Seeing Relief: Mirror Box Therapy as a Treatment for Chronic Regional Pain Syndrome

In collaboration with an occupational therapist who works in a physical therapy private practice as a hand therapist, the following clinical questions were identified: Is mirror box therapy (MT) effective in reducing pain for patients with complex regional pain syndrome (CRPS); secondary to orthopedic injury or peripheral nerve damage in the upper extremity (UE)? What protocols and dosages are the most effective? A structured review of the literature identified 18 studies that focus on the use of MT for CRPS of the UE: one meta-analysis of systematic reviews, five systematic reviews (SR) and 12 individual studies of which four are not reviewed in the SRs. Research regarding the use of MT for CRPS shows positive effects on outcomes for pain reduction with CRPS Type I, both acute and chronic, and emerging evidence for increased functional use, sensation and decreased swelling. However, currently, evidence is considered of low quality due to small sample sizes and replication by the same research group. Protocols are highly variable and sometimes vague, but the most commonly researched protocol has been L. Moseley’s graded motor imagery (GMI) program. The following knowledge translation products were selected in collaboration with the clinician: an in-service for clinicians and educational pamphlet for consumers. The clinician expressed satisfaction with the pamphlet and regret that we could not schedule the in-service. Further research evaluating the effectiveness of the different protocols and dosages available is recommended, as well as describing the experiences of both the clients and clinicians utilizing MT

“We Wait”—The Impact of Character Responsiveness and Self Embodiment on Presence and Interest in an Immersive News Experience

A virtual reality scenario called “We Wait” gives people an immersive experience of the plight of refugees waiting to be picked up by a boat on a shore in Turkey to be illegally taken to Europe, crossing a dangerous stretch of sea. This was based on BBC news reporting of the refugee situation, but deliberately depicted as an animation with cartoon-like characters representing the refugees. Of interest was the level of presence that might be experienced by participants and the extent to which the scenario might prompt participants to follow-up further information about the refugee crisis. By presence we refer to both Place Illusion, the illusion of being in the rendered space, and Plausibility, the illusion that the unfolding events were really happening. The follow-up was assessed by whether and when participants accessed a web page that contained further information about the refugee crisis after the experiment. Two factors were considered in a balanced between-groups design with 32 participants. The Responsiveness factor was either “None” or “Look at.” In the first the virtual characters in the scenario never responded to actions of the participant, and in the second they would occasionally look at the participant after the participant looked at them. The second factor was Embodiment, which was either “No Body” or “Body.” In the No Body condition participants had no virtual body, and in the Body condition they would see a virtual body spatially congruent with their own if they looked down toward themselves. The virtual body was animated by the head tracking move the upper body. The results showed that the major factor positively contributing to presence was Responsiveness (“Look at”), and that Embodiment (“Body”) may have contributed but to a lesser extent. There were important differences between men and woman in the degree of follow-up, with men more likely to do so than women. The experiment shows that adding in some simple responses in an immersive journalism scenario, where the characters acknowledge the presence of the participant through gaze, can enhance the degree of presence felt by the participants

Virtually Being Lenin Enhances Presence and Engagement in a Scene From the Russian Revolution

Virtual Reality (VR) has been widely applied to cultural heritage such as the reconstruction of ancient sites and artifacts. It has hardly been applied to the reprise of specific important moments in history. On the other hand immersive journalism does attempt to recreate current events in VR, but such applications typically give the viewer a disembodied non-participatory role in the scene of interest. Here we show how VR was used to reconstruct a specific historical event, where a famous photograph was brought to life, showing Lenin, the leader of the 1917 October Russian Revolution, giving a speech to Red Army recruits in Moscow 1920. We carried out a between groups experimental study with three conditions: Embodied—where the participant was first embodied as Lenin and then later in the audience watching Lenin; Included—where the participant was not embodied as Lenin but was embodied as part of the audience; and Observing—where the participant mainly viewed the scene from a disembodied third person point of view. Twenty participants were assigned to each of the three conditions in a between-groups design. We found that the level of presence was greatest in the Embodied and Included conditions, and that participants were least likely to later follow up information about the Russian Revolution in the Observing condition. Our conclusion is that if the VR setup allows for a period of embodiment as a character in the scenario then this should be employed in order to maximize the chance of participant presence and engagement with the story

Priority species to support the functional integrity of coral reefs

Ecosystem-based management on coral reefs has historically focussed on biodiversity conservation through the establishment of marine reserves, but it is increasingly recognised that a subset of species can be key to the maintenance of ecosystem processes and functioning. Specific provisions for these key taxa are essential to biodiversity conservation and resilience-based adaptive management. While a wealth of literature addresses ecosystem functioning on coral reefs, available information covers only a subset of specific taxa, ecological processes and environmental stressors. What is lacking is a comparative assessment across the diverse range of coral reef species to synthesise available knowledge to inform science and management. Here we employed expert elicitation coupled with a literature review to generate the first comprehensive assessment of 70 taxonomically diverse and functionally distinct coral reef species from microbes to top predators to summarise reef functioning. Although our synthesis is largely through the lens of the Great Barrier Reef, Australia, a particularly data-rich system, it is relevant to coral reefs in general. We use this assessment to evaluate which taxa drive processes that maintain a healthy reef and whether management of these taxa is considered a priority (i.e. are they vulnerable?) or is feasible (i.e. can they be managed?). Scientific certainty was scored to weight our recommendations, particularly when certainty was low. We use five case studies to highlight critical gaps in knowledge that limit our understanding of ecosystem functioning. To inform the development of novel management strategies and research objectives, we identify taxa that support positive interactions and enhance ecosystem performance, including those where these roles are currently underappreciated. We conclude that current initiatives effectively capture many priority taxa but that there is significant room to increase opportunities for underappreciated taxa in both science and management to maximally safeguard coral reef functioning

Embodying compassion: A virtual reality paradigm for overcoming excessive self-criticism

Virtual reality has been successfully used to study and treat psychological disorders such as phobias and posttraumatic stress disorder but has rarely been applied to clinically-relevant emotions other than fear and anxiety. Self-criticism is a ubiquitous feature of psychopathology and can be treated by increasing levels of self-compassion. We exploited the known effects of identification with a virtual body to arrange for healthy female volunteers high in self-criticism to experience self-compassion from an embodied first-person perspective within immersive virtual reality. Whereas observation and practice of compassionate responses reduced self-criticism, the additional experience of embodiment also increased self-compassion and feelings of being safe. The results suggest potential new uses for immersive virtual reality in a range of clinical conditions.N/

Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study

BACKGROUND: Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS: A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS: 159 caregivers (60.5 yrs ± 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION: Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses

Chapter 5 Priority Species to Support the Functional Integrity of Coral Reefs

Ecosystem-based management on coral reefs has historically focused on biodiversity conservation through the establishment of marine reserves, but it is increasingly recognised that a subset of species can be key to the maintenance of ecosystem processes and functioning. Specific provisions for these key taxa are essential to biodiversity conservation and resilience-based adaptive management. While a wealth of literature addresses ecosystem functioning on coral reefs, available information covers only a subset of specific taxa, ecological processes and environmental stressors. What is lacking is a comparative assessment across the diverse range of coral reef species to synthesise available knowledge to inform science and management. Here we employed expert elicitation coupled with a literature review to generate the first comprehensive assessment of 70 taxonomically diverse and functionally distinct coral reef species from microbes to top predators to summarise reef functioning. Although our synthesis is largely through the lens of the Great Barrier Reef, Australia, a particularly data-rich system, it is relevant to coral reefs in general. We use this assessment to evaluate which taxa drive processes that maintain a healthy reef, and whether or not management of these taxa is considered a priority (i.e. are they vulnerable?) or is feasible (i.e. can they be managed?). Scientific certainty was scored to weight our recommendations, particularly when certainty was low. We use five case studies to highlight critical gaps in knowledge that limit our understanding of ecosystem functioning. To inform the development of novel management strategies and research objectives, we identify taxa that support positive interactions and enhance ecosystem performance, including those where these roles are currently underappreciated. We conclude that current initiatives effectively capture many priority taxa, but that there is significant room to increase opportunities for underappreciated taxa in both science and management to maximally safeguard coral reef functioning

Evidence for increases in vegetation species richness across UK Environmental Change Network sites linked to changes in air pollution and weather patterns

We analysed trends in vegetation monitored at regular intervals over the past two decades (1993–2012)at the twelve terrestrial Environmental Change Network (ECN) sites. We sought to determine the extent to which flora had changed and link any such changes to potential environmental drivers. We observed significant increases in species richness, both at a whole network level, and when data were analysed within Broad Habitat groupings representing the open uplands, open lowlands and woodlands. We also found comparable increases in an indicator of vegetation response to soil pH, Ellenberg R. Species characteristic of less acid soils tended to show more consistent increases in frequency across sites relative to species with a known tolerance for strongly acidic soils. These changes are, therefore, broadly consistent with a response to increases in soil solution pH observed for the majority of ECN sites that, in turn, are likely to be driven by large reductions in acid deposition in recent decades. Increases in species richness in certain habitat groupings could also be linked to increased soil moisture availability in drier lowland sites that are likely to have been influenced by a trend towards wetter summers in recent years, and possibly also to a reduction in soil nitrogen availability in some upland locations. Changes in site management are also likely to have influenced trends at certain sites, particularly with respect to agricultural practices. Our results are therefore indicative of wide-scale responses to major regional-scale changes in air pollution and recent weather patterns, modified by local management effects. The relative consistency of management of ECN sites over time is atypical of much of the wider countryside and it is therefore not appropriate to scale up these observations to infer national scale trends. Nevertheless the results provide an important insight into processes that may be operating nationally. It will now be necessary to test for the ubiquity of these changes using appropriate broader spatial scale survey data