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The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: a single group design with multiple time points.

BACKGROUND: Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred. OBJECTIVE: To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities. DESIGN: A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started. SETTINGS: Two 300-400 bed veteran homes in Taiwan. PARTICIPANTS: The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded. METHODS: The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization. RESULTS: A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038). CONCLUSIONS: Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Activities of Daily Living↗

The role of the GABA(A) agonist muscimol on memory performance: reward contingencies determine the nature of the deficit.

A matching-to-position (MTP) paradigm was altered to influence the type of associations a rat would use to solve the task. Our main behavioral manipulation was the application of the differential outcomes procedure (DOP). The DOP involves correlating each to-be-remembered event with a distinct reward condition. This procedure results in the development of unique reward expectancies that enhance and guide choice behavior. Such distinct reward expectancies are not formed when either a common or random assignment of reward is used (a non-differential outcomes procedure [NOP]). Intracerebroventricular infusions of the amnestic agent muscimol (GABA(A) agonist) or aCSF were delivered to male rats trained on a delayed MTP task that implemented either the DOP or the NOP. Muscimol impaired performance in a dose dependent fashion in both groups--but the nature of the deficit differed as a function of reinforcement contingencies. Rats trained with the DOP displayed a non-mnemonic delay-independent impairment: performance at all delay intervals was disrupted. In contrast, NOP-trained rats displayed a delay-dependent impairment demonstrating that muscimol can also have memory-disrupting effects. The difference in pattern of impairment appears to be a function of the associations formed during training and the type of cognitive strategies involved in maintaining behavior on a conditional delayed discrimination task when reinforcement contingencies are varied. Thus, these results demonstrate that increasing GABA(A) receptor activation impairs a range of associative and memory functions.

Animals↗

Use of a computer-assisted program to improve metacognition in persons with severe intellectual disabilities.

Metacognition and self-regulation are processes extremely relevant to education of persons with intellectual disabilities. They play a central role in specific limitations, such as outer-directedness and lack of strategy transfer, and are related to desirable educational objectives such as self-determination. Although computer-assisted training has shown to be successful in training specific abilities and general cognitive processes, interventions of this nature centering on metacognitive development are rare. A computer-assisted program aimed in this direction is presented. It was applied to 21 adolescents and young adults with a mean IQ of 36. Metacognitive scores improved for this group at posttest relative to pretest to a degree significantly different from gains found in an equivalent control group. Improvement was clear from the first sessions of the intervention and was maintained at a 6-month follow-up.

Adult↗

Neuroethics: a modern context for ethics in neuroscience.

Neuroethics, a recently modernized field at the intersection of bioethics and neuroscience, is founded on centuries of discussion of the ethical issues associated with mind and behavior. Broadly defined, neuroethics is concerned with ethical, legal and social policy implications of neuroscience, and with aspects of neuroscience research itself. Advances in neuroscience increasingly challenge long-held views of the self and the individual's relationship to society. Neuroscience also has led to innovations in clinical medicine that have not only therapeutic but also non-therapeutic dimensions that extend well beyond previously charted boundaries. The exponential increase in cross-disciplinary research, the commercialization of cognitive neuroscience, the impetus for training in ethics, and the increased attention being paid to public understanding of science all illuminate the important role of neuroethics in neuroscience.

Bioethical Issues↗

Interrelation between cerebral energy metabolism and behaviour in a rat model of permanent brain vessel occlusion.

The present study investigates the interrelation between cerebral energy metabolism and memory capacities after acute and permanent occlusions of carotid and vertebral arteries in adult Wistar rats (n=60). Tissue ATP, phosphocreatine, ADP, AMP and adenosine concentrations were determined in rat brain by high-pressure liquid chromatography (HPLC) analysis. Lactate and pyruvate were measured spectrophotometrically. Rats underwent psychometric testing by means of a holeboard test, closed field activity, and passive avoidance behaviour. Acute cerebral ischaemia was associated with a substantial deficit in energy load (-50%). Cortical adenosine and lactate exhibited a 7- and a 10-fold increase, respectively, in concentration. After 2 weeks of four-vessel occlusion, cortical ATP and phosphocreatine showed a partial enhancement in their concentrations if compared with acute ischaemia. Consequently, energy load (micromol/g) increased from 0.59 to 1.42 in cerebral cortex and from 0.58 to 1.14 in hippocampus under conditions of acute and permanent ischaemia, respectively. While lactate was normalized, adenosine showed a 2-fold increase in its cortical concentration. All animals improved their abilities in learning, memory and cognition after a 7-day training period. Acute vessel occlusion severely decreased working memory (WM), reference memory (RM) and locomotor activity. Simultaneously, the passive avoidance test showed a significant reduction in latency time from 247+/-85 s (sham) to 145+/-132 s. The partial improvement in brain energy state was accompanied by a relative improvement in WM and RM, although both memory capacities remained significantly lower than in controls. The data of the present study demonstrate a linear relationship between cerebral energy metabolism and brain memory capacities after acute and permanent vessel occlusions in rats.

Animals↗

Four issues concerning colour constancy and relational colour constancy.

Four issues concerning colour constancy and relational colour constancy are briefly considered: (1) the equivalence of colour constancy and relational colour constancy; (2) the dependence of relational colour constancy on ratios of cone excitations due to light from different reflecting surfaces, and the association of such ratios with von Kries' coefficient rule; (3) the contribution of chromatic edges to colour constancy and relational colour constancy; and (4) the effects of instruction and observer training. It is suggested that cognitive factors affect colour constancy more than relational colour constancy, which may be an inherently more robust phenomenon.

Color Perception↗

Current advances in Alzheimer's disease. A medical model paradigm for psychiatric education.

Psychiatrists have the expertise to play a major leadership role in the diagnosis and treatment of Alzheimer's disease. Psychiatry residents should be trained to recognize both the cognitive and noncognitive symptoms of this disease. Psychiatrists are in an excellent position to keep up with the rapidly expanding pharmacologic armamentarium to treat this devastating illness. Although such potentials are exciting, they undoubtedly will be complicated. Residency directors and departmental chairs should instill enthusiasm toward basic science advances and their clinical implications. Understanding the mechanisms underlying specific central nervous system illnesses should increase the likelihood of discovering the pathophysiology of others. The more psychiatrists and psychiatric residents become interested in these discoveries and the science underlying such progress in Alzheimer's disease, the better they will be able to keep up to date with progress in understanding other psychiatric disorders.

Aged↗

Pain in cerebral palsy: the relation of coping strategies to adjustment.

Pain is a serious secondary problem for many persons with cerebral palsy (CP). Cognitive-behavioral models of pain hypothesize that how patients cope with painful episodes plays an important role in their adjustment to chronic pain. The utility of this model, however, has never been tested in persons with CP-related pain. Fifty adults with CP and chronic pain were interviewed to assess pain experience, the interference of pain on activities (BPI), depressive symptoms (CES-D), and coping strategies used for the pain (CSQ and CPCI). The results indicated that pain-contingent rest and catastrophizing were both significantly associated with pain interference and depressive symptoms even when controlling for pain severity. These findings support a cognitive-behavioral model of chronic pain as it might be applied to persons with CP. The results also support the need for research to determine if, and to what extent, cognitive-behavioral interventions that provide training in specific coping responses reduce depressive symptoms and pain interference in persons with CP.

Adaptation, Psychological↗

Perceptual skill, radiology expertise, and visual test performance with NINA and WALDO.

RATIONALE AND OBJECTIVES: The goal of this study was to determine if radiologists possess superior visual search and analysis skills compared with those of laypeople. MATERIALS AND METHODS: In two experiments, radiologists and laypeople searched one of two complex pictorial scenes for hidden targets. Eye position was recorded during the search. Two measures of performance were obtained: accuracy of detecting targets as measured by using alternative free response receiver operating characteristic analysis and visual search efficiency as measured by using eye position analysis. RESULTS: There were no statistically significant differences in detection performance between radiologists and laypeople for either of the search tasks. Radiologists took longer on average to search the images and to first fixate on the targets than did the laypeople. For both groups, true-positive and false-positive decisions were associated with longer dwell times than true-negative decisions. As with radiology search tasks, false-negative decisions were also associated with longer dwell times than true-negative decisions. CONCLUSION: Performance on two visual search and detection tasks indicate that radiologists do not possess superior visual skills compared with laypeople. Radiology expertise is more likely to be a combination of specific visual and cognitive skills derived from medical training and experience in detecting and determining the diagnostic importance of radiographic findings.

Clinical Competence↗

Biofeedback and behavioral treatment of persistent pain in the older adult: a review and a study.

Persistent pain is a common health problem for older adults, age 60+, with a prevalence twice that in younger adults. Yet, older adults with chronic pain and headache are underrepresented in behaviorally oriented clinical programs that have proven effective for younger adults. A review of the literature indicates that older adults develop multiple pain-related problems that are similar to those of younger individuals. When offered the opportunity, older pain patients accept and benefit from multidisciplinary pain programs, cognitive-behavioral therapies and biofeedback training. A study comparing 58 older and 59 younger adults in a multidisciplinary pain program indicates that older pain patients readily acquire the physiological self-regulation skills taught in biofeedback-assisted relaxation training, and achieve comparable decreases in pain for the pain program as a whole.

Adult↗

Electromyographic (EMG) biofeedback in the comprehensive treatment of central pain and ataxic tremor following thalamic stroke.

Peripheral pain and ataxic tremor can appear suddenly following thalamic stroke and can significantly alter a patient's psychological, social, and physical functioning. The present paper reports the case of a 70-year-old Caucasian female who sustained an acute left posterior cerebral artery infarction involving the thalamus and left mesiotemporal regions. She subsequently developed Central Poststroke Pain and ataxic movement of her right arm and hand in addition to a significant right-side claudication. She was treated over 16 weeks (6 weeks of EMG biofeedback and 10 weeks of psychotherapy) with a combination of EMG biofeedback, progressive muscle relaxation, behavioral pain coping skills training, Forced Use Therapy, and Cognitive Behavioral Therapy 7 years after her initial cerebral accident. The case demonstrates the utility of biofeedback when combined as part of a comprehensive treatment program to address the multiple complications associated with thalamic stroke.

Aged↗

Behavioral intervention to reduce AIDS risk activities.

Behavior change can curtail the spread of acquired immune deficiency syndrome (AIDS). In this study, 104 gay men with a history of frequent AIDS high-risk behavior completed self-report, self-monitoring, and behavioral measures related to AIDS risk. The sample was randomly divided into experimental and waiting-list control groups. The experimental intervention provided AIDS risk education, cognitive-behavioral self-management training, sexual assertion training, and attention to the development of steady and self-affirming social supports. Experimental group participants greatly reduced their frequency of high-risk sexual practices and increased behavioral skills for refusing sexual coercions, AIDS risk knowledge, and adoption of "safer sex" practices. Change was maintained at the 8-month follow-up.

Acquired Immunodeficiency Syndrome↗

Children's understanding of illness: students' assessments.

The purpose of this study was to examine the perceptions of graduate students in the fields of nursing, social work, child life, and counseling education regarding children's understanding of illness concepts. Students were assessed as to their knowledge of children's perceptions of illness as described from a Piagetian developmental viewpoint. Eighty-five graduate students from a southern university in the fields of nursing, social work, child development/child life, and counseling categorized statements made by children regarding their understanding of illness concepts. A data-gathering instrument, developed by Perrin & Perrin (1983), was used to assess the graduate students' ability to assign a developmental age to children's responses to illness-concept questions. Additionally, the students were evaluated on their knowledge of how children perceive illness identification, causality, prevention, treatment, and use of medication. The students correctly categorized by age, children's statements regarding illness concepts only 38% of the time and correctly identified knowledge statements 50% of the time. No remarkable differences were found among the areas of specialization. Without a knowledge base of developmental theories that can be applied directly to clinical practice, nurses are at a disadvantage when working with children and their families. A better understanding of children's communication needs can ultimately lead to improved coping abilities on the part of the child and appropriate interventions on the part of the nurse. The relatively low number of correct responses suggests a need for additional training opportunities that would incorporate cognitive developmental theory into clinical practice for nurses and other health care professionals who plan to work with children.

Adaptation, Psychological↗

[Psychotherapy in schizophrenic psychoses--historical development, effectiveness and currently accepted methods].

Psychotherapy has a long tradition in the treatment of schizophrenic psychosis. Individual therapies--based on psychoanalysis in continental Europe and in the first half of this century due to emigrants in England and the United States--were predominant. The development of family therapy then led to modified forms and in particular group therapy for relatives of schizophrenic patients. There is a variety of treatments available today: assistance in coping with the disease, cognitive therapies and social skill training, psychotherapy based on depth psychology, family therapy and work with the relatives of patients. Some encouraging studies on efficacy are already available. Drug treatment continues to be the dominant form of therapy, but modified psychotherapeutic programs for patients and their relatives have become an important supplement to neuroleptic therapy and relapse prevention, particularly since the "Vulnerability-Stress-Hypotheses" became widely accepted.

Combined Modality Therapy↗

Learning and memory is preserved after induced asanguineous hyperkalemic hypothermic arrest in a swine model of traumatic exsanguination.

BACKGROUND: Induced asanguineous hypothermic metabolic arrest (suspended animation) could provide valuable time to repair major vascular injuries if safely induced in patients with trauma. We report a novel method of doing this in a swine model of uncontrolled lethal hemorrhage (ULH) that resulted in preservation of learning ability and memory. METHODS: Yorkshire swine (100 to 125 lb) underwent ULH before rapid intra-aortic infusion of a hypothermic (4 degrees C), hyperkalemic (70 mEq/L) organ preservation solution by a left thoracotomy. Cooling continued until core temperature reached 10 degrees C, and this was maintained for 60 minutes using low-flow cardiopulmonary bypass. Vascular injuries were repaired during this state of suspended animation, which was then reversed, and the animals were observed for 6 weeks. Cognitive functions were tested by training animals to retrieve food from color-coded boxes. Postoperatively, the ability to remember this task and a 75-point objective neurologic scale were used to test neurologic function. In experiment I, ULH was caused by lacerating thoracic aorta (n = 9). Five preoperatively untrained animals were trained to perform the task and compared with control animals (n = 15), and 4 preoperatively trained animals were tested for memory retention postoperatively. In experiment II, ULH was induced by creating an iliac artery and vein injury (n = 15). Animals were kept in shock for 15, 30, and 60 minutes before the induction of hypothermia. RESULTS: In experiment I, surviving animals (7/9) were neurologically intact, and their capacity to learn new skills was no different than for control animals. All pretrained animals demonstrated complete memory retention. In experiment II, survival with 15, 30, and 60 minutes of shock were 80%, 60%, and 80%, respectively. All animals (except 1) in the 60-minute group were neurologically intact and displayed normal learning capacity. CONCLUSIONS: Induction of hypothermic metabolic arrest (by thoracotomy) for repair of complex traumatic injuries is feasible with preservation of normal neurologic function, even after extended periods of shock from an intra-abdominal source of uncontrolled hemorrhage.

Animals↗

Behavioral medicine. Broadening the interface between medicine and behavioral science.

The work of psychotherapists who have a cognitive-behavioral orientation and are trained in time-limited, focused psychotherapy has proved to be beneficial in the setting of a comprehensive medical and health maintenance organization. Group interventions that deal with relaxation, social skills, depression, agoraphobia, smoking cessation, problem drinking, weight modification, and Type A behavior, to mention a few, are conducted on an ongoing basis, allowing staff to treat large numbers of people in a time-efficient and cost-effective way. These groups also help the staff to provide a coordinated set of therapeutic and training experiences for patients through their participation in appropriate group treatment during the course of their individual treatment.

Behavior Therapy↗

Specific components in the etiology, assessment, and treatment of male sexual dysfunctions: controlled outcome studies.

Controlled outcome studies investigating specific components in the etiology, assessment, and treatment of male sexual disorders are reviewed. Premature ejaculators appear just as accurate in assessing their levels of sexual arousal as are men not suffering from this condition. Absolute levels of sexual activity or desire do not seem to be as important for these individuals as has been suggested. Attempts to distinguish organic versus functional erectile failure using the MMPI or historical data have generally proved unsuccessful. Treatment effectiveness in premature ejaculation may be due to elevating the sensory threshold or may be an artifact of simply prescribing more frequent sexual activities. Removing performance demands through cognitive restructuring and sexual communication training shows promise in the treatment of erectile failure.

Ejaculation↗

Human Experience Modeler: context-driven cognitive retraining to facilitate transfer of learning.

We describe a cognitive rehabilitation mixed-reality system that allows therapists to explore natural cuing, contextualization, and theoretical aspects of cognitive retraining, including transfer of training. The Human Experience Modeler (HEM) mixed-reality environment allows for a contextualized learning experience with the advantages of controlled stimuli, experience capture and feedback that would not be feasible in a traditional rehabilitation setting. A pilot study for testing the integrated components of the HEM is discussed where the participant presents with working memory impairments due to an aneurysm.

Activities of Daily Living↗