DIR/Floortime® Parent Training Intervention for Children with Developmental Disabilities: a Randomized Controlled Trial

Objective: To determine whether adding a parent training program utilizing the Developmental Individual-difference Relationship-based (DIR/Floortime®) approach for children with developmental disabilities can improve their capacities for attention and initiation.  Methods: Forty-eight pairs of parents and their preschool children with developmental disabilities were randomly assigned to three 1-hour one on one DIR/Floortime® parent training sessions during a 4-month period or to a control group. Results: Between-group comparison demonstrated a significant difference in favor of the intervention group for attention (F(1, 46) = 34.52, p = .031,  ph2 = .099)  and initiation composite scores (F(1, 46) = 6.55, p = .014, ph2 = .127). Effect sizes were medium to large for the attention composite score (Cohen’s d = .526) and initiation composite score (Cohen’s d = .653) respectively. Conclusion: Adding a modest home-based DIR/Floortime® parent training approach may yield clinically meaningful improvements in attention and initiation for children with a range of developmental challenges

“Artlift” Arts-on-Referral Intervention in UK Primary Care: Updated findings from an ongoing observational study

Background: Arts for health interventions are an accepted option for medical management of mental wellbeing in health care. Updated findings are presented from a prospective longitudinal follow-up (observational) design study of an arts on referral programme in UK general practice, over a 7-year period (2009–2016). Methods: Primary care process and mental wellbeing outcomes were investigated, including progress through the intervention, changes in mental wellbeing, and factors associated with those outcomes. A total of n =1297 patients were referred to an eight or 10-week intervention over a period from 2009 to 2016. Patient sociodemographic information was recorded at baseline, and patient progress (e.g. attendance) assessed throughout the intervention. Results: Of all referrals, 51.7% completed their course of prescribed art (the intervention). Of those that attended, 74.7% engaged with the intervention as rated by the artists leading the courses. A significant increase in wellbeing was observed from pre- to post-intervention (t = −19.29, df =523, P < 0.001, two-tailed) for those that completed and/or engaged. A sub sample (N =103) of these referrals self-reported multi-morbidities. These multiple health care service users were majority completers (79.6%), and were rated as having engaged (81.0%). This group also had a significant increase in well-being, although this was smaller than for the group as a whole (t = −7.38, df =68, P < 0.001). Conclusion: Findings confirm that art interventions can be effective in the promotion of well-being for those that complete, including those referred with multi-morbidity, with significant changes in wellbeing evident across the intervention periods

Interventions for treating anxiety after stroke

Background Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke. Physicians can treat these patients with antidepressants or other anxiety-reducing drugs, or both, or they can provide psychological therapy. This review looks at available evidence for these interventions. This is an update of the review first published in October 2011. Objectives The primary objective was to assess the effectiveness of pharmaceutical, psychological, complementary, or alternative therapeutic interventions in treating stroke patients with anxiety disorders or symptoms. The secondary objective was to identify whether any of these interventions for anxiety had an effect on quality of life, disability, depression, social participation, caregiver burden, or risk of death. Search methods We searched the trials register of the Cochrane Stroke Group (January 2017). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2017, Issue 1: searched January 2017); MEDLINE (1966 to January 2017) in Ovid; Embase (1980 to January 2017) in Ovid; the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1937 to January 2017) in EBSCO; and PsycINFO (1800 to January 2017) in Ovid. We conducted backward citation searches of reviews identified through database searches and forward citation searches of included studies. We contacted researchers known to be involved in related trials, and we searched clinical trials registers for ongoing studies. Selection criteria We included randomised trials including participants with a diagnosis of both stroke and anxiety for which treatment was intended to reduce anxiety. Two review authors independently screened and selected titles and abstracts for inclusion. Data collection and analysis Two review authors independently extracted data and assessed risk of bias. We performed a narrative review. We planned to do a meta-analysis but were unable to do so as included studies were not sufficiently comparable. Main results We included three trials (four interventions) involving 196 participants with stroke and co-morbid anxiety. One trial (described as a ’pilot study’) randomised 21 community-dwelling stroke survivors to four-week use of a relaxation CD or to wait list control. This trial assessed anxiety using the Hospital Anxiety and Depression Scale and reported a reduction in anxiety at three months among participants who had used the relaxation CD (mean (standard deviation (SD) 6.9 (± 4.9) and 11.0 (± 3.9)), Cohen’s d = 0.926, P value = 0.001; 19 participants analysed). The second trial randomised 81 participants with co-morbid anxiety and depression to paroxetine, paroxetine plus psychotherapy, or standard care. Mean levels of anxiety severity scores based on the Hamilton Anxiety Scale (HAM-A) at follow-up were 5.4 (SD ± 1.7), 3.8 (SD ± 1.8), and 12.8 (SD ± 1.9), respectively (P value < 0.01). The third trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean levels of anxiety based on the HAM-A were 6.5 (SD± 3.1) and 12.6 (SD± 3.4) in the two groups, respectively, which represents a significant difference (P value < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting, or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. Trial authors provided no information about the duration of symptoms associated with adverse events. The trial of relaxation therapy reported no adverse events. The quality of the evidence was very low. Each study included a small number of participants, particularly the study of relaxation therapy. Studies of pharmacological agents presented details too limited to allow judgement of selection, performance, and detection bias and lack of placebo treatment in control groups. Although the study of relaxation therapy had allocated participants to treatment using an adequate method of randomisation, study recruitment methods might have introduced bias, and drop-outs in the intervention group may have influenced results. Authors’ conclusions Evidence is insufficient to guide the treatment of anxiety after stroke. Further well-conducted randomised controlled trials (using placebo or attention controls) are required to assess pharmacological agents and psychological therapies

The Relationship between Resilience Quotient, Social Support and Spiritual Well-Being of Caregivers of Patients with Hemiplegia

Objective: There are three main objectives of this study. The first is to study the levels of resilience quotient, social support and spiritual well-being of caregivers of patients with hemiplegia. The second is to study the relationship between resilience quotient and spiritual well-being of caregivers to patients with hemiplegia. The third objective is to study the relationship between social support and spiritual well-being of caregivers of patients with hemiplegia. Methods: The sample of this study is composed of 170 caregivers of patients with hemiplegia who received treatment at the Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital. Data for this study were collected using a psychological questionnaire, and then by adopting analytical statistics, which are percentage, mean, standard deviation and Pearson’s Product Moment Correlation Coefficient. Results: After data collection and analysis, caregivers of patients with hemiplegia were found to have relatively high levels of resilience quotient and social support. Moreover, they have a high level of spiritual well-being. Taken together, these results suggest that there is a positive correlation between resilience quotient and the spiritual well-being of caregivers of patients with hemiplegia, with statistical significance at the .01 level. There is also a positive correlation between social support and the spiritual well-being of caregivers of patients with hemiplegia, with a statistical significance at the .01 level. Conclusion: This research results can be used as a guideline for efforts to enhance the resilient quotient, social support and spiritual well-being of caregivers by providing knowledge, information and caregiving equipment to them. Moreover, caregivers should be encouraged to enjoy their free time by engaging in creative activities and religious activities, which are believed to help increase mental peace