of target velocity and increased only slightly thereafter. These results indicate that at least two mechanisms operate to overcome the VOR and allow gaze to track the target during CEHT: (1) the SP system provides a signal to cancel a normally-operating VOR (this cancellation signal is not needed by labyrinthine-deficient patients who have no VOR to cancel), and (2) a reduction of the gain of the VOR is achieved, an ability that is preserved even in patients with cerebral lesions that impair SP.

  14. An Investigation of Horizontal Combined Eye-Head Tracking in Patients with Abnormal Vestibular and Smooth Pursuit Eye Movements

    NASA Technical Reports Server (NTRS)

    Huebner, William P.; Leigh, R. John; Seidman, Scott H.; Billian, Carl

    1993-01-01

    We investigated the interaction of smooth ocular pursuit (SP) and the vestibulo-ocular reflex (VOR) during horizontal, combined eye-head tracking (CEHT) in patients with abnormalities of either the VOR or SP movements. Our strategy was to apply transient stimuli that capitalized on the different latencies to onset of SP and the VOR. During CEHT of a target moving at 15 deg/sec, normal subjects and patients with VOR deficits all tracked the target with a gain close to 1.O. When the heads of normal subjects were suddenly and unexpectedly braked to a halt during CEHT, the eye promptly began to move in the orbit to track the target, but eye-in-orbit velocity transiently fell to about 60-70% of target velocity. In patients with deficient labyrinthine function, following the onset of the head brake, eye movements to track the target were absent, and SP movements were not generated until about 100 msec later. In patients with deficient SP, CEHT was superior to SP tracking with the head stationary; after the onset of the head brake, tracking eye movements were initiated promptly, but eye velocity was less than 50% of target velocity and increased only slightly thereafter. These results indicate that at least two mechanisms operate to overcome the VOR and allow gaze to track the target during CEHT: (1) the SP system provides a signal to cancel a normally-operating VOR (this cancellation signal is not needed by labyrinthine-deficient patients who have no VOR to cancel), and (2) a reduction of the gain of the VOR is achieved, an ability that is preserved even in patients with cerebral lesions that impair SP.

  15. Use of NeuroEyeCoach™ to Improve Eye Movement Efficacy in Patients with Homonymous Visual Field Loss

    PubMed Central

    Zihl, Josef

    2016-01-01

    Visual field deficits are common in patients with damaged retinogeniculostriate pathways. The patient's eye movements are often affected leading to inefficient visual search. Systematic eye movement training also called compensatory therapy is needed to allow patients to develop effective coping strategies. There is a lack of evidence-based, clinical gold-standard registered medical device accessible to patients at home or in clinical settings and NeuroEyeCoach (NEC) is developed to address this need. In three experiments, we report on performance of patients on NEC compared to the data obtained previously on the earlier versions of the search task (n = 32); we assessed whether the self-administered computerised tasks can be used to monitor the progress (n = 24) and compared the findings in a subgroup of patients to a healthy control group. Performance on cancellation tasks, simple visual search, and self-reported responses on activities of daily living was compared, before and after training. Patients performed similarly well on NEC as on previous versions of the therapy; the inbuilt functionality for pre- and postevaluation functions was sensitive to allowing assessment of improvements; and improvements in patients were significantly greater than those in a group of healthy adults. In conclusion, NeuroEyeCoach can be used as an effective rehabilitation tool to develop compensatory strategies in patients with visual field deficits after brain injury. PMID:27703974

  16. Periodic leg movements in RLS patients as compared to controls: Are there differences beyond the PLM index?

    PubMed

    Boehm, Gwendolyn; Wetter, Thomas C; Trenkwalder, Claudia

    2009-05-01

    To characterize periodic leg movements (PLM) and their association with sleep disturbances in drug-free patients with restless legs syndrome (RLS) and healthy subjects without sleep complaints. Polysomnographic recordings of 95 patients with idiopathic RLS and 31 age-matched controls were compared, and correlation analysis between sleep efficiency and PLM variables was performed. All patients and controls were free of medication for 10 days prior to polysomnography. PLM measures revealed a significantly longer mean duration of single PLM during wakefulness and non rapid eye movement (NREM) sleep in RLS patients as compared to controls. PLM indices were higher in RLS patients than in controls during all sleep stages, but not during wakefulness and slow wave sleep. A significantly higher number of PLM sequences was found in RLS patients than in controls. In RLS patients decreased sleep efficiency was associated with a higher number and a shorter duration of PLM sequences. The mean duration of single PLM might be an appropriate parameter to discriminate between healthy subjects with PLM and patients with RLS. High numbers of PLM sequences of short duration might be an indicator for the decreased sleep quality in RLS patients.

  17. Assessment of Mandibular Movements in 10 to 15 Year-old Patients With and Without Temporomandibular Disorders.

    PubMed

    Cortese, Silvina G; Biondi, Ana M; Fridman, Diana E; Guitelman, Ingrid; Farah, Catalina L

    2015-12-01

    The aim of this study was to establish reference values for mandibular movements in 10- to 15-year-olds without dysfunction and compare these values to those in patients of the same age with tempromandibular disorders (TMD) and those found previously in a group of children younger than 11 years old without TMD. Children of both genders who visited the Department of Comprehensive Pediatric Dentistry at Buenos Aires University in 2013 and whose parents or guardians provided consent were evaluated using TMD/RDC by standardized pediatric dentists (Kappa 0.88). Three groups were formed according to diagnostic summary: Group C, without TMD; Group Ia, with myofascial pain, and Group Ib, pain with limited mouth opening. The following variables were analyzed: age, gender and mandibular movements. The sample included 169 patients aged 12.5±1.76 years, of whom 62.36% did not have TMD (C) while 37.27% were diagnosed with muscle disorder (29.58% Ia and 7.69% Ib). For Group C, the following values (in mm) were recorded: maximal unassisted opening: 48.28±6.14; right lateral movement 8.78±2.50; left lateral movement: 9.60±2.64; protrusion: 4.94±2.58 and overbite: 2.98 ± 2.5, with no variation associated to sex, but with differences in the values recorded for all movements compared to those obtained for mixed dentition (p=0.0001). Analysis of mean values for mandibular movements in all 3 groups only revealed differences for maximal unassisted opening (p= 0.0317). With relation to gender, TMD was more frequent in females, with significant differences between Groups C and Ia (p=0.019). In males without dysfunction, average maximal opening was 48.28±6.14mm, with lower values in patients with TMD. Mandibular movements in pediatric patients without TMD showed significant differences according to dentition type and age.

  18. The use of the Actiwatch-Neurologica system to objectively assess the involuntary movements and sleep-wake activity in patients with mild-moderate Huntington's disease.

    PubMed

    Hurelbrink, Carrie B; Lewis, Simon J G; Barker, Roger A

    2005-06-01

    Huntington's disease (HD) is a neurodegenerative disorder characterised by cognitive, psychiatric and motor abnormalities including a range of involuntary movements. Currently, assessment of these movements involves the use of subjective rating scales such as the Unified Huntington's Disease Rating Scales (UHDRS) for bradykinesia and maximal dystonia and chorea, without any objective measures. As new therapies emerge, it is critical that an objective means of evaluating these abnormal movements is developed and we have investigated the use of a wrist-worn activity monitor, the Actiwatch-Neurologica, to determine whether these movements can be measured. In addition, this activity monitor and subjective reports were used to objectively measure the degree of sleep disruption in these same HD patients. Eight patients with mild-moderate HD and 8 age- and sex-matched control subjects wore the monitor for a period of 48 hours and recorded in a diary whether they were asleep or awake for each hour over the 2-day period. Assessment of various movement parameters revealed that HD patients exhibited significantly greater total and maximum activity levels and spent longer performing high acceleration movements while they were awake compared with controls. During sleep, patients not only showed significantly more activity and spent more time making high acceleration movements, but they also made significantly more movements than control subjects. These results demonstrate that the Actiwatch-Neurologica activity monitor can be used to objectively assess movements in HD patients during periods of high activity as well as during sleep.

  19. Movement diagram and "end-feel" reliability when measuring passive lateral rotation of the shoulder in patients with shoulder pathology.

    PubMed

    Chesworth, B M; MacDermid, J C; Roth, J H; Patterson, S D

    1998-06-01

    Findings related to joint function can be recorded with movement diagrams or by characterizing the "end-feel" according to the procedure described by Cyriax. Because both methods are used to classify pain and resistance in relation to joint range of motion (ROM), the purpose of this study was to simultaneously evaluate the reliability of these categorizations in a patient sample. Two physical therapists performed 2 assessments of passive lateral rotation of the shoulder in 34 patients. Pain and resistance findings were recorded using movement diagrams and end-feel categories. Intraclass correlation coefficients (ICC[2,1]) were used to analyze the ratio (movement diagram) data, and kappa statistics (kappa) were used to analyze the categorical (end-feel) data. Intrarater ICCs varied from .58 to .89. Interrater ICCs for locating maximum pain and resistance in joint ROM varied from .85 to .91. Other interrater ICCs were lower (ICC = .34-.88). Intrarater kappa values for end-feel were moderate (kappa = .48-.59), and interrater kappa values were substantial (kappa = .62-.76). Movement diagram measures conceptually related to the end of joint ROM and end-feel were highly reliable. This finding and the fact that additional end-feel categories were introduced in the study may partially explain the end-feel reliability findings. Consideration of their use in future studies may help to determine their clinical utility.

  20. Jaw movements in patients with a history of pain: an exploratory study.

    PubMed

    Bhaskaracharya, M; Memon, S M; Whittle, T; Murray, G M

    2015-01-01

    The aims were to determine whether individuals with a past history of pain exhibit (i) altered jaw movement (e.g. reduced amplitude, increased jaw movement variability) in comparison with matched asymptomatic controls, and (ii) correlations between psychological measures (e.g. catastrophising) and altered jaw movement variables. Sixteen participants with a history of trigeminal neuropathic pain (TNP) and 15 age- and gender-matched healthy controls had jaw movements recorded during open/close, free gum chewing and chewing at standardised rates. All completed the Pain Catastrophising Scale (PCS), the Pain Self-Efficacy Questionnaire (PSEQ), and the Depression, Anxiety and Stress Scales (DASS). Velocity and amplitude for open/close and chewing, as well as variability, bias and mean square error for open/close jaw movements were compared between groups. Spearman's rank correlation coefficient was used to relate kinematic variables with psychological variables. Statistical significance: P < 0·05. There were no significant differences in mean jaw velocity and amplitude between the TNP and control groups during the open/close jaw movements or free or standardised chewing. In comparison with control, the TNP participants exhibited significantly greater variability, bias and/or mean square error during slow and/or fast opening, and significantly greater variance in velocity and/or amplitude during free and standardised chewing. There were significant negative correlations between PCS scores and velocity and/or amplitude of free and/or standardised chewing. This exploratory study suggests that individuals with a history of pain have altered patterns of jaw movements in comparison with asymptomatic control participants and that catastrophising may play a role in the manifestation of these altered jaw movements.

  1. Advocacy and mass education in plastic surgery: Efforts and outcomes

    PubMed Central

    Panse, Nikhil Shrikrishna

    2017-01-01

    Background: Awareness of plastic surgery is lacking. Be it reconstructive surgery, or aesthetic surgery, public education and awareness regarding the spectrum is the need of the hour. Materials and Methods: We undertook a string of activities for patient awareness and education for burn prevention, occupational hand injuries prevention, skin banking awareness and various other conditions relevant to us as plastic surgeons. Use of social media helped us for increasing the reach of our projects. Observation and Results: Some of the projects we started, we are still pursuing with sincerity, and some never really picked up. A wide range and spectrum of activities were undertaken, and we would like to think that we have made some impact towards advocacy of plastic surgery; however, the measurable impact of these initiatives is questionable. Conclusion: Collective efforts for promotion of the speciality using innovative methods, use of celebrities for awareness and social media amongst other things must be undertaken to make a sustained and demonstrable impact towards advocacy of plastic surgery. PMID:28615817

  2. On advocacy by environmental scientists: what, whether, why, and how.

    PubMed

    Nelson, Michael P; Vucetich, John A

    2009-10-01

    Debate about the nature and appropriateness of advocacy by environmental scientists is important--it represents understanding the role of these citizens in our society. Much has been written about advocacy by scientists, and that literature describes substantial diversity in reasons why advocacy by scientists is or is not appropriate. Despite the nature of this literature there has been no comprehensive, systematic review of why some favor and others oppose advocacy by environmental scientists. Through a literature review we catalogued, categorized, and critiqued the arguments used for and against the appropriateness of advocacy by environmental scientists. Most arguments, whether for or against advocacy, are characterized by some significant deficiency. From our analysis of the literature an argument emerges that to date has never been fully articulated: that advocacy is nearly unavoidable, and that scientists, by virtue of being citizens first and scientists second, have a responsibility to advocate to the best of their abilities, to improve their advocacy abilities, and to advocate in a justified and transparent manner. We also discuss the meaning and relevance of advocacy being justified and transparent. We suggest scientists expend their efforts to better understand what constitutes appropriate advocacy and spend less effort pondering whether they should advocate.

  3. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment

    PubMed Central

    Pylvänäinen, Päivi M.; Muotka, Joona S.; Lappalainen, Raimo

    2015-01-01

    We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60–0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15–0.37. The results indicated that DMT is beneficial in the treatment of depressed patients. PMID:26217292

  4. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment.

    PubMed

    Pylvänäinen, Päivi M; Muotka, Joona S; Lappalainen, Raimo

    2015-01-01

    We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60-0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15-0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.

  5. The effects on cognitive functions of a movement-based intervention in patients with Alzheimer's type dementia: a pilot study.

    PubMed

    Yágüez, Lidia; Shaw, Kendra N; Morris, Robin; Matthews, David

    2011-02-01

    To explore the effect of a non-aerobic movement based activity on cognition in people with Alzheimer's type dementia (AD). The sample consisted of 27 patients fulfilling the AD ICD-10 diagnostic criteria. The patient sample was randomly divided into two groups: The Exercise Group received 6 weeks movement training and comprised 15 participants with a mean age of 70.5 years (SD: 8). Control Group participated in a standard care group, which served as a control intervention, and consisted of 12 patients with an average age of 75.7 years (SD: 6.90). Cognitive functions were assessed using six computerised tests from the CANTAB, pre and post training. Data were analysed using t-tests. The false discovery rate (FDR) for multiple comparisons as well as Cohen's d effect size was used to assess the significant effects. Significant improvements in sustained attention, visual memory and a trend in working memory were found in the Exercise Group compared to Control Group after the 6 weeks training. In addition, after 6 weeks the Control Group deteriorated significantly in attention, while the AD patients who undertook the physical exercise showed a discrete improvement. The present study shows that a short course of non-aerobic movement based exercise is already effective at least in some aspects of cognitive functioning in patients with AD. Although the present study is a pilot study with small samples, nevertheless, the results are promising for the further investigation and development of non-aerobic movement programmes. Copyright © 2010 John Wiley & Sons, Ltd.

  6. The art and science of political advocacy.

    PubMed

    Kosiorowski, Donna

    2014-01-01

    School nurses throughout the nation, individually and collectively, work to bring about change for the school nursing profession and to safeguard the health of children and the public. School nurses practice amidst education reform, health care reform, changes in society, and medical and technological advancements. School nurses must be active in decisions that affect their daily practice by involvement in the local, state, and federal political process. School nurses must craft the art and develop the science of political advocacy.

  7. Feasibility of Using Microsoft Kinect to Assess Upper Limb Movement in Type III Spinal Muscular Atrophy Patients.

    PubMed

    Chen, Xing; Siebourg-Polster, Juliane; Wolf, Detlef; Czech, Christian; Bonati, Ulrike; Fischer, Dirk; Khwaja, Omar; Strahm, Martin

    2017-01-01

    Although functional rating scales are being used increasingly as primary outcome measures in spinal muscular atrophy (SMA), sensitive and objective assessment of early-stage disease progression and drug efficacy remains challenging. We have developed a game based on the Microsoft Kinect sensor, specifically designed to measure active upper limb movement. An explorative study was conducted to determine the feasibility of this new tool in 18 ambulant SMA type III patients and 19 age- and gender-matched healthy controls. Upper limb movement was analysed elaborately through derived features such as elbow flexion and extension angles, arm lifting angle, velocity and acceleration. No significant differences were found in the active range of motion between ambulant SMA type III patients and controls. Hand velocity was found to be different but further validation is necessary. This study presents an important step in the process of designing and handling digital biomarkers as complementary outcome measures for clinical trials.

  8. Feasibility of Using Microsoft Kinect to Assess Upper Limb Movement in Type III Spinal Muscular Atrophy Patients

    PubMed Central

    Siebourg-Polster, Juliane; Wolf, Detlef; Czech, Christian; Bonati, Ulrike; Fischer, Dirk; Khwaja, Omar; Strahm, Martin

    2017-01-01

    Although functional rating scales are being used increasingly as primary outcome measures in spinal muscular atrophy (SMA), sensitive and objective assessment of early-stage disease progression and drug efficacy remains challenging. We have developed a game based on the Microsoft Kinect sensor, specifically designed to measure active upper limb movement. An explorative study was conducted to determine the feasibility of this new tool in 18 ambulant SMA type III patients and 19 age- and gender-matched healthy controls. Upper limb movement was analysed elaborately through derived features such as elbow flexion and extension angles, arm lifting angle, velocity and acceleration. No significant differences were found in the active range of motion between ambulant SMA type III patients and controls. Hand velocity was found to be different but further validation is necessary. This study presents an important step in the process of designing and handling digital biomarkers as complementary outcome measures for clinical trials. PMID:28122039

  9. Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing.

    PubMed

    Raboni, Mara R; Alonso, Fabiana F D; Tufik, Sergio; Suchecki, Deborah

    2014-01-01

    Posttraumatic stress disorder (PTSD) patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective, and objective sleep. The sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and 1 day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. In addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. In conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms.

  10. Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing

    PubMed Central

    Raboni, Mara R.; Alonso, Fabiana F. D.; Tufik, Sergio; Suchecki, Deborah

    2014-01-01

    Posttraumatic stress disorder (PTSD) patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective, and objective sleep. The sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and 1 day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. In addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. In conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms. PMID:24959123

  11. Efficacy of Eye Movements Desensitization and Reprocessing on the Quality of Life of the Patients with Myocardial Infarction.

    PubMed

    Salehian, Tahmineh; Saeedinejad, Saidzaker; Behnammoghadam, Mohammad; Shafiee, Mohsen; Mohammadhossini, Sima; Behnammoghadam, Zargham; Behnammoghadam, Aziz; Ebrahimpour, Soheil; Paymard, Akvan

    2016-10-01

    Myocardial infarction causes limitations in the physical activity and perturbation of quality of life.The aim of this study was to evaluate the effect of eye movements desensitization and reprocessing (EMDR) on the quality of life of these patients. This study was conducted in two groups as the before and after while the effect of eye movements desensitization and reprocessing on the quality of life of the patients with Myocardial infarction. Sampling was done based on the purposive sampling. Patients were randomly divided into two experimental and control groups (30 patients in each group). Samples were assigned through randomized allocation. In the experimental group, the EMDR method was carried out on the patients in five 90-minute sessions over a two week period. In the control group no intervention was received. Data of Quality of life, pre-treatment, post-treatment were analyzed using SPSS. The results showed that the quality of life increase in all its dimensions of the experimental group, after performing the EMDR therapy significantly (P=0.001). Treatment what has already been stated, was effective on the quality of life in patients. Treatment team members can use this method as an effective intervention in order to improve the quality of life of their patients.

  12. Innovation in social policy: collaborative policy advocacy.

    PubMed

    Sherraden, Margaret S; Slosar, Betsy; Sherraden, Michael

    2002-07-01

    In a time of policy devolution, social workers have a unique opportunity to develop a significant voice in constructing state social welfare policy. This article examines a method of collaborative policy advocacy led by social work researchers, practitioners, advocates, and students. It is illustrated with a five-year project to reduce wealth inequality through community economic development. Researchers brought expertise in ideas and analysis to real-world applications. Social work practitioners brought essential "on the ground" expertise. Students brought much-needed assistance and a fresh perspective to the social policy process. Advocates, working in social welfare advocacy organizations, bridged these perspectives and provided experience in policy advocacy. Working with coalition partners, social workers successfully placed asset-based community economic development strategies on the state agenda and were instrumental in passage of innovative legislation. The article demonstrates that the policy-making process is open to influence by social workers, especially if they come prepared with innovative and promising ideas about long-standing social issues. Social workers can and should take the lead and become significant actors in state policy development.

  13. Bilateral leg movements during sleep: detailing their structure and features in normal controls and in patients with restless legs syndrome.

    PubMed

    Ferri, Raffaele; Manconi, Mauro; Rundo, Francesco; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Cosentino, Filomena I I; Ferini-Strambi, Luigi; Fulda, Stephany

    2017-04-01

    The aim of this study was to analyze statistically the number of single leg movements (LMs) forming bilateral LMs during sleep, along with their combined duration, to eventually provide evidence-based data for the adjustment of the current scoring rules defining bilateral LMs. Polysomnographic recordings of 111 untreated patients with RLS with a median age of 56.0 years, along with 42 normal controls with a mean age of 60.0 years, were included. In each recording, we identified all LMs that were considered as bilateral when two or more LMs were overlapping or the onset of the following movement was <0.5 second after the offset of the preceding LM. The remaining LMs were classified as monolateral. A series of parameters were computed for both bilateral and monolateral LMs. The duration of monolateral LMs in RLS patients was significantly longer than that of normal controls. For bilateral LMs, the maximum number of single LMs forming a bilateral movement and the maximum duration were slightly higher in RLS patients; however, the distribution of the number of individual LMs forming a single bilateral LM was similar. Only 0.12% and 0.27% of bilateral LMs consisted of >4 individual movements, and only 0.16% and 1.90% of bilateral LMs were >15 seconds in RLS patients and healthy controls, respectively. Our results strongly suggest that bilateral LMs during sleep should be constituted by no more than four individual LMs and should have a maximum duration of 15 seconds. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Complete resolution of myoclonus-like involuntary movements under subarachnoid block after midazolam administration in a patient undergoing cesarean section: a case report.

    PubMed

    Nakamoto, Takahiro; Hirota, Kiichi; Iwai, Teppei; Shingu, Koh

    2015-04-01

    Involuntary movement during and after neuraxial anesthesia, such as spinal and epidural anesthesia, is rarely observed. In this report, we describe a case of myoclonus-like involuntary movement of the upper extremities in a patient undergoing a planned repeat cesarean section under spinal anesthesia with bupivacaine that completely subsided after administration of 2 mg of midazolam. The myoclonus-like movement did not recur or cause any apparent neurological side effects.

  15. Advocacy to address disabling diseases: TDR holds brainstorming session.

    PubMed

    1998-06-01

    The UN Development Program/World Bank/World Health Organization's Special Program for Research and Training in Tropical Diseases hosted a meeting in January 1998 to discuss new ways of generating sustained commitment to combat disabling tropical diseases, such as filariasis and onchocerciasis. The participants agreed that advocacy should be targeted to a wider audience than the health sector, including international donors, industry, national governments, and endemic communities themselves. Advocacy efforts will be supported by development of a standard protocol that will 1) identify and present the type of evidence that generates sustainable commitment, 2) develop and use appropriate messages for each audience, 3) evaluate new advocacy approaches for their impact on behavioral change and disease control, and 4) evaluate advocacy campaigns. Advocacy about lymphatic filariasis will target all levels, while advocacy about onchocerciasis will target national and local levels.

  16. Media advocacy: a strategy for empowering people and communities.

    PubMed

    Wallack, L

    1994-01-01

    Media advocacy is a new strategy that is emerging in the public health community. It has been particularly visible in communities of color. Media advocacy is defined as the strategic use of mass media to advance public policy initiatives. Media advocacy is rooted in community advocacy and has as its goal the promotion of healthy public policies. It can be differentiated from traditional mass media strategies in a number of ways. Media advocacy shifts the focus from the personal to the social, from the individual to the political, from the behavior or practice to the policy or environment. While traditional media approaches try to fill the "knowledge gap," media advocacy addresses the "power gap." Improvements in health status are believed to come about primarily from gaining more power over the policy environment rather than simply gaining more knowledge about health behaviors.

  17. A Relationship between Periodic Limb Movements in Sleep and High Nocturnal Blood Pressure Values in Patients with Insomnia

    PubMed Central

    Sieminski, Mariusz; Partinen, Markku

    2016-01-01

    Study Objectives: Insomnia, which is the most common sleep disorder, is a significant public health burden. Growing evidence suggests the existence of a relationship between insomnia and hypertension. The aim of this study was to verify the hypothesis that periodic limb movements in sleep (PLMS) are related to increased nocturnal blood pressure (BP) values in patients with insomnia. Methods: We retrospectively analyzed polysomnographic recordings of patients with insomnia who were seen in our clinic from January to December 2012. Patients were divided into two groups based on their nocturnal BP values: group I had normal nocturnal BP values (n = 27) and group II (n = 29) had elevated nocturnal BP values. The sleep architecture of the groups was compared. Results: The groups did not differ in terms of age, sex, or the prevalence of cardiovascular disorders. However, we found that the number of PLMS was significantly higher in group II than in group I (PLMS index: 18.8 vs. 6.5; p = 0.01). Conclusions: Our results suggest that PLMS are related to increased nocturnal BP values in patients with insomnia, which may partly explain the relationship between insomnia and hypertension. Therefore, it is possible that treatment of PLMS may normalize nocturnal BP in patients with insomnia. Citation: Sieminski M, Partinen M. A relationship between periodic limb movements in sleep and high nocturnal blood pressure values in patients with insomnia. J Clin Sleep Med 2016;12(6):865–869. PMID:27070247

  18. Comparison of motor pattern of periodic limb movements in patients with restless legs syndrome and obstructive sleep apnea syndrome.

    PubMed

    Gültekin, Murat; Ismailoğullari, Sevda; Aksu, Murat

    2014-01-01

    Periodic limb movements (PLMs) are repetitive and stereotypical movements of the lower extremities that occur during sleep. The purpose of this study was to analyze the leg muscle activity patterns in PLMs seen in restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS). In this study, 1260 PLMs from 4 patients with RLS and 4 patients with OSAS were analyzed. The spreading and frequency characteristics of the gastrocnemius, medial hamstring, and vastus muscles were examined separately for each muscle in addition to the tibialis anterior muscle already included in the standard polysomnography recording. A greater number of PLMs (57.34%) were observed in patients with RLS. A greater number of apnea-related PLMs (59.83%) were observed in patients with OSAS. The number of PLMs with spreading characteristics was higher in both patient groups. In both groups, the first muscle to contract was most frequently the tibialis anterior. Analysis of the subsequent contraction patterns showed no regular course in RLS and OSAS patients. PLMs may occur with a nonstereotypical muscle spreading pattern generated by different, independent, and, most frequently, unsynchronized spinal generators.

  19. Impact on Clinical Outcomes of Periodic Leg Movements During Sleep in Hospitalized Patients Following Acute Decompensated Heart Failure.

    PubMed

    Yatsu, Shoichiro; Kasai, Takatoshi; Suda, Shoko; Matsumoto, Hiroki; Shiroshita, Nanako; Kato, Mitsue; Kawana, Fusae; Murata, Azusa; Kato, Takao; Hiki, Masaru; Daida, Hiroyuki

    2017-03-24

    Periodic leg movements during sleep (PLM) are characterized by regularly recurring movement of the legs during sleep. Although PLM is common and a predictor of death in patients with chronic heart failure, the clinical significance of PLM in hospitalized patients with a reduced left ventricular ejection fraction (LVEF) following acute decompensated heart failure (ADHF) remains unknown.Methods and Results:After initial improvement of acute signs and symptoms of ADHF, 94 consecutive patients with reduced LVEF who underwent polysomnography were enrolled. They were divided into 2 groups based on the presence or absence of severe PLM defined as PLM index ≥30. The risks for clinical events, composite of all-cause death and rehospitalization, were assessed using a stepwise multivariable Cox proportional model including variables showing P<0.10 in univariate analyses. Severe PLM was observed in 21 patients (22%). At a median follow-up of 5.2 months, 30 patients experienced clinical events (32%). In the multivariable analysis, the presence of severe PLM was significantly associated with increasing clinical events (hazard ratio, 2.16; 95% confidence interval, 1.03-4.54; P=0.042) independent of hemoglobin level and the severity of sleep-disordered breathing. In hospitalized patients with systolic dysfunction following ADHF, severe PLM was prevalent and significantly associated with increased risk of death and/or rehospitalization.

  20. Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery.

    PubMed

    Kuwahara, Wataru; Deie, Masataka; Fujita, Naoto; Tanaka, Nobuhiro; Nakanishi, Kazuyoshi; Sunagawa, Toru; Asaeda, Makoto; Nakamura, Haruka; Kono, Yoshifumi; Ochi, Mitsuo

    2016-12-01

    Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1month postoperatively for the patients. Compared to that observed preoperatively, the clinical outcomes significantly improved at 1month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain. The epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Head-eye movement control tests in patients with chronic neck pain; inter-observer reliability and discriminative validity.

    PubMed

    Della Casa, Eveline; Affolter Helbling, Jutta; Meichtry, André; Luomajoki, Hannu; Kool, Jan

    2014-01-14

    Head-eye movement control deficit is an identified problem in patients with chronic neck pain, particularly in cases of whiplash associated disorders (WAD). To date, there is no evidence concerning the reliability and validity of visually assessed active head-eye movement control tests. Therefore, the objectives of the present cross-sectional study were, a) to develop a test battery; and b) to investigate inter-observer reliability and discriminative validity in patients with chronic neck pain compared to healthy controls. The study was conducted at two physiotherapy clinics in Switzerland. Ethics Committee approval was obtained. Ten active head-eye coordination tests, on 23 patients with chronic neck pain and associated symptoms and 19 healthy controls, were videotaped. The tests included eye movements in the neutral head position and 45° relative neck rotation, gaze stability and sequential head-eye movements. All tests were performed in the sitting and standing positions. Two blinded physiotherapists independently rated the randomized videos. Performance was rated as "negative", "moderately positive" or "clearly positive". Weighted kappa (wK) and 95% confidence intervals (CI) were calculated to investigate inter-observer reliability. Good reliability was defined as wK >0.5 with a lower boundary of 95% CI >0.2. Odds ratios (to define cut-off points) and the distribution of the classificator, numbers of positive tests, were calculated. Three out of ten tests showed "excellent" (wK 0.82 to 0.86), five out of ten tests showed "substantial" (wK 0.69 to 0.79) and two out of ten tests showed "moderate" (wK 0.54 to 0.59) reliability. Results were comparable in the sitting and standing positions. On average, three out of five tests were rated positive in patients and one out of five tests was rated positive in healthy controls. An odds ratio of 13.3 to 18.6 was obtained using ≥2/5 tests as a cut-off point. Visual assessment by physiotherapists of head-eye movement

  2. Functional eye movement disorders.

    PubMed

    Kaski, D; Bronstein, A M

    2017-01-01

    Functional (psychogenic) eye movement disorders are perhaps less established in the medical literature than other types of functional movement disorders. Patients may present with ocular symptoms (e.g., blurred vision or oscillopsia) or functional eye movements may be identified during the formal examination of the eyes in patients with other functional disorders. Convergence spasm is the most common functional eye movement disorder, but functional gaze limitation, functional eye oscillations (also termed "voluntary nystagmus"), and functional convergence paralysis may be underreported. This chapter reviews the different types of functional eye movement abnormalities and provides a practical framework for their diagnosis and management.

  3. Computer-assisted detection of nocturnal leg motor activity in patients with restless legs syndrome and periodic leg movements during sleep.

    PubMed

    Ferri, Raffaele; Zucconi, Marco; Manconi, Mauro; Bruni, Oliviero; Miano, Silvia; Plazzi, Giuseppe; Ferini-Strambi, Luigi

    2005-08-01

    To assess the performance of a new method for automatic detection of periodic leg movements during sleep. Leg movements during sleep were visually detected in the tibialis anterior muscles recordings of 15 patients with restless legs syndrome and 15 normal controls. Leg movements were detected automatically by means of a new computer method with which electromyogram signals are first digitally band-pass filtered and then rectified; subsequently, the detection of leg movements is performed by using 2 thresholds: one for the starting point and another to detect the end point of each leg movement. Sensitivity and false-positive rate were obtained; the American Sleep Disorders Association parameters were also computed, and the results analyzed by means of the Kendall W coefficient, the linear correlation coefficient and the Bland-Altman plots. N/A. Fifteen patients with restless legs syndrome and periodic leg movements and 15 controls. High values of the Kendall W coefficient of concordance between automatic and visual analysis were found with values close to 1 and the linear correlation coefficient for leg movements index and total leg movements index was > 0.950 (p < .000001). The Bland-Altman plots provided the limits of agreement between visual and computer detection, which were -9.01 and +9.89 for the periodic leg movement index. None of the normal controls was found to have periodic leg movement indexes >5 after automatic analysis. Our method can be applied to the clinical evaluation of periodic leg movements during sleep, with some caution in patients with a low periodic leg movement indexes. Large-scale research application is possible and can be considered as reliable.

  4. Impact of Communication Competency Training on Nursing Students' Self-advocacy Skills.

    PubMed

    Doherty, Christi; Landry, Heidi; Pate, Barbara; Reid, Helen

    2016-01-01

    Deficiencies in nursing students' communication skills need to be addressed for students to influence and skillfully collaborate in crucial patient and self-advocacy conversations. This study evaluated the effectiveness of a communication competency educational program for nursing students (N = 61). A paired-sample t test determined that there was a statistical significance from pre to post intervention, indicating the importance of communication competency education for nursing students' ability to advocate for themselves and their patients.

  5. Are Movements Necessary for the Sense of Body Ownership? Evidence from the Rubber Hand Illusion in Pure Hemiplegic Patients

    PubMed Central

    Burin, Dalila; Livelli, Alessandro; Garbarini, Francesca; Fossataro, Carlotta; Folegatti, Alessia; Gindri, Patrizia; Pia, Lorenzo

    2015-01-01

    A question still debated within cognitive neuroscience is whether signals present during actions significantly contribute to the emergence of human’s body ownership. In the present study, we aimed at answer this question by means of a neuropsychological approach. We administered the classical rubber hand illusion paradigm to a group of healthy participants and to a group of neurological patients affected by a complete left upper limb hemiplegia, but without any propriceptive/tactile deficits. The illusion strength was measured both subjectively (i.e., by a self-report questionnaire) and behaviorally (i.e., the location of one’s own hand is shifted towards the rubber hand). We aimed at examining whether, and to which extent, an enduring absence of movements related signals affects body ownership. Our results showed that patients displayed, respect to healthy participants, stronger illusory effects when the left (affected) hand was stimulated and no effects when the right (unaffected) hand was stimulated. In other words, hemiplegics had a weaker/more flexible sense of body ownership for the affected hand, but an enhanced/more rigid one for the healthy hand. Possible interpretations of such asymmetrical distribution of body ownership, as well as limits of our results, are discussed. Broadly speaking, our findings suggest that the alteration of the normal flow of signals present during movements impacts on human’s body ownership. This in turn, means that movements have a role per se in developing and maintaining a coherent body ownership. PMID:25775041

  6. Are movements necessary for the sense of body ownership? Evidence from the rubber hand illusion in pure hemiplegic patients.

    PubMed

    Burin, Dalila; Livelli, Alessandro; Garbarini, Francesca; Fossataro, Carlotta; Folegatti, Alessia; Gindri, Patrizia; Pia, Lorenzo

    2015-01-01

    A question still debated within cognitive neuroscience is whether signals present during actions significantly contribute to the emergence of human's body ownership. In the present study, we aimed at answer this question by means of a neuropsychological approach. We administered the classical rubber hand illusion paradigm to a group of healthy participants and to a group of neurological patients affected by a complete left upper limb hemiplegia, but without any propriceptive/tactile deficits. The illusion strength was measured both subjectively (i.e., by a self-report questionnaire) and behaviorally (i.e., the location of one's own hand is shifted towards the rubber hand). We aimed at examining whether, and to which extent, an enduring absence of movements related signals affects body ownership. Our results showed that patients displayed, respect to healthy participants, stronger illusory effects when the left (affected) hand was stimulated and no effects when the right (unaffected) hand was stimulated. In other words, hemiplegics had a weaker/more flexible sense of body ownership for the affected hand, but an enhanced/more rigid one for the healthy hand. Possible interpretations of such asymmetrical distribution of body ownership, as well as limits of our results, are discussed. Broadly speaking, our findings suggest that the alteration of the normal flow of signals present during movements impacts on human's body ownership. This in turn, means that movements have a role per se in developing and maintaining a coherent body ownership.

  7. Cultural carrying capacity: Organ donation advocacy, discursive framing, and social media engagement.

    PubMed

    Bail, Christopher A

    2016-09-01

    Social media sites such as Facebook have become a powerful tool for public health outreach because they enable advocacy organizations to influence the rapidly increasing number of people who frequent these forums. Yet the very open-ness of social media sites creates fierce competition for public attention. The vast majority of social media messages provoke little or no reaction because of the sheer volume of information that confronts the typical social media user each day. In this article, I present a theory of the "cultural carrying capacity" of social media messaging campaigns. I argue that advocacy organizations inspire more endorsements, comments, and shares by social media users if they diversify the discursive content of their messages. Yet too much diversification creates large, disconnected audiences that lack the sense of shared purpose necessary to sustain an online movement. To evaluate this theory, I created a Facebook application that collects social media posts produced by forty-two organ donation advocacy organizations over 1.5 years, as well as supplemental information about the organization, its audience, and the broader social context in which they interact. Time series models provide strong evidence for my theory net of demographic characteristics of social media users, the resources and tactics of each organization, and broader external factors. I conclude by discussing the implications of these findings for public health, cultural sociology, and the nascent field of computational social science. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The effects of head movement and walking speed on gait parameters in patients with chronic neck pain.

    PubMed

    Uthaikhup, Sureeporn; Sunkarat, Somporn; Khamsaen, Khanamporn; Meeyan, Kitti; Treleaven, Julia

    2014-04-01

    It has been documented that neck pain can influence sensorimotor function. However, little is known about the effects of head movement and walking speed on gait characteristics in patients with neck pain. The aim of this study was to determine gait characteristics of patients with neck pain during walking with different head movements and gait speeds as compared to a control group without neck pain. Twenty women aged between 18 and 59 years with chronic neck pain (>3 months) and 20 healthy controls of similar age, weight and height were recruited into the study. Participants with neck pain completed the Neck Disability Index and Visual Analogue Pain Scale. The experiment consisted of two walking sessions. The first session included walking with head straight, head up-down, and head turns from side to side. The second session included walking at comfortable and maximum speeds. Each trial was performed twice. Gait parameters measured using GAITRite walkway system were step length, stride length, step time, stride time, step width, cadence and gait speed. Patients with chronic neck pain demonstrated a narrower step width, a shorter step length and a slower gait speed during walking with the head movements and at maximum speed compared to the control group (all p < 0.05). Maximum gait speed was moderately correlated with pain intensity and disability (p < 0.01). The results suggest that patients with chronic neck pain have gait disturbances. This supports the notion that assessment of gait should be addressed in patients with persistent neck pain.

  9. Age-related cutoffs for cervical movement behaviour to distinguish chronic idiopathic neck pain patients from unimpaired subjects.

    PubMed

    Niederer, Daniel; Vogt, Lutz; Wilke, Jan; Rickert, Marcus; Banzer, Winfried

    2015-03-01

    The present study aims to develop age-dependent cutoff values in a quasi-experimental, cross-sectional diagnostic test study. One hundred and twenty (120) asymptomatic subjects (n = 100, 36♀, 18 75 years, for normative values; n = 20, 23-75 years, 15♀, for selectivity analyses) and 20 patients suffering from idiopathic neck pain (selectivity analyses, 22-71 years, 15♀) were included. Subjects performed five repetitive maximal cervical flexion/extension movements in an upright sitting position. Cervical kinematic characteristics (maximal range of motion (ROM), coefficient of variation (CV) and mean conjunct movements in rotation and flexion (CM)) were calculated from raw 3D ultrasonic data. Regression analyses were conducted to reveal associations between kinematic characteristics and age and gender and thus to determine normative values for healthy subjects. Age explains 53 % of the variance in ROM (decrease 10.2° per decade), 13 % in CV (increase 0.003 per decade) and 9 % in CM (increase 0.57° per decade). Receivers operating characteristic (ROC) analyses were conducted for differences between individual values of the kinematic characteristics and normative values to optimise cutoff values for distinguishing patients from unimpaired subjects (20 patients and 20 healthy). Cutoff values distinguished asymptomatic subjects' and chronic nonspecific neck patient's movement characteristics with sufficient quality (sensitivity 70-80 %, specificity 65-70 %). By including such classifications, the present findings expand actual research stating an age-related decrease in kinematic behaviour only using categorising span widths across decades. Future study is warranted to reveal our results' potential applicability for intervention onset decision making for idiopathic neck pain patients.

  10. SU-E-J-72: Design and Study of In-House Web-Camera Based Automatic Continuous Patient Movement Monitoring and Controlling Device for EXRT.

    PubMed

    Senthil Kumar, S; Suresh Babu, S S; Anand, P; Dheva Shantha Kumari, G

    2012-06-01

    The purpose of our study was to fabricate in-house web-camera based automatic continuous patient movement monitoring device and control the movement of the patients during EXRT. Web-camera based patient movement monitoring device consists of a computer, digital web-camera, mounting system, breaker circuit, speaker, and visual indicator. The computer is used to control and analyze the patient movement using indigenously developed software. The speaker and the visual indicator are placed in the console room to indicate the positional displacement of the patient. Studies were conducted on phantom and 150 patients with different types of cancers. Our preliminary clinical results indicate that our device is highly reliable and can accurately report smaller movements of the patients in all directions. The results demonstrated that the device was able to detect patient's movements with the sensitivity of about 1 mm. When a patient moves, the receiver activates the circuit; an audible warning sound will be produced in the console. Through real-time measurements, an audible alarm can alert the radiation technologist to stop the treatment if the user defined positional threshold is violated. Simultaneously, the electrical circuit to the teletherapy machine will be activated and radiation will be halted. Patient's movement during the course for radiotherapy was studied. The beam is halted automatically when the threshold level of the system is exceeded. By using the threshold provided in the system, it is possible to monitor the patient continuously with certain fixed limits. An additional benefit is that it has reduced the tension and stress of a treatment team associated with treating patients who are not immobilized. It also enables the technologists to do their work more efficiently, because they don't have to continuously monitor patients with as much scrutiny as was required. © 2012 American Association of Physicists in Medicine.

  11. Scientific basis for learning transfer from movements to urinary bladder functions for bladder repair in human patients with CNS injury.

    PubMed

    Schalow, G

    2010-01-01

    Coordination Dynamics Therapy (CDT) has been shown to be able to partly repair CNS injury. The repair is based on a movement-based re-learning theory which requires at least three levels of description: the movement or pattern (and anamnesis) level, the collective variable level, and the neuron level. Upon CDT not only the actually performed movement pattern itself is repaired, but the entire dynamics of CNS organization is improved, which is the theoretical basis for (re-) learning transfer. The transfer of learning for repair from jumping on springboard and exercising on a special CDT and recording device to urinary bladder functions is investigated at the neuron level. At the movement or pattern level, the improvement of central nervous system (CNS) functioning in human patients can be seen (or partly measured) by the improvement of the performance of the pattern. At the collective variable level, coordination tendencies can be measured by the so-called 'coordination dynamics' before, during and after treatment. At the neuron level, re-learning can additionally be assessed by surface electromyography (sEMG) as alterations of single motor unit firings and motor programs. But to express the ongoing interaction between the numerous neural, muscular, and metabolic elements involved in perception and action, it is relevant to inquire how the individual afferent and efferent neurons adjust their phase and frequency coordination to other neurons to satisfy learning task requirements. With the single-nerve fibre action potential recording method it was possible to measure that distributed single neurons communicate by phase and frequency coordination. It is shown that this timed firing of neurons is getting impaired upon injury and has to be improved by learning The stability of phase and frequency coordination among afferent and efferent neuron firings can be related to pattern stability. The stability of phase and frequency coordination at the neuron level can

  12. Effect of observation of simple hand movement on brain activations in patients with unilateral cerebral palsy: an fMRI study.

    PubMed

    Dinomais, Mickael; Lignon, Gregoire; Chinier, Eva; Richard, Isabelle; Ter Minassian, Aram; Tich, Sylvie N'Guyen The

    2013-06-01

    The aim of this functional magnetic resonance imaging (fMRI) study was to examine and compare brain activation in patients with unilateral cerebral palsy (CP) during observation of simple hand movement performed by the paretic and nonparetic hand. Nineteen patients with clinical unilateral CP (14 male, mean age 14 years, 7-21 years) participated in the study. Hand motor impairment was assessed using the sequential finger opposition task. Using fMRI block design, brain activation was examined following observation at rest of a simple opening-closing hand movement, performed by either the left or right hand of an actor. Eighteen fMRI dataset were analyzed. Observing hand movement produced large bilateral activations in temporo-parieto-fronto-occipital network, comprising most of the nodes of the well described action-observation network. For either side, observing hand movements recruits the primary motor cortex (M1), contralateral to the viewed hand, as would be expected in healthy persons. Viewing movement performed by an actor's hand representing the paretic side of patients activated more strongly ipsilesional M1 than viewing movement performed by an actor's hand representing the nonparetic side of patients. Observation of hand movement in patients with CP engaged the motor execution network regardless of the degree of motor impairment.

  13. Experimental integrative muscular movement technique enhances cervical range of motion in patients with chronic neck pain: a pilot study.

    PubMed

    Rohe, Benjamin G; Carter, Ronald; Thompson, William R; Duncan, Randall L; Cooper, Carlton R

    2015-04-01

    Neck pain presents a tremendous physical and financial burden. This study compared the efficacy of the complementary and alternative medical treatments of integrative muscular movement technique (IMMT) and Swedish massage on neck pain in women of occupation age, the largest demographic group with neck pain. A total of 38 women were assigned to IMMT (n=28) or Swedish massage (n=10) in a blinded manner. Both groups received eight 30-minute treatments over 4 weeks. Cervical range of motion (ROM) in flexion, extension, sidebending, and rotation was measured before and after treatment. Each patient's pain was assessed by using an analogue pain scale of 0-10. Compared with the Swedish massage group, patients receiving IMMT experienced a significant increase in ROM in cervical flexion (p<0.001), extension (p<0.001), sidebending (p<0.05), and rotation (p<0.001). Absolute change in pain for IMMT was -1.75 units compared with -0.3 units for Swedish massage (p<0.05). Patients receiving the IMMT demonstrated significantly improved cervical ROM in every movement measured compared with Swedish massage. Inclusion of the IMMT in a treatment regimen for chronic neck pain may lead to decreased pain and increased cervical ROM. These positive effects of the IMMT intervention may have a role in enhancing functional outcomes in patients with neck pain.

  14. A new measure of movement symmetry in early Parkinson's disease patients using symbolic processing of inertial sensor data.

    PubMed

    Sant'Anna, Anita; Salarian, Arash; Wickström, Nicholas

    2011-07-01

    Movement asymmetry is one of the motor symptoms associated with Parkinson's disease (PD). Therefore, being able to detect and measure movement symmetry is important for monitoring the patient's condition. The present paper introduces a novel symbol based symmetry index calculated from inertial sensor data. The method is explained, evaluated, and compared to six other symmetry measures. These measures were used to determine the symmetry of both upper and lower limbs during walking of 11 early-to-mid-stage PD patients and 15 control subjects. The patients included in the study showed minimal motor abnormalities according to the unified Parkinson's disease rating scale (UPDRS). The symmetry indices were used to classify subjects into two different groups corresponding to PD or control. The proposed method presented high sensitivity and specificity with an area under the receiver operating characteristic (ROC) curve of 0.872, 9% greater than the second best method. The proposed method also showed an excellent intraclass correlation coefficient (ICC) of 0.949, 55% greater than the second best method. Results suggest that the proposed symmetry index is appropriate for this particular group of patients. © 2011 IEEE

  15. No Cases of PANDAS on Follow-Up of Patients Referred to a Pediatric Movement Disorders Clinic

    PubMed Central

    Kilbertus, Sarah; Brannan, Renee; Sell, Erick; Doja, Asif

    2014-01-01

    Introduction: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) remains a controversial diagnosis and it is unclear how frequently it is encountered in clinical practice. Our study aimed to determine how many children with acute-onset tics and/or Obsessive–Compulsive Disorder (OCD) met criteria for PANDAS. Materials and methods: A retrospective review was performed on 39 children who presented to a movement disorders clinic with acute-onset tics or OCD from 2005 to 2012. Results: Out of 284 patients seen over the course of 7 years, only 39 had acute-onset tics and/or OCD symptoms. None of the 39 children who presented to us acutely met full criteria for PANDAS. Thirty-eight percent had no association between their symptoms and group A beta-hemolytic streptococcal infection, while 54% had prior inconclusive laboratory testing done and no exacerbations during the course of the study. Only 8% of patients had an acute exacerbation after their initial visit; however, testing for GAHBS in these patients was negative Discussion: Our results support the notion that PANDAS, if it exists, is an exceedingly rare diagnosis encountered in a pediatric movement disorder clinic. While none of our patients met criteria for PANDAS, two with acute-onset OCD would have met criteria for pediatric acute-onset neuropsychiatric syndrome (PANS) indicating that PANS may be a more appropriate diagnosis. PMID:25309889

  16. The effects of a vibrational appliance on tooth movement and patient discomfort: a prospective randomised clinical trial.

    PubMed

    Miles, Peter; Smith, Heath; Weyant, Robert; Rinchuse, Daniel J

    2012-11-01

    The aim of this study was to assess the rate of tooth movement and discomfort experienced by orthodontic patients using a vibrational appliance (Tooth Masseuse). In this randomised controlled trial (RCT), 66 consecutive patients were assigned to a control or experimental group. The experimental group was instructed to use a vibrational appliance for a minimum of 20 minutes per day. All of the patients had the same fixed appliance and a 0.014 inch thermal NiTi wire during the 10 week study period. Impressions of the mandibular six anterior teeth were taken at 4 time points: at the start of treatment, 5 weeks, 8 weeks, and at 10 weeks after commencement. Little's Irregularity Index was used to record alignment and assess the rate of tooth movement. A discomfort score chart was used to evaluate patient pain levels at 5 time points. The experimental group showed a 65% reduction in irregularity at 10 weeks, while the control group showed a 69% reduction in irregularity over the same period. No significant differences in irregularity or pain levels were observed at any of the time points between the groups. The results demonstrate that, for 20 minute use per day, there appears to be no clinical advantage in using the vibrational appliance for the early resolution of crowding or the alleviation of pain during initial alignment.

  17. No Cases of PANDAS on Follow-Up of Patients Referred to a Pediatric Movement Disorders Clinic.

    PubMed

    Kilbertus, Sarah; Brannan, Renee; Sell, Erick; Doja, Asif

    2014-01-01

    Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) remains a controversial diagnosis and it is unclear how frequently it is encountered in clinical practice. Our study aimed to determine how many children with acute-onset tics and/or Obsessive-Compulsive Disorder (OCD) met criteria for PANDAS. A retrospective review was performed on 39 children who presented to a movement disorders clinic with acute-onset tics or OCD from 2005 to 2012. Out of 284 patients seen over the course of 7 years, only 39 had acute-onset tics and/or OCD symptoms. None of the 39 children who presented to us acutely met full criteria for PANDAS. Thirty-eight percent had no association between their symptoms and group A beta-hemolytic streptococcal infection, while 54% had prior inconclusive laboratory testing done and no exacerbations during the course of the study. Only 8% of patients had an acute exacerbation after their initial visit; however, testing for GAHBS in these patients was negative Discussion: Our results support the notion that PANDAS, if it exists, is an exceedingly rare diagnosis encountered in a pediatric movement disorder clinic. While none of our patients met criteria for PANDAS, two with acute-onset OCD would have met criteria for pediatric acute-onset neuropsychiatric syndrome (PANS) indicating that PANS may be a more appropriate diagnosis.

  18. A new automated implementation of the Posturo-Locomotion-Manual (PLM) method for movement analysis in patients with parkinson's disease.

    PubMed

    Zackrisson, T; Holmberg, B; Johnels, B; Thorlin, T

    2011-04-01

    The Posturo-Locomotion-Manual (PLM) test, which uses an optoelectronic laboratory system, has here been further developed into an automated, more user-friendly, standardized tool for movement analysis named the QbTestMotus. This paper compares the accuracy of QbTestMotus to the PLM test, in particular the automated data analysis. Both QbTestMotus and the PLM recorded data simultaneously from the same 61 patients. The correlation coefficients of movement time (MT), postural time (P), locomotion time (L), and manual time (M) were calculated between the systems. The absolute differences between the result parameters for each patient were also studied. Finally, the differences in MT between the systems were compared with the positive responses in the levodopa (L-dopa) challenges as measured in the PLM test for 11 patients. The comparisons in all the 61 patients showed high correlation coefficients for all four parameters. The absolute differences between the parameters were small and had small standard deviations, and the decreases in MT because of L-dopa in the positive L-dopa responders were much larger than the absolute difference between the systems. The PLM test and QbTestMotus are equivalent along all parameters, thus indicating that the test quality is equivalent between the PLM test and the automated QbTestMotus system. © 2010 John Wiley & Sons A/S.

  19. Perceptions of Health Information Seeking and Partner Advocacy in the Context of a Cardiology Office Visit: Connections with Health Outcomes.

    PubMed

    Checton, Maria G; Greene, Kathryn; Carpenter, Amanda; Catona, Danielle

    2017-05-01

    This paper explores perceived active health information seeking, informal advocacy by a partner or other, cardiac efficacy, and cardiovascular health indicators for patients surveyed while visiting their cardiologist. Participants include 208 patients with a diagnosed heart condition. Variables include predisposing characteristics (e.g., illness severity, demographics), perceived active health information seeking during an office visit, informal advocacy by partner or other, cardiac efficacy, and cardiovascular health indicators (i.e., basal metabolic index (BMI), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides). Data were analyzed using correlations, t-tests, and structural equation modeling. As hypothesized, perceived active health information seeking during an office visit (positively) and informal advocacy by partner or other (negatively) predicted cardiac efficacy. One path was added from active information seeking to BMI. Cardiac efficacy, in turn, significantly predicted total cholesterol and BMI. The model was also replicated for LDLs but not for HDLs or triglycerides. We discuss implications for cardiac disease management.

  20. Evaluation and comparison of a 1-month versus a 2-week community pediatrics and advocacy rotation for pediatric residents.

    PubMed

    Delago, Cynthia; Gracely, Edward

    2007-11-01

    This prospective study was conducted to assess the effects of a 4-week community pediatrics and advocacy rotation with a unique project (Curriculum A), a 2-week community pediatrics rotation with advocacy training and unique project throughout residency (Curriculum B), or no curriculum exposure on residents' attitudes, perceived competence, knowledge, and behaviors. A 27-item questionnaire was used to assess attitudes, competence, and knowledge. Examination of residents' patients' use of Early Intervention services during the 5-year period after curricula introduction assessed behaviors. Seventy percent of questionnaires distributed over several years were completed by 105 of 111 eligible residents. Residents exposed to Curriculum A or B demonstrated improved competence and knowledge but no significant increase in positive attitudes toward community pediatrics and advocacy. Residents' patients' use of Early Intervention services increased 65% during the 5-year period after curriculum introduction. No significant differences in outcome measures were observed between Curriculum A and Curriculum B.

  1. A remote monitor of bed patient cardiac vibration, respiration and movement.

    PubMed

    Mukai, Koji; Yonezawa, Yoshiharu; Ogawa, Hidekuni; Maki, Hiromichi; Caldwell, W Morton

    2009-01-01

    We have developed a remote system for monitoring heart rate, respiration rate and movement behavior of at-home elderly people who are living alone. The system consists of a 40 kHz ultrasonic transmitter and receiver, linear integrated circuits, a low-power 8-bit single chip microcomputer and an Internet server computer. The 40 kHz ultrasonic transmitter and receiver are installed into a bed mattress. The transmitted signal diffuses into the bed mattress, and the amplitude of the received ultrasonic wave is modulated by the shape of the mattress and parameters such as respiration, cardiac vibration and movement. The modulated ultrasonic signal is received and demodulated by an envelope detection circuit. Low, high and band pass filters separate the respiration, cardiac vibration and movement signals, which are fed into the microcontroller and digitized at a sampling rate of 50 Hz by 8-bit A/D converters. The digitized data are sent to the server computer as a serial signal. This computer stores the data and also creates a graphic chart of the latest hour. The person's family or caregiver can download this chart via the Internet at any time.