Neuropsychological functioning and prosthetic and psychosocial rehabilitation outcomes in people with lower limb amputations

People with lower limb amputations often face challenges in rehabilitation and returning to normal living. Peripheral vascular disease and diabetes are the most prevalent precipitating causes of lower limb amputation in economically developed countries. Both of these aetiologies are associated with a range of deficits in cognitive functioning. Deficits in cognitive functioning have the potential to impact rehabilitation engagement, and rehabilitation outcomes. The first aim of the present research was to establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation rehabilitation.The second aim was to examine relationships between selected cognitive functions, rehabilitation engagement, and prosthetic, mobility, and psychosocial rehabilitation outcomes. Comprehensive neuropsychological data was collected from 87 participants with lower limb amputations on admission to comprehensive rehabilitation. Prosthetic (use, satisfaction), mobility, and psychosocial (activation, adjustment, distress, social support, community participation) outcomes were examined at discharge, six months, and 12 months post-discharge. Clinician-rated rehabilitation engagement was examined at discharge. Impairments in overall cognitive functioning, estimated premorbid cognitive functioning, reasoning, psychomotor function, information processing, attention, memory, visuospatial functions, language, and executive functions were evident. Aetiology was not related to cognitive functioning. Outcomes were generally longitudinally stable. Higher rehabilitation engagement was related to favourable discharge and six month outcomes, and higher overall cognitive functioning, information processing, delayed recall, and visuospatial construction abilities (but not cognitive flexibility or planning). Generally, cognitive functions were not predictive of rehabilitation outcomes when controlling for rehabilitation engagement. Findings support the need for cognitive screening at rehabilitation admission, including of persons with non-dysvascular amputations. Administration of comprehensive neuropsychological assessment with a battery sensitive to cerebrovascular disease sequelae is recommended. Rehabilitation engagement may be a potentially modifiable contributor to outcomes. Cognitive functioning is a potential intervention point for improvement of rehabilitation engagement. Understanding precise relationships between outcomes and executive functioning warrants further research

Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review

Objective: To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. Design: Systematic review. Population: Adults (aged 18 years and over) with intellectual disabilities. Intervention: Deinstitutionalisation, that is, the move from institutional to community settings. Primary and secondary outcome measures: Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost–utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs). Search: We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality. Results: Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs. Conclusion: A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours

Nurturing voices: psychologists’ role in amplifying children and young people's participation rights in decision making

Children have a fundamental right to participate in decision making across settings, including physical (Quaye, Coyne, Soderback, 2019) and mental health, family law proceedings (Tisdall, 2016), and educational and local area planning processes (Usher, 2023). However, it is sometimes the case that children experience obstacles, for example when their opinion, wishes and values are not heard and they are not included in decision making processes. For participation to be optimal and meaningful, health and social care professionals—including psychologists—need organisational, social, paediatric and pedagogical competence, critical awareness and reflection, and an openness to change in the practice and culture of service delivery (Quaye, Coyne, Soderback, 2019; Bijleveld, Bunders-Aelen, & Bedding, 2020; Bjønness, Viksveen, Johannessen, & Storm, 2020). Psychologists are increasingly asked to play a role in advancing the human rightsagenda. The APA suggests that we have a responsibility to advocate for the human rights of our patients, clients, students, research participants, and their families and communities of clients, including marginalised populations made vulnerable by societal inequalities (Huminiuk, 2023). As rights-based and person-centred paradigms become more central to our profession, there is a growing need to learn about human rights and how to integrate rights-based approaches with practice. In the Rep. of Ireland, rights-based practice is particularly important to children’s well-being and the protection of their right to the highest standard of health. Recently, the PSI explicitly stated that ‘children and young people who attend specialist mental health services … have the right to expect safe and effective support in a timely manner with their rights and needs at the centre of that care’ (PSI Statement, 2023). More than ever, psychologists are being asked to implement a rights-based approach for children— one that integrates equality, equity or even freedom from discrimination to the implementation and evaluation of mental health programmes (e.g. Mental Health Commission, 2023). In this article, we focus on legal frameworks and principles helpful to the implementation of children’s participation rights. We set out some practical ways for psychologists to start engaging with, or reflecting on, rights-based approaches in theory and practice

A scoping review of augmented/virtual reality health and wellbeing Interventions for older adults: redefining Immersive virtual reality

Augmented and virtual reality (AR/VR) technologies are regularly used in psychology research to complement psychological interventions and to enable an individual to feel as if they are in an environment other than that of their immediate surroundings. A scoping review was performed to identify how AR/VR was being used with older adult populations to impact their physical and mental health. The review also sought to determine whether the terminology used in AR/VR research was consistent. The results show that 65 studies have been published in the last 20 years that meet the inclusion criteria (virtual/augmented reality) technology to impact older adults’ physical/mental health and wellbeing. Participants included healthy, physically, and cognitively impaired, and emotionally vulnerable older adults. We argue that over 70% of the studies included in this review were mislabeled as VR and only six papers included fully immersive VR/AR. The remaining studies use less immersive variants of virtual reality with their populations, and only one study made use of AR, which prompted the suggestion of a new definition for virtual reality. This paper also calls for an updated taxonomy of augmented and virtual reality definitions to address the lack of consistency found in studies that identify themselves as AR/VR when they are using less immersive technical set-ups, including displaying non-interactive videos on 2D screens

Older Adult's Digital Health Technology Acceptance

Older Adult's Digital Health Technology Acceptanc

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Resumen tomado del autor. Resumen en castellano e inglésEl conocimiento científico de la educación se construye, entre otros, desde tres pilares: la Filosofía de la Ciencia, la Sociología de la Ciencia y la Historia de la Ciencia. Ésta última consta de dos clases de Historia de la Ciencia: la tradicional, hoy cuestionada, y la moderna Historia de la Ciencia. Se analizan los factores que potenciaron el cambio y se da cuenta de los métodos con los que la moderna Historia de la Ciencia se desarrolla.AsturiasBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Cognitive functioning in persons with lower limb amputations: A review

Purpose. To review the literature on cognitive functioning in persons with lower limb amputations. Method. A search of the MEDLINE, PsycINFO and Web of Science databases was carried out. Results. Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation. Conclusions. These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients’ strengths so that maximal mobility and independence is achieve

Cognitive functioning in persons with lower limb amputations: A review

Purpose. To review the literature on cognitive functioning in persons with lower limb amputations. Method. A search of the MEDLINE, PsycINFO and Web of Science databases was carried out. Results. Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation. Conclusions. These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients’ strengths so that maximal mobility and independence is achieve

Applying the ‘Human Rights Model of Disability’ to Informed Consent: Experiences and Reflections from the SHAPES Project

Understanding the complexity of informed consent processes is critically important to the success of research that requires participants to test, develop, or inform research data and results. This is particularly evident in research involving persons experiencing neurodegenerative diseases (e.g., Alzheimer’s disease, dementia) that impair cognitive functioning, who according to national law are considered to have a diminished capacity, or to lack the capacity, to consent to research participation. Those who would potentially benefit most from applied research participation may be excluded from participating and shaping data and outcomes. This article offers insights into challenges faced by the Smart and Healthy Ageing through People Engaging in Supportive Systems (SHAPES) Project in obtaining the consent of older persons, including older persons with disabilities. The promotion of continuing health, active ageing, and independent living is central to SHAPES, requiring project partners to reflect on traditional informed consent approaches to encourage the full, cognisant participation of older persons with disabilities. We examine how this issue may be addressed, with reference to the inclusive approach of SHAPES. In respecting the inalienable legal capacity of all legal persons, SHAPES uses the UN Convention on the Rights of Persons with Disabilities (CRPD) and the human rights model of disability as part of the theoretical framework. A novel, inclusive, representative informed consent framework was designed and is detailed herein. This framework provides significant opportunity to advance the inclusion of persons with disabilities or those experiencing neurodegenerative diseases in innovative research and is readily transferable to other research studies. The SHAPES approach is a substantial contribution to research on informed consent, demonstrating the utility of the human rights model of disability in facilitating the full research participation of target populations