Examining the functions of prison critical incidents: a preliminary qualitative analysis of public reporting

Purpose: The current study explored the function of crisis incidents in prisons within the UK and US. The incidents reviewed included riots and hostage-incidents, focusing only on information that was available publically. It did not intend to capture official reports not in the public domain. Design/methodology/approach: Publically available information on incidents were systematically reviewed. Functional assessment and grounded theory were employed to examine background factors, triggers and maintaining factors. Twenty-five crisis incidents were analysed (UK = 10 and US = 15) from the past 30 years. It was predicted that crisis incidents would be motivated by negative and positive reinforcement, with negative more evidenced than positive. Precipitating factors (i.e. triggers) were predicted to include negative emotions, such as frustration and anger. Findings: Similarities in triggers and background factors were noted between hostage taking and riot incidents. Positive reinforcement was primarily indicated. Riots appeared driven by a need to communicate, to secure power, rights, control and/or freedom whereas for hostage taking these functions extended to capture the removal of negative emotions, to inflict pain, to punish/gain revenge, to effect a release, to manage boredom, and to promote positive emotions. Research limitations/implications: The study is preliminary and focused on the reporting of incidents in publically available sources; consequently, the data is secondary in nature and further limited by sample size. Nevertheless, it highlights evidence for similarities between types of crisis incidents but also some important potential differences. The need to understand the protective factors preventing incidents and minimising harm during incidents is recommended. Originality/value: This is an under-researched area. The study contributes to the field not only by focusing on providing a detailed analysis of an under-used source (public reporting) but by also identifying where gaps in research remain. The results demonstrate the value in understanding incidents through their motivation, particularly in distinguishing between negative and positive reinforcement

An exploration of stakeholders’ perceptions of the barriers to clinical use of Assistive Technologies in services for upper-limb stroke rehabilitation

Introduction Half of all patients commencing stroke rehabilitation have marked impairment of the hemiplegic arm, with only 14% regaining useful function. Assistive technologies (ATs) have been developed and evaluated yet currently reach only a fraction of patients. The NIHR funded a five year research programme to generate understanding necessary to develop cost-effective stroke services in upper-limb rehabilitation. This stage aims to understand the potential advantages and disadvantages to the clinical use of ATs, and the needs and priorities of stakeholders. Method Participants include people with a stroke (n=40), their carers (n=20), health care professionals (n= 40), budget holders (n=15) and service commissioners (n=15). An interactive exhibition was held at the University of Southampton in October 2009 where stakeholders tested a range of ATs. Focus groups with each stakeholder group will be conducted within three months of the exhibition to discuss personal involvement in AT use, and positive and negative views on the AT presented. Results Results will be categorised in terms of barriers and facilitators to the use of upper-limb technologies addressing issues such as user comfort and acceptability, cost-benefit, evidence of effect and funding provision. Conclusion Getting research implemented in practice is challenging. This novel approach explores the barriers to using new technologies from the perspective of all key stakeholders. These findings will be combined with those of a national survey, and systematic review to inform a clinical trial resulting in a recommended care pathway for upper-limb rehabilitation

The effects of group directed versus individual directed instruction within a group instructional setting

One contribution of behavior modification to educational settings is the functional analysis of teaching behavior. The components of teaching consist of (a) prompts which set the occasion for a response to occur; (b) student responses; and (c) consequences which alter the frequency of student responses. Many investigations specifying the functions and parameters of each of these components have been conducted. The present investigation considered instruction as a "package" composed of both antecedent and consequent components. The research question was the relative merits of directing instruction to individuals within a group versus groups of students. The performance task of beginning archery was chosen as a dependent measure. Twenty-six subjects were matched on shoulder-girdle strength and assigned to one of two experimental conditions. In the individual instructional condition, the instructor was required to direct at least 90 percent of the instructions to individuals within the group; not more than 10 percent of the instructions were directed to the group as a whole. In the group instructional condition, the reverse was true. Daily observations of the teacher's instructional behaviors were used to determine that the experimental conditions of the study were met

A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment?

Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.This review formed part of the COST Action TD 1006A European Network on Robotics for Neurorehabilitation. It was an interdisciplinary EU-funded research network concentrating on the coordination of European research in the area of rehabilitation robotics

Religion between State and Society

In contrast to mainstream historiography, secularisation was not a distinct process in nineteenth-century Europe, since the century was a period of religious revival. In the late nineteenth century, in spite of weakening church attendance and rising agnosticism brought on by urbanisation and migration, religion remained attractive for the middle class and social movements related to church membership emerged in politics. In this chapter the diversity of religion in Europe is treated. The author distinguishes between hierarchical and nonhierarchical types of Christian churches, and between four religious regions in Europe. This situation had effects on the relationship between state and religion

Participant Feedback in the Evaluation of Novel Stroke Rehabilitation Technologies

Purpose: Stroke participant perspectives are used to evaluate a novel rehabilitation system employing electrical stimulation (ES) technology combined with robotic assistance and virtual reality. The broader implications of such feedback for future technological development are discussed. Method: While supported by a robot, ES was applied to the triceps and anterior deltoid muscles of 5 chronic stroke participants with upper limb impairment to assist them in completing functional, virtual reality tracking tasks. Advanced ES controllers adjusted the amount of ES applied on each attempt to improve accuracy and maximise voluntary effort. The system was evaluated in terms of participants’ perspectives, expressed during a semi-structured interview, and clinical outcome measures. Results: The rehabilitation system was well accepted by participants and viewed positively, despite mixed opinions regarding effectiveness. Feedback demonstrated an alignment in participants’ perceptions of reduced impairment and clinical outcomes, in which a significant (p < 0.001) mean change of 9.3 in Fugl-Meyer scores was observed. Participant feedback also provided insight into individual differences observed in clinical outcomes. From our findings six key issues regarding effectiveness, muscles trained, system flexibility and portability, possible discomfort and the value of participant perspectives emerged that may be relevant for researchers developing new rehabilitation technologies. Conclusion: Participant feedback via a semi-structured interview provided important insight into the usability and effectiveness of using this system as a platform for upper limb stroke rehabilitation

European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus

Background: Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods: Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. Results: In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions: The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.The European Network on Robotics for NeuroRehabilitation (Working Group 1) developed these recommendations. Their work was funded by the European Co-Operation in Science and Technology (COST Action TD1006) programme. The funding body had no role in or infuence on the selected approach and synthesis, analysis, and interpretation of data and in writing the manuscript

Translation of evidence-based Assistive Technologies into stroke rehabilitation: Users' perceptions of the barriers and opportunities

Background: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. Methods. Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. Results: 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. Conclusion: Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation. © 2014 Hughes et al.; licensee BioMed Central Ltd

Upper limb and eye movement coordination during reaching tasks in people with stroke

Purpose: To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke. Methods: Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session. Results: Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group. Conclusion: Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support. -Implications for Rehabilitation -Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks. -Upper limb support can reduce deficits in hand-eye coordination. -Stroke rehabilitation outcomes should consider motor and oculomotor performance