Play therapy insights into everyday social pedagogical practice in residential child care

Psychotherapy and social pedagogical care, help and support in relation to children placed in out-of-home care are typically perceived as two separate forms of practice. In its typical form, psychotherapy is pictured as a meeting between therapist and client in a ‘therapeutic space’ separated out from daily life and activities, while social pedagogical care, help, and support is carried out in close proximity to everyday life in what is regarded as the person’s home. This article analyses an alternative relationship and way of collaborating between psychotherapy – more specifically play therapy – and everyday social pedagogical practice in residential care for children with severe emotional and behavioural problems. This is done by drawing on an empirical case study of the relationship between everyday practice and expertise of social pedagogical practice and play therapy in a children’s home in Denmark. Meeting the needs of children who have been severely neglected and/or abused is challenging in different ways, and it requires highly developed relational, emotional, and reflective skills. The authors argue that play therapy has a particular potential in foregrounding and developing core social pedagogical knowledge and skills. When designed and carried out as an integrated part of everyday social pedagogical practice, play therapy can support practitioners in integrating a reflective and conscious approach to understanding and meeting the children’s emotional and relational needs with the ability to create and enter into ‘playful encounters’ with the children that challenges one-sided and taken-for-granted power relationships, practices and norms

Measurement properties of the high-level mobility assessment tool for mild traumatic brain injury

Background. The High-Level Mobility Assessment Tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). Measurement properties of the HiMAT have not been tested in the mild TBI (MTBI) population. Objective. The aim of this study was to examine the reliability, validity, and responsiveness of the HiMAT in a sample of the MTBI population. Design. A cohort, pretest-posttest, comparison study was conducted. Methods. Ninety-two patients (69% men, 31% women) with a mean age of 37.1 years (SD 13.8) and a mean Glasgow Coma Scale score of 14.7 (SD 0.7) were recruited from Oslo University Hospital. All patients were tested with the HiMAT (range of scores 0 [worst] to 54 [best]) at 3 months postinjury. Fifty-one patients were retested at 6 months. A subgroup of 25 patients was selected for the reliability testing. Balance function reported on the Rivermead Post Concussion Symptoms Questionnaire was chosen as a criterion and anchor. Criterion-related validity was studied with correlation analysis. Intraclass correlation coefficients (ICCs) were used for assessing interrater and intrarater reliability. Minimal detectable change (MDC) for the HiMAT was estimated. Responsiveness was assessed with receiver operating characteristic curve analyses. Results. The mean HiMAT sum score was 46.2 (95% confidence interval 44.4 to 48.1). The HiMAT had a ceiling effect of 22.8%. The correlation between HiMAT scores and self-reported balance problems was large (r .63, P .001). Interrater and intrarater reliability of the HiMAT sum score was high (interrater ICC .99, intrarater ICC .95). The MDC was 3 to 4 points. Responsiveness was good, and the HiMAT discriminated well between patients with self-perceived improved balance function versus unchanged balance function (area under the curve 0.86). Limitations. The small sample size, a ceiling effect, and lack of a gold standard were limitations of the study. Conclusions. The HiMAT demonstrated satisfactory measurement properties for patients with MTBI. The HiMAT can be used as an outcome measure of balance and mobility problems in patients with MTB

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

OBJECTIVE: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (≥ 16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3–8 during the first 24 h post-injury. A total of 126 patients were included. METHODS: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. RESULTS: Mean QOLIBRI score was 68.5 (standard deviation = 18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p = 0.05), GOSE (p = 0.05), RPQ (p < 0.001) and HADS (p < 0.001). The adjusted R2 showed that the model explained 64.0% of the variance in the QOLIBRI score. CONCLUSION: Symptom pressure and global functioning in the sub-acute phase of traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury

Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial

Background A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces. Methods/design This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed. Discussion The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided. Trial registration ClinicalTrials.gov, NCT03092713. Registered on 10 March 2017

FGF21, a liver hormone that inhibits alcohol intake in mice, increases in human circulation after acute alcohol ingestion and sustained binge drinking at Oktoberfest

Objective: Excessive alcohol consumption is a leading cause of global morbidity and mortality. However, knowledge of the biological factors that influence ad libitum alcohol intake may be incomplete. Two large studies recently linked variants in the KLB locus with levels of alcohol intake in humans. KLB encodes β-klotho, co-receptor for the liver-derived hormone fibroblast growth factor 21 (FGF21). In mice, FGF21 reduces alcohol intake, and human Fgf21 variants are enriched among heavy drinkers. Thus, the liver may limit alcohol consumption by secreting FGF21. However, whether full-length, active plasma FGF21 (FGF21 (1–181)) levels in humans increase acutely or sub-chronically in response to alcohol ingestion is uncertain. Methods: We recruited 10 healthy, fasted male subjects to receive an oral water or alcohol bolus with concurrent blood sampling for FGF21 (1–181) measurement in plasma. In addition, we measured circulating FGF21 (1–181) levels, liver stiffness, triglyceride, and other metabolic parameters in three healthy Danish men before and after consuming an average of 22.6 beers/person/day (4.4 g/kg/day of ethanol) for three days during Oktoberfest 2017 in Munich, Germany. We further correlated fasting FGF21 (1–181) levels in 49 healthy, non-alcoholic subjects of mixed sex with self-reports of alcohol-related behaviors, emotional responses, and problems. Finally, we characterized the effect of recombinant human FGF21 injection on ad libitum alcohol intake in mice. Results: We show that alcohol ingestion (25.3 g or ∼2.5 standard drinks) acutely increases plasma levels of FGF21 (1–181) 3.4-fold in fasting humans. We also find that binge drinking for three days at Oktoberfest is associated with a 2.1-fold increase in baseline FGF21 (1–181) levels, in contrast to minor deteriorations in metabolic and hepatic biomarkers. However, basal FGF21 (1–181) levels were not correlated with differences in alcohol-related behaviors, emotional responses, or problems in our non-alcoholic subjects. Finally, we show that once-daily injection of recombinant human FGF21 reduces ad libitum alcohol intake by 21% in mice. Conclusions: FGF21 (1–181) is markedly increased in circulation by both acute and sub-chronic alcohol intake in humans, and reduces alcohol intake in mice. These observations are consistent with a role for FGF21 as an endocrine inhibitor of alcohol appetite in humans. Keywords: Fibroblast growth factor 21, FGF21, Alcohol, Alcohol appetit

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries. Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age  Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination

Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries

This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population

Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan.

Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan. Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Background The clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians. Methods Between November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction. Results A total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P\0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms ([20 on the 0–100 scale, P\0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment. Conclusion SEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patientreported outcomes is important in evaluating SEMS treatment