Including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment

Objective: To test the feasibility, safety and effectiveness of the My Therapy programme for inpatients with mild-moderate cognitive impairment. Design: Observational pilot study. Patients: Rehabilitation inpatients with mild-moderate cognitive impairment. Methods: During their inpatient admission, participants received My Therapy, a programme that can increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy. Outcomes included My Therapy participation, falls, Functional Independence Measure (FIM) and 10-m walk test. Outcomes were compared with those of participants without cognitive impairment from the original My Therapy study (n = 116) using χ2 and independent t-tests. Results: Eight participants with mild-moderate cognitive impairment (mean (standard deviation (SD)) age 89.6 years (4.8); 3 women) were included. All participants completed the My Therapy programme on at least one day of their admission, with no associated falls. Participants had an 8.4 s (SD 5.1) reduction in their 10-m walk test and a 21.5 point (SD 11.1) improvement on FIM scores from admission to discharge. There were no significant between-group differences in feasibility, safety or effectiveness for participants with and without cognitive impairment. Conclusion: This pilot study has shown that including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment. Lay Abstract This study aimed to determine whether it was practical, safe and effective for patients in a rehabilitation hospital with memory or thinking problems to participate in a programme called My Therapy. My Therapy aimed to increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy sessions. There were 8 participants in the study and all of them reported completing the My Therapy programme on at least one day of their rehabilitation stay. There were no falls relating to My Therapy participation. Participants improved their walking speed and function during their rehabilitation stay. There were no differences in the results between people with and without memory or thinking problems, in terms of practicality, safety or effectiveness. This study has shown that including exercise self-management as part of rehabilitation is practical, safe and effective for patients with memory or thinking problems.

Attachment theory and music therapy: What was the relevance of attachment theory to a student’s music therapy programme for ‘at-risk’ mothers and their babies?

<p>This qualitative secondary analysis research project sought to explore the relevance of attachment theory as it might apply to a music therapy programme set up and run within a residential service for ‘at risk’ mothers and their babies. The explicit purpose of the music therapy programme was to assist the mothers in bonding with their babies. The researcher was a student music therapist on placement at the facility, involved in weekly one-to-one sessions with a total of nineteen young women and their babies, over the time that each was resident at the facility. The music therapist also ran some weekly group sessions (mothers with babies) as part of the facility’s mandatory education programme. The music therapy programme took place over twenty-two weeks, with a two week break after the first ten weeks. The research analysis commenced on completion of the programme. Thematic analysis was used to look at two types of data; data from the placement (including clinical notes and personal reflective journal), and literature on attachment theory. There was an initial review of selected literature on attachment theory and music therapy. The researcher/student music therapist then carried out an inductive qualitative secondary analysis of the data that had been generated as a standard part of her practice over the period of the student placement. This was followed by a further examination of attachment theory literature to confirm key aspects of the theory. The findings from the inductive analysis were then looked at in the light of those identified key features of attachment theory. The research findings showed many strong links between key concepts of attachment theory, and the patterns that emerged from the placement data, manifesting on a number of different levels. However some patterns might be more usefully explained and/or elucidated by other theories. Findings suggested that attachment theory provided a useful framework and language for observing and understanding the interactive behaviours and external and personal structures that appeared to work for or against mother-infant bonding. In addition, the music therapy programme seemed a particularly suitable vehicle for promoting positive mother-infant bonding. However it was found that although the music therapy programme may have been helpful in a positive mother-infant bonding process, there was no evidence to suggest that this would necessarily extend to promoting a secure attachment relationship, given the personal, structural and legal factors associated with the high ‘at-risk’ context. An attachment-based music therapy programme may well have a more useful role to play in a lower risk context where mothers and babies remained for longer in the facility, and where the programme could continue throughout the women’s transition into the community and beyond.</p>

Attachment theory and music therapy: What was the relevance of attachment theory to a student’s music therapy programme for ‘at-risk’ mothers and their babies?

<p>This qualitative secondary analysis research project sought to explore the relevance of attachment theory as it might apply to a music therapy programme set up and run within a residential service for ‘at risk’ mothers and their babies. The explicit purpose of the music therapy programme was to assist the mothers in bonding with their babies. The researcher was a student music therapist on placement at the facility, involved in weekly one-to-one sessions with a total of nineteen young women and their babies, over the time that each was resident at the facility. The music therapist also ran some weekly group sessions (mothers with babies) as part of the facility’s mandatory education programme. The music therapy programme took place over twenty-two weeks, with a two week break after the first ten weeks. The research analysis commenced on completion of the programme. Thematic analysis was used to look at two types of data; data from the placement (including clinical notes and personal reflective journal), and literature on attachment theory. There was an initial review of selected literature on attachment theory and music therapy. The researcher/student music therapist then carried out an inductive qualitative secondary analysis of the data that had been generated as a standard part of her practice over the period of the student placement. This was followed by a further examination of attachment theory literature to confirm key aspects of the theory. The findings from the inductive analysis were then looked at in the light of those identified key features of attachment theory. The research findings showed many strong links between key concepts of attachment theory, and the patterns that emerged from the placement data, manifesting on a number of different levels. However some patterns might be more usefully explained and/or elucidated by other theories. Findings suggested that attachment theory provided a useful framework and language for observing and understanding the interactive behaviours and external and personal structures that appeared to work for or against mother-infant bonding. In addition, the music therapy programme seemed a particularly suitable vehicle for promoting positive mother-infant bonding. However it was found that although the music therapy programme may have been helpful in a positive mother-infant bonding process, there was no evidence to suggest that this would necessarily extend to promoting a secure attachment relationship, given the personal, structural and legal factors associated with the high ‘at-risk’ context. An attachment-based music therapy programme may well have a more useful role to play in a lower risk context where mothers and babies remained for longer in the facility, and where the programme could continue throughout the women’s transition into the community and beyond.</p>

Medical Interactive Recovery Assistant: a useful clinical tool in paediatric shoulder rehabilitation?

Background/aims Outpatient physical therapy is the mainstay of treatment in shoulder instability, but lack of motivation and intermittent monitoring of progress is associated with poor compliance. ‘Exergames’ (a combination of videogames and physical exercise) may provide an additional or alternative motivational factor. The aim of this study was to determine the applicability of the Medical Interactive Recovery Assistant Xbox Kinect gaming software in the management of adolescent atraumatic shoulder instability. Methods Patients completed six 30-minute sessions playing games using the Medical Interactive Recovery Assistant while participating in a therapy programme. Pain and fatigue questionnaires, functional assessments and a framework analysis of free-text comments were used. Results A total of 20 female patients (15 unilateral, five bilateral pathology, mean age 14.1 years) completed the sessions. An average session length was 10.8 mins (range 0–24 mins). After each session using the Medical Interactive Recovery Assistant, 80% were neither in pain, nor overly tired. At 2 weeks, the Stanmore Percentage of Normal Shoulder Assessment scores had improved by a mean 17.9% and 10 (50%) patients showed improvements in Oxford Shoulder Instability Scores. Overall, 15 participants (75%) liked the technology; however six (32%) preferred standard physiotherapy, because of software limitations and lack of personal interaction. Conclusions Medical Interactive Recovery Assistant gamification is applicable for this patient cohort and could be integrated into adolescent atraumatic shoulder instability rehabilitation programmes; however, results emphasise the importance of personal contact.

Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death

Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.

#3031 Outcome and evaluation of an outpatient multidisciplinary group-based rehabilitative therapy programme for functional neurological disorder

AimsWe report findings from an eight-week rehabilitative therapy programme, delivered in a neuropsychiatric outpatient setting, with co-primary aims to (1) reduce symptom severity, and (2) improve functional mobility, in selected adults with a diagnosis of Functional Neurological Disorder (FND). Effectiveness of the programme was assessed in regard to outcome data routinely collected throughout the programme, and at three-month follow-up.MethodFollowing appropriate referral, criteria screening and initial assessment, suitable individuals attended as day patients for two days per week over an eight-week period, and a follow-up session provided at three months. The programme comprised individual sessions of Physiotherapy (PT), Cognitive Behavioural Therapy (CBT) and self-management, as well as group physiotherapy workshops and psycho-educational sessions. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-ii), Work and Social Adjustment Scale (WSAS), and clinician-rated observation of mobility-aid requirement. Mobility-aid requirement was categorised as follows: unaided, walking-aid, and wheelchair user. Analyses included only data from individuals completing both treatment and follow-up (n = 31). Friedmans ANOVA assessed overall change in outcome measure scores over time. Dunn-Bonferroni post-hoc tests were used to compare pairs of time-points (Weeks 1, 8, three-month follow-up).ResultsThere were statistically significant overall improvements on the BAI,χ2(2) = 15.35, p <.001,BDI-ii,χ2(2) = 24.61, p <.001,WSAS,χ2(2) = 24.61, p =.001, and in category of mobility-aid requirement, χ2(2) = 19.50, p <.001.Descriptive statistics indicated that 45% of patients could mobilise unaided prior to programme attendance, with 84%able to mobilise unaided at follow-up. Post-hoc Dunn-Bonferroni tests indicated that reductions in scores were significant between Week 1 and Week 8 for the BAI, p =.004, BDI-ii, p <.001, and WSAS, p =.004, and between Week 1 and three-month follow-up for the BAI, p =.002, BDI-ii, p =.001, and WSAS, p =.006.ConclusionsThese findings suggest that an outpatient rehabilitative therapy programme can be a beneficial treatment approach, as patients reported reduced symptom severity in terms of anxiety, depression, and functional impairment, as demonstrated by scores on the BAI, BDI-ii and WSAS, and displayed improvements in mobility, as determined by reduced mobility-aid requirement. Although further evaluation would be encouraged to address limitations of these findings, they serve as a positive indication of an effective alternative to inpatient treatment.

Therapeutic mountain hiking in psychiatric rehabilitation

In recent years, there has been a major shift towards bringing nature-based interventions (green therapy) into the mainstream of activities improving the psychological well-being of the population. Various interventions generally based on practising mindfulness in nature and training in psychosocial skills are also increasingly integrated into psychiatric rehabilitation. In Poland, the most commonly used therapeutic intervention involving contact with nature has traditionally been horticultural therapy (also known as social and therapeutic horticulture). A variety of therapeutic methods with an established status in other European countries, for example mountain hiking, forest bathing/shinrin-yoku, wilderness therapy, outdoor therapy or adventure therapy, are not sufficiently well-known in Poland. A specific type of therapeutic intervention based on contact with nature is therapy in the mountain setting, which taps into the potential of interventions based on mindfulness, climate therapy, and occupational therapy. The paper outlines the principles of organisation, therapeutic factors, and conditions determining the effectiveness of therapeutic mountain hiking, also known as mountain therapy or psychosocial mountain therapy. In addition, the paper aims to provide an overview of the tasks facing the therapist/guide. Mountain therapy has a strictly defined therapeutic goal which is pursued in a specific mountain environment. It is important to highlight that the effectiveness of therapeutic methods and the plan of the mountain hike are supported by sufficiently strong empirical evidence. The authors propose their own therapy programme in a mountain environment, complete with the preconditions and consecutive stages of the therapeutic process. Multiple research-documented benefits of the mountain setting in psychiatric rehabilitation may convince specialists to incorporate this therapeutic modality more widely into their practice, especially in the context of restrictions related to the current epidemiological situation.