Impaired Insight Research Articles

A hospital-based cohort study on risk factors for diabetic retinopathy among patients with type 2 diabetes mellitus

IntroductionDiabetic retinopathy (DR) is caused by microvascular complications due to high blood sugar in patients with diabetes mellitus and results in severe sight impairment. ObjectiveTo identify the prevalence of DR and its associated risk factors among patients of working age with type 2 DM (T2DM) at Khulna Chokkhu Hospital, Khulna, Bangladesh. Materials and methodsA hospital-based cross-sectional study was conducted in 320 patients with T2DM using a random sampling technique. Semi-structured questionnaires, document reviews, and physical examinations were used to collect the data. Logistic regression and receiver operating characteristic curve analyses were used to identify associations between the severity of DR and socio-demographic and physiological risk factors. ResultsAmong the 320 participants in this study, all of whom were suffering from T2DM, the mean age was 50.05 ± 8.6 years and DR was detected in 94 patients (29.4%). The risk factors identified for DR were age (odds ratio [OR] = 1.184), body mass index (OR = 2.067), systolic blood pressure (OR = 1.112), diastolic blood pressure (OR = 1.224), fasting blood glucose (OR = 2.694), 2 h after breakfast sugar test (OR = 2.396), hemoglobin A1c (OR = 18.759), total cholesterol (OR = 9.213), triglycerides (OR = 7.749), low-density lipoprotein cholesterol (OR = 5.485), high-density lipoprotein cholesterol (OR = 16.728), serum creatinine (OR = 1.929), and duration of DM (OR = 1.170), as these risk factors were found to be significantly associated with DR (p < 0.05). Conclusion and recommendationThe identification of risk factors associated with DR in patients with T2DM is clinically significant, as it reveals that self-management of DM can reduce the complications of DR.

Residual or re-emergent impaired insight into delusions following remission is unrelated to later relapse during a randomized clinical trial of continuation pharmacotherapy for psychotic depression – The STOP-PD II Study

BackgroundImpaired insight into delusions is associated with a lower probability of remission of psychotic depression, independent of illness severity. The relationship between participant characteristics and impaired insight into delusions in remitted psychotic depression, and whether impaired insight is associated with risk of relapse of psychotic depression during continuation pharmacotherapy were examined. MethodsData were analyzed from 126 participants in the STOP-PD II study who experienced sustained remission of psychotic depression during 8-week stabilization treatment with sertraline plus olanzapine and were then randomized to 36 weeks of continuation treatment with sertraline plus either olanzapine or placebo. Insight into delusions was assessed with the Resolution of Delusions Scale (RODS). Linear regression analyses examined the associations between participant characteristics and insight into delusions. Cox proportional-hazards models examined whether i) change in RODS during stabilization treatment; or ii) RODS at the end of stabilization treatment predicted risk of relapse during 36 weeks of continuation treatment. ResultsSeverity of psychosis before initiation of treatment was the only participant characteristic associated with the change in insight during stabilization treatment. Neither change in insight during stabilization treatment nor insight at the end of stabilization treatment was associated with risk of relapse. LimitationsInsufficient statistical power and the lack of variability in RODS scores at the time of randomization may have contributed to the absence of a relationship between RODS and risk of relapse. ConclusionResidual or reemergent insight impairment following acute treatment does not preclude patients from sustaining remission of psychotic depression in a randomized placebo-controlled trial.

Being seen: The lived experience of psychodynamic practitioners disclosing or not disclosing sight impairment

ABSTRACT The taboo of therapist self-disclosure and literature addressing disclosure and disability issues from a psychodynamic perspective is explored. Research on disclosure decisions among physically impaired practitioners is limited. Interpretative Phenomenological Analysis qualitative research methodology was employed to understand the lived experience of psychodynamic practitioners with sight impairment to understand disclosure decision-making processes in a therapeutic setting. Six participants self-identified as sight impaired psychodynamic practitioners and were interviewed using a semi-structured questionnaire. Findings showed that the experience of working as a practitioner with sight impairment is a tenacious endeavour, requiring high levels of self-awareness and determination in navigating the minefield of self-disclosure, daring to be seen by others, holding the patient’s need to be seen and journeying through loss and acceptance of the changing self. Results showed that there is an inverse relationship between likelihood to self-disclose sight impairment and the extent to which practitioners work with unconscious process and transference. Ultimately, the capacity to reclaim disavowed parts of the self, defined therapists’ ability to make therapeutic disclosure decisions. Suggestions for future research, clinical and ethical implications are provided plus recommendations for impaired practitioners and those who work with difference.

Impaired insight into illness is unrelated to subjective happiness, success, and life satisfaction in schizophrenia.

Impaired insight into illness is a common feature of schizophrenia. Improved insight is associated with better treatment adherence and clinical outcomes. At the same time, improving insight has been suggested to increase depressive symptoms and diminish quality of life. The aim of this study was to examine the associations between impaired insight and degree of subjective happiness, perceived level of success, and life satisfaction in patients with schizophrenia spectrum disorders. A total of 108 participants with schizophrenia or schizoaffective disorder were included. Data for this study were obtained from our group's previous investigation that examined the relationship between impaired insight and visuospatial attention. Insight into illness was measured by the VAGUS scale, which assesses general illness awareness, accurate symptom attribution, awareness of the need for treatment, and awareness of the negative consequences attributable to the illness. Our results revealed no association among the VAGUS average and subscale scores and degree of subjective happiness, perceived level of success, and life satisfaction. Our study suggests that insight into illness is not related to subjective happiness, life satisfaction, or perceived level of success in patients with schizophrenia, which is in contrast to previous reports that demonstrate an association between insight into illness and depression.

I Let Go Now! Towards a Voice-User Interface for Handovers between Robots and Users with Full and Impaired Sight

Handing over objects is a collaborative task that requires participants to synchronize their actions in terms of space and time, as well as their adherence to social standards. If one participant is a social robot and the other a visually impaired human, actions should favorably be coordinated by voice. User requirements for such a Voice-User Interface (VUI), as well as its required structure and content, are unknown so far. In our study, we applied the user-centered design process to develop a VUI for visually impaired humans and humans with full sight. Iterative development was conducted with interviews, workshops, and user tests to derive VUI requirements, dialog structure, and content. A final VUI prototype was evaluated in a standardized experiment with 60 subjects who were visually impaired or fully sighted. Results show that the VUI enabled all subjects to successfully receive objects with an error rate of only 1.8%. Likeability and accuracy were evaluated best, while habitability and speed of interaction were shown to need improvement. Qualitative feedback supported and detailed results, e.g., how to shorten some dialogs. To conclude, we recommend that inclusive VUI design for social robots should give precise information for handover processes and pay attention to social manners.

Investigation of PTC124-mediated translational readthrough in a retinal organoid model of AIPL1-associated Leber congenital amaurosis.

SummaryLeber congenital amaurosis type 4 (LCA4), caused by AIPL1 mutations, is characterized by severe sight impairment in infancy and rapidly progressing degeneration of photoreceptor cells. We generated retinal organoids using induced pluripotent stem cells (iPSCs) from renal epithelial cells obtained from four children with AIPL1 nonsense mutations. iPSC-derived photoreceptors exhibited the molecular hallmarks of LCA4, including undetectable AIPL1 and rod cyclic guanosine monophosphate (cGMP) phosphodiesterase (PDE6) compared with control or CRISPR-corrected organoids. Increased levels of cGMP were detected. The translational readthrough-inducing drug (TRID) PTC124 was investigated as a potential therapeutic agent. LCA4 retinal organoids exhibited low levels of rescue of full-length AIPL1. However, this was insufficient to fully restore PDE6 in photoreceptors and reduce cGMP. LCA4 retinal organoids are a valuable platform for in vitro investigation of novel therapeutic agents.

Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial

BackgroundImpaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia.MethodsIn a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression–Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated.ResultsAmong 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed.ConclusionsIn the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe–severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.

Animism and Magical Thinking: Clinical Review of Dereism

From a clinical viewpoint, dereism can be an evil warning sign, which may hint at disruption of thought organization, damaged reality testing, impaired insight, compromised judgement and serious mental condition. So, in the realm of descriptive psychopathology and phenomenological diagnosis, dereistic thinking or animism, demands, first of all, exclusion of organic problems, like space occupying lesions of brain, and, then, ruling out psychosis, like schizophrenia. On the other hand, dereism can be found in neuroses or personality syndromes, a finding that may indicate its multidimensional connotation. In the present article, while dereism has been appraised from psychoanalytic and cognitive viewpoints, it has been tried to delineate some of its valuable aspects, as well, which may be ignored clinically during routine psychiatric evaluation, counseling or psychotherapeutic approaches.

How Residing in a Long-Term Care Facility Affects Suicidal Risk in Patients With Dementia: A Systematic Review.

This study aims to review the current literature regarding the association between suicide risk in patients aged 65 years or over with dementia residing in long-term care facilities (LTCs). We also evaluate the most common methods of suicide and protective versus risk factors of nursing home (NH) life on suicide behavior in patients with dementia.Following preferred reporting items for systematic reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the relevant free full-text articles found in PubMed, Pub Psych, Cochrane library, and Science Direct up until April 4, 2022. Medical Subject Heading (MeSH) terms and keywords (nursing home, long-term care facility, suicide, self-injurious behavior, dementia), were used to search for full-text randomized clinical trials (RCTs), cross-sectional, case-control, cohort studies, systematic reviews, and studies published in the English language in the last 12 years, focused on human subjects 65 years and older were selected based on predefined eligibility criteria. The search yielded 57,909 articles, of which 12 studies met our inclusion criteria. The articles were subjected to quality appraisal by two reviewers. We used the Newcastle Ottawa scale (NOS) for quality assessment with a mean score of six for 12 observational studies used in this paper.Of the included reports, six were cross-sectional, five were cohort, and one was case-control. Four articles carefully examine the relationship between dementia and suicide, and all confirm the hypothesis that staying in LTCs reduces the risk of suicide in patients with dementia. However, the rest of the articles generally determine a higher risk of suicide in demented patients and describe male gender, non-Hispanic white race, younger age, newly diagnosed with dementia within one-year, mild dementia, comorbidities, depression, previous history of suicidal behavior, low social support and unstable family relationship as the risk factors of suicide in this population. In comparison, extended stay in NHs and other kinds of LTCs, severe dementia with impaired insight, older age, comorbid schizophrenia, physical disability with limitation and more difficulty preparing and executing a suicide plan, positive and robust social relationships, access to professional caregivers and high frequency of visits from relatives marked as the protective factors.Existing research on suicide risk in long-term care facility residents with dementia is limited. However, due to the increase in dementia rates that require people to reside in NHs and on the other hand, considering the multiple risk factors of suicide in the elderly living in such places, the need for a screening system for identifying people at suicide risk and performing preventive therapeutic and behavioral interventions is well felt.

Protective Effects of the Bilobalide on Retinal Oxidative Stress and Inflammation in Streptozotocin-Induced Diabetic Rats.

Diabetic retinopathy (DR) is a diabetes mellitus (DM) complication that causes visual acuity impairment and loss of sight in the working population, mainly in developed countries. According to the WHO, DR accounts for 5% of the world's 37 million blind people. The prevalence of diabetic retinopathy was highest in Africa, followed by North America and the Caribbean and South and Central America. Hyperglycemia can generate excessive ROS that activates multiple pathways, which can damage the cells. Oxidative stress and inflammatory process are intricate in the DR pathological mechanism. Bilobalide is the main bioactive compound isolated from the Ginkgo biloba, a plant utilized in folklore medicine. Bilobalide, a sesquiterpene trilactone, exhibits excellent antioxidant activity. But the molecular mechanisms associated with such effects, especially the antioxidant-related mechanism, have not been documented. Hence, this investigation explored whether bilobalide may attenuate DR in streptozotocin (STZ)-prompted diabetic rats. The effects of bilobalide on parameters of antioxidant content, oxidative stress, and inflammatory factors in the retinal tissues were evaluated by ELISA, RT-PCR, and immunohistochemistry methods. Bilobalide improved caloric management by reducing food consumption and increasing body weight. Furthermore, the administration of bilobalide decreases the blood glucose level and glycosylated (HbA1c) hemoglobin. The anti-retinopathy activity of bilobalide was established by the increase in the total retina thickness (TRT), inner nuclear layer (INL), and outer nuclear layer (ONL) in diabetic rats. Additionally, the serum level of MDA was decreased. In contrast, the antioxidant enzyme (SOD and CAT) levels were increased with TAC plus lower Keap1 and higher Nrf2 expression in the retina when associated with the DM rats. Moreover, bilobalide increased the nuclear factor erythroid 2-related factor 2 (Nrf2) and Heme oxygenase-1 (HO-1) expression level and inflammatory mediators (NF-κβ p65, TNF-α, IL-1β, and VEGF), thus inhibiting oxidative stress. Bilobalide can be effective against DR, and the possible mechanism may be relatively elucidated by decreasing oxidative stress and anti-inflammatory activities. But the further investigation should be directed to expose the precise mechanism.

Visual impairment service review

Aims: To assess the quality of documentation of patients with a visual impairment within a neurosurgery department to see if they have a corresponding vision alert within their medical notes. Methods: Retrospective case note analysis over 3 years of neurosurgical patients diagnosed with a space occupying lesion involving the anterior fossa near the optic apparatus was conducted. Post-surgical clinical assessment validated by formal visual assessment revealed 56 patients had a visual impairment diagnosis. Visual acuity and visual field mean deviations in the best eye were studied, along with the documentation of a vision alert. A total of nine patients did not meet the inclusion criteria and were removed from the study. Results: Out of 47 patients, four were found to have a severe sight impairment. Only 11 (23.40%) patients had a vision alert on their medical records. Out of the 47 patients with a visual impairment, three patients certified as sight impaired and severely sight impaired (75%) did not have a vision alert on their medical record. Conclusions: Although visual impairment was common in this study population, most patients had useful vision. Documentation to alert clinicians and carers about visual impairment was poor and needs improvement.

Efficacy of Transcranial Direct Current Stimulation to Improve Insight in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Impaired insight into the illness and its consequences is associated with poor outcomes in schizophrenia. While transcranial direct current stimulation (tDCS) may represent a potentially effective treatment strategy to relieve various symptoms of schizophrenia, its impact on insight remains unclear. To investigate whether tDCS would modulate insight in patients with schizophrenia, we undertook a meta-analysis based on results from previous RCTs that investigated the clinical efficacy of tDCS. We hypothesize that repeated sessions of tDCS will be associated with insight improvement among patients. PubMed and ScienceDirect databases were systematically searched to identify RCTs that delivered at least 10 tDCS sessions in patients with schizophrenia. The primary outcome was the change in insight score, assessed by the Positive and Negative Syndrome Scale (PANSS) item G12 following active tDCS sessions as opposed to sham stimulation. Effect sizes were calculated for all studies and pooled using a random-effects model. Meta-regression and subgroup analyses were conducted. Thirteen studies (587 patients with schizophrenia) were included. A significant pooled effect size (g) of -0.46 (95% CI [-0.78; -0.14]) in favor of active tDCS was observed. Age and G12 score at baseline were identified as significant moderators, while change in total PANSS score was not significant. Ten sessions of active tDCS with either frontotemporoparietal or bifrontal montage may improve insight into the illness in patients with schizophrenia. The effect of this treatment could contribute to the beneficial outcomes observed in patients following stimulation.

Navigating the Unseen City: Town Planners, Architects, Ophthalmic Professionals, and Charity Opinions on Navigating of the Built Environment with a Visual Impairment.

People with a visual impairment often find navigating around towns and cities difficult. Streetscape features such as bollards, street cafés, and parked cars on pavements are some of the most common issues. in this paper semi-structured interviews were conducted with stakeholders including built environment professionals, visually impaired individuals, ophthalmic professionals, and sight loss charities. All stakeholders felt there were barriers and enablers to navigating streets with a visual impairment. Stakeholders agreed these can have an impact on the daily lives of those with a visual impairment. While built environment professionals knew of policies and guidance around accessibility for people with a visual impairment, there was a lack of professional knowledge about the spectrum of visual impairment. Despite this, stakeholders felt these small changes could have a positive impact, making accessible cities for all. A collaborative approach to streetscape design and further education could help create better environments for all.

Long-term trends in incidence and prevalence of severe sight impairment due to diabetes in South East Scotland before and after implementation of diabetic retinopathy screening

The study set out to examine the impact of the introduction of a national diabetic retinopathy screening programme in Scotland in 2006 on incidence and trends in severe sight impairment (SSI) certification due to diabetes over three decades. We analysed SSI certification due to diabetic eye disease in Fife, Scotland, between 2010 and 2019 and compared it to previously published estimates from 1990 onwards. Population estimates of the general population and those with diabetes were obtained from the National Records of Scotland and the National Diabetes Register, NHS SCI Diabetes, respectively. Mean annual incidence of SSI in the population with diabetes, 1990–2019, before and after the introduction of diabetic retinopathy screening was compared using a Mann–Whitney U Test. Mean incidence in 2007–2019 was 19.8/100,000 and was significantly less than the period before the systematic screening, 1990–2006 (57.5/100,000, p &lt; .001). Mean SSI incidence due to diabetes in Fife between 2010 and 2019 was significantly lower than in the previous decades ( p &lt; .001) at 16.4 per 100,000 for the population with diabetes, per year ( SD 10.0; 95% confidence interval: [9.2, 23.5]) compared to 42.7 per 100,000 in 2000–2009 and 64.3 per 100,000 in 1990–1999. This study demonstrates a significant reduction in the annual incidence of SSI due to diabetes before and after the introduction of the screening programme provides evidence for the benefit of systematic diabetic retinopathy screening programmes. Other factors including improved management of diabetes and risk factors will have also had an impact emphasizing the importance of a multidisciplinary approach to the prevention of sight loss in diabetes.

Mental State of Inpatients With COVID-19: A Computational Psychiatry Approach.

BackgroundThe overload of healthcare systems around the world and the danger of infection have limited the ability of researchers to obtain sufficient and reliable data on psychopathology in hospitalized patients with coronavirus disease 2019 (COVID-19). The relationship between severe acute respiratory syndrome with the coronavirus 2 (SARS-CoV-2) infection and specific mental disturbances remains poorly understood.AimTo reveal the possibility of identifying the typology and frequency of psychiatric syndromes associated with acute COVID-19 using cluster analysis of discrete psychopathological phenomena.Materials and MethodsDescriptive data on the mental state of 55 inpatients with COVID-19 were obtained by young-career physicians. Classification of observed clinical phenomena was performed with k-means cluster analysis of variables coded from the main psychopathological symptoms. Dispersion analysis with p level 0.05 was used to reveal the clusters differences in demography, parameters of inflammation, and respiration function collected on the basis of the original medical records.ResultsThree resulting clusters of patients were identified: (1) persons with anxiety; disorders of fluency and tempo of thinking, mood, attention, and motor-volitional sphere; reduced insight; and pessimistic plans for the future (n = 11); (2) persons without psychopathology (n = 37); and (3) persons with disorientation; disorders of memory, attention, fluency, and tempo of thinking; and reduced insight (n = 7). The development of a certain type of impaired mental state was specifically associated with the following: age, lung lesions according to computed tomography, saturation, respiratory rate, C-reactive protein level, and platelet count.ConclusionAnxiety and/or mood disturbances with psychomotor retardation as well as symptoms of impaired consciousness, memory, and insight may be considered as neuropsychiatric manifestations of COVID-19 and should be used for clinical risk assessment.

Metacognitive insight into cognitive performance in Huntington’s disease gene carriers

ObjectivesInsight is an important predictor of quality of life in Huntington’s disease and other neurodegenerative conditions. However, estimating insight with traditional methods such as questionnaires is challenging and subjected to...

Sensory integration of the tactile sensory system of children with developmental disabilities

Sensory integration is the organization of the senses for their use. It is a neuro-biological activity that allows the reception and processing of sensory information, which in large quantities from the senses come to the brain, at all times. The aim of the study is to examine the prevalence of sensory integration difficulties of the tactile sensory system of children with developmental disabilities, and to establish the statistical significance of differences in relation to the type of difficulty. The total sample of respondents (N=60) consisted of four subsamples of 15 respondents, namely; children with autism, children with Down syndrome, children with hearing impairment and children with sight impairment. The Mann-Whitney U test and the Wilcoxon W test at the level of statistical significance of p&lt;0.05 were used to test the statistical significance of the differences between the subsamples of the subjects. The results of the study show that 86.67% of children with autism, 66.67% of children with Down syndrome, 20% of children with hearing impairment and 40% of children with sight impairment have difficulties with sensory integration of the tactile system. Children with hearing impairment (Rank M 43.97), children with sight impairment (Rank M 35.03), children with Down syndrome, and children with autism (Rank M 14.93) show the least difficulty in sensory integration of the tactile sensory system. There is a statistically significant difference in the difficulties of sensory integration of the tactile sensory system between children with autism, children with Down syndrome, children with hearing impairment and children with sight impairment at the level of statistical significance of p&lt;0.05.

Is preventable sight loss truly preventable? An exploration of a public health indicator for sight loss due to age-related macular degeneration in England

BackgroundAge-related macular degeneration accounts for the majority of severe sight impairment and sight impairment registration and certifications in adults in the UK [1, 2]. Whilst these treatments are effective in arresting nAMD progression, there is currently no treatment for GA [1, 3, 4].MethodsThis paper provides an update to the data collected by Bunce et al. [3] and details the number of people certified together with incidence rates for the various types of AMD by: sex, sight impairment status, and for all ages using the 2016/2017 and 2017/2018 CVI due to AMD data for England from the Moorfields Eye Hospital, supplemented with 2017–2018 PHOF indicator 4.12i/E12a data. The study population includes individuals of all ages in England who were newly certified with visual impairment due to AMD.ResultsBetween 2016 and 2017, CVIs due to AMD totalled to 11,215; between 2017 and 2018, CVIs due to AMD totalled to 10,914. The PHOF indicator 4.12i/E12a assessed showed that overall rates of AMD certifications have steadily declined in England from 131.5 per 100,000 in 2010/2011 to 106.7 per 100,000 in 2017/2018.ConclusionAs treatment is available for nAMD, a reduction in nAMD certifications could be expected; however, growth of the elderly population in England combined with there currently being no treatment available for GA means AMD certification rates should be increasing. Therefore, it is postulated that not all cases of AMD are being certified and registered with some likely going undiagnosed.

A multinational online survey of the goal setting practice of rehabilitation staff with stroke survivors with aphasia

ABSTRACT Purpose Goal setting is an essential rehabilitation activity. However, multidisciplinary rehabilitation staff goal-setting practice with stroke survivors with aphasia and associated training needs are not well understood. Methods We designed, piloted, and conducted a survey of stroke rehabilitation staff in the UK, Australia, Aotearoa New Zealand, Canada, Ireland. Analysis included descriptive statistics, chi-square and Fisher’s exact tests, and qualitative content analysis. Results We received 251 responses from 118 SLTs and 133 non-SLTs. Most reported setting goals with most or all people with aphasia (78%, 197/251); 57% (138/244) rarely or never provided an accessible copy of goals. All disciplines reported significantly less confidence setting goals with people with aphasia than without aphasia (p = 0.012, n = 119). Barriers to goal setting included the communication impairment (especially severe aphasia) and poor insight. Staff described feeling ill-equipped to support people with aphasia in goal setting; only 27% (67/251) had accessed training to do so. Conclusions Rehabilitation staff described involving stroke survivors with aphasia in goal setting but lacked confidence doing so and receive inadequate training and support. Training should target multidisciplinary staff confidence and communication support strategies and resources so that people with aphasia and families are supported as goal-setting partners.

Association between fear of falling and spatial and temporal parameters of gait in older adults: the FIBRA-RJ study.

To evaluate the association between fear of falling (FoF) and spatial and temporal parameters of gait in older adults. This cross-sectional study evaluated 291 clients of a private health care insurance who were over 65years of age and living in the North Zone of Rio de Janeiro City in 2013. FoF was assessed by the Falls Efficacy Scale-International (FES-I-BR), and gait parameters, such as gait speed, cadence, step time, step length, stride length, and variability (standard deviation of stride length), were assessed using GAITRite®. The covariates were age, sex, history of falls, number of medications, cognitive decline, body mass index, and sight impairment. The association between FoF and gait parameters was assessed by linear regression, and the respective 95% confidence intervals (95% CIs) were calculated. The prevalence of FoF was 51.9%. The adjusted analyses showed an association between FoF and the following gait parameters: decreased gait speed, decreased cadence, increased step time, and decreased step and stride length. No association was found between FoF and stridelenght variability. This study suggests that FoF is associated with changes in gait parameters, with the exception of stride length variability. These findings show a need for interventions to reduce FoF in older adults, which is a modifiable factor that is related to gait changes. More studies are needed to elucidate the relationship between FoF and motor control of gait in older adults.