Therapeutic Sessions Research Articles

HIPPOTHERAPY OF CHILDREN WITH DOWN SYNDROME: DIFFICULTIES, RECOMMENDATIONS FOR WORK

There are many forms of therapy for children with Down syndrome. Among them, hippotherapy is gaining more and more scientific recognition in Poland. Hippotherapy represents an alternative form of rehabilitation, with a key link being an adequately trained horse. The major benefit of hippotherapy is a broad spectrum of effect. It is important for the rehabilitation of people with Down syndrome that hippotherapy offers great opportunities to stimulate physical, cognitive, sensory and verbal areas. Its effect on social functioning of the individual is also substantial. Attractive forms of the therapeutic sessions, positive results of hippotherapeutic effects and the increasing popularity represent the motivation for both practitioners and scholars for organization of knowledge and limitation of scepticism about this field of science. This paper presents author’s observations collected over many years of work as a hippotherapist with people with disabilities. It is aimed to bring closer the aspect of using hippotherapy in the work with children with Down syndrome. The paper also stresses the difficulties and methods to overcome them. It identifies the risks and the observed successes.

Discursive psychology as a method of analysis for the study of couple and family therapy.

The field of couple and family therapy has benefitted from evidence generated from qualitative approaches. Evidence developed from approaches relying on language and social interaction using naturally occurring recordings of real-world practice has the benefit of facilitating practice-based recommendations and informing practice. The aim of this article is to provide an overview of one approach to discourse analysis, Discursive Psychology (DP), demonstrating how a social constructionist framework and focus on discourse can provide an important contribution to the field of therapy. To illustrate the methodological decision-making process for researchers and/or practitioners who utilize DP, we draw upon a video-recorded therapeutic session involving Tom Andersen. To conclude, we make recommendations for practitioners using DP to explore and examine therapeutic practice.

Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy.

In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires—to assess UI, we used the King’s Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.

Functional Analytic Psychotherapy Enhanced Behavioral Activation for Depression: A Concurrent and Non-Concurrent Between-Participants Study

Functional analytic psychotherapy enhanced behavioral activation (FEBA) is a therapeutic approach that combines strategies from behavioral activation and functional analytic psychotherapy to improve therapeutic outcomes in clients who lack stable sources of reinforcement in their natural environments. In FEBA, therapists modify clients’ behaviors within the therapeutic session and simultaneously change clients’ environmental conditions in their natural contexts. A concurrent and nonconcurrent multiple-baseline design between participants was conducted. Four participants—2 men and 2 women—who reported depressive symptoms were independently treated in a psychological services center by 2 male therapists. FEBA increased the frequency of healthy behaviors (e.g., engaging in meaningful conversations with friends) in session and out of session. However, depressive behaviors in therapeutic and natural settings did not show stable changes. The implications for implementing some of the results of this study with clients with depression are discussed. Methodological recommendations for using FEBA with specific populations and in other contexts are also presented.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial.

ObjectivesThe esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS).Material and MethodsForty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests.ResultsTG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT.ConclusionThere were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

The Influence of Exercise Dosing on Outcomes in Patients With Knee Disorders: A Systematic Review.

Study Design Systematic review. Background Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear. Large variations exist in exercise prescription, and research related to specific dosing variables for knee osteoarthritis, patellar tendinopathy, and patellofemoral pain is sparse. Objectives To identify specific doses of exercise related to improved outcomes of pain and function in individuals with common knee disorders, categorized by effect size. Methods Five electronic databases were searched for studies related to exercise and the 3 diagnoses. Means and standard deviations were used to calculate effect sizes for the exercise groups. The overall quality of evidence was assessed using the Physiotherapy Evidence Database scale. Results Five hundred eighty-three studies were found after the initial search, and 45 were included for analysis after screening. Physiotherapy Evidence Database scale scores were "fair" quality and ranged from 3 to 8. For knee osteoarthritis, 24 total therapeutic exercise sessions and 8- and 12-week durations of exercise were parameters most often associated with large effects. An exercise frequency of once per week was associated with no effect. No trends were seen with exercise dosing for patellar tendinopathy and patellofemoral pain. Conclusion This review suggests that there are clinically relevant exercise dosing variables that result in improved pain and function for patients with knee osteoarthritis, but optimal dosing is still unclear for patellar tendinopathy and patellofemoral pain. Prospective studies investigating dosing parameters are needed to confirm the results from this systematic review. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(3):146-161. Epub 10 Jan 2018. doi:10.2519/jospt.2018.7637.

Effect of Stuttering Intervention on Depression, Stress and Anxiety among individuals with Stuttering: Case Study

Previous literature has reported that stuttering is linked with lowered life quality across a wide range of domains such as vitality, social presentation, significant risks of social anxiety disorder and emotional functioning. The aim of the present study was to assess the status of the psychological variables mainly depression, anxiety and stress in two clients diagnosed with stuttering, who had attended regular intensive therapeutic sessions. Both of them exhibited negative emotional states regarding their problem and were feeling highly stressed due to stuttering. The severity of stuttering was assessed using Stuttering Severity Scale (SSI-4) and negative emotional states of depression, anxiety and stress were measured by DASS (Depression Anxiety Stress Scale) in two stages i.e. preand post-stuttering intervention. The outcome of the present study revealed reduction in depression, anxiety and stress after stuttering therapy. The finding of the present study highlighted on the fact that evidence based stuttering therapy techniques must be followed and implemented during the therapeutic sessions based on the client’s severity of stuttering. This study also proves very strong correlation between speech behavior and emotional aspects among stutterers. The findings also showed that intensive stuttering modification therapy techniques can be effective in reducing severity of stuttering as well as reducing the psychological issues such as depression, stress, anxiety and attitude due to stuttering; thus improving quality of life in persons with stuttering.

The effectiveness of cognitive therapy on quality of life in patients with type II diabetes

Context: Patients with diabetes face various physical and psychological problems such as depression, anxiety, disability, low mobility and obesity leading eventually to decrease quality of life. As a result, life quality is so important about diabetes and its treatment. Aims: The aim of this study was to determine the effectiveness of cognitive therapy on quality of life in patients with diabetes. Subjects and Methods: The research method was semi-experimental with pretest/posttest/follow-up and control group design. The population of the research were included all patients with type II diabetes who were referred to the Diabetes Clinic of Ganjavian Hospital. The sample volume included 40 subjects and an available sampling method was applied. Moreover, the substitution between control group and experimental group was randomly implemented. To collect the data, diabetes quality of life questionnaire was used. The intervention group has been received therapeutic sessions, and the control group was in waiting list. Data were collected through questionnaire of quality of life. Results: The results of the covariance analysis showed that cognitive therapy improved the quality of life in the experimental group in the posttest and follow-up stage (P

Psicodrama interno no tratamento de traumas: direcionadores de manejo

Internal psychodrama is one of the intervention techniques used in situations of high emotional tension and in simple or complex traumatic events, it has been shown to be safer in preventing re-traumatization than the classic dramatization itself. Depending on the development of the therapeutic session, other techniques can be integrated in the intervention. This article aims to present the handling drivers of the internal psychodrama in traumatic situations and its theoretical fundaments based on recent neuroscience and empirical knowledge of clinical practice researches.

Active hip orthosis for assisting the training of the gait in hemiplegics

The gait restoration is a significant component of the rehabilitation of patients with hemiplegia after central nervous system lesion. The typical symptom of the disability is the lack of hip extension during the stance phase and hip flexion during the swing phase of the affected leg; therefore, asymmetry and perturbed balance while walking. We developed a new modular orthosis for assisting hip flexion and extension during the therapeutic sessions of the gait in hemiplegic individuals based on thorough analysis of the gait characteristics of normal gait. The system is designed to fit into the powered postural controller Walkaround?. The system is developed based on the estimation of torque and power requirement for the gait at speeds up to 1.1 m/s. The model used for the simulation is a known double pendulum in the sagittal plane. The kinematics and dynamics used as the input for the simulation have been recorded in the gait laboratory with eight cameras and force platforms. The system needs to be clinically evaluated before it possibly can be turned into innovation.

Effect of Repeated Sessions of Transcranial Direct Current Stimulation on Functional Balance in Parkinson’s Disease: A Pilot Randomized Controlled Study

Background: Trans cranial direct current stimulation is a new treatment for neuromodulation and in several studies showed positive effect on Parkinson's disease especially motor symptoms. The aim of this study was to assess additive effects of consecutive sessions of tDCS on functional balance in patients with PD. Method: In this pilot randomized double blind parallel study, 23 patients with Parkinson’s disease (PD) divided in two groups of real Trans Cranial Direct Current Stimulation plus occupational therapy and sham Trans Cranial Direct Current Stimulation plus occupational therapy and the effects of therapeutic sessions (8 sessions Trans Cranial Direct Current Stimulation with 0.6 mA/cm2 current, 20 minute on dorsolateral prefrontal cortex ) were evaluated on balance just after therapeutic course and in 3 months follow-up. Results: There was no significant time-Group interaction in any time point showing that behavior of experimental and sham groups didn’t differ regarding changes in BBS (df=1.44, F=0.91, p=0.38). Conclusion: Based on the results of the present study there is no significant effect of tDCS on functional balance in patients with PD at any time point.

Experimental study of person-centered psychotherapy in somatogenic disorders treatment (A study of chronic gastrointestinal diseases)

This article touches upon the problem of Person-centered psychotherapy in the treatment of specific psycho-emotional problems caused by chronic physical illnesses. The study involved the patients with chronic diseases of gastroenterological spectrum on the exacerbation stage. Total sample size was 144 people: 85 females (59.09%) and 59 males (40.01%) at the age from 24 to 59 y. The average duration of therapy ranged from 15 to 20 hours. A separate group of patients (15 people) were treated with medications prescribed by a psychiatrist in accordance with psychopathological report taking into account the basic diagnosis (anxiolytic, sedative, nootropic, anti-depressants). Methods. At the sample selection and the final stages the MMPI, M. Luscher Colour Test and L. Szondi Test were applied. Before and after each therapeutic session express-diagnostics via SAM- techniques (self-esteem, activity, mood), in form of personal semantic differential was applied. Results and conclusions. The most significant results in terms of clinical features (health, strengthening, stress reduction, reduction of scales’ peaks, indicating the severity of the reactive state, positive dynamics of the lab tests, etc.) have been observed in the group of patients receiving concomitant (psychological, pharmacological and nosology-oriented) therapy. It may be assumed that various psychotherapeutic approaches should be considered as subsidiary, rather than principal, means of chronic illness treatment. Psychological methods proper would be useful for emotional abreaction, switching attention from the dominant physical suffering to the patient's personal resources, as well as self-presentation processes.

Addiction to Video Games: A Case Study on the Effectiveness of Psychodynamic Psychotherapy on a Teenage Addict Struggling with Low Self-Esteem and Aggression Issues

The present case study focused on a 14 years old teenager who struggled with addiction to computer games and subsequent issues of aggression and social withdrawal. Drawing from theories on addiction, self-esteem, and mentalization, we focused the connection of addiction to low self-esteem and poor mental representations. In addition, we examined the effectiveness of psychodynamic psychotherapy on treating addiction improving levels of self-esteem and alleviating aggressive behaviour over a course of two and a half years. Indeed, the use of a combination of three projective tests, namely the Thematic Apperception Test, the Kinetic Family Drawing, the Family Apperception Test and the Rosenberg Self-Esteem Scale helped us determine our patient’s emotional state and lack of self-esteem at the beginning of therapy. The same tests were administered at the end of the therapeutic sessions and the results are discussed in relation to the progress of the patient over the course of the therapy.

Moving closer. A Conversation Analytic Perspective on how a Psychotherapeutic Dyad Works on Closing their Encounters

This pilot study analyzes a blank space of research: How is the actual therapeutic session closed and how do single closings contribute to the over-all process of therapy? Data corpus is a completely transcribed single short-term psychodynamic psychotherapy. All 28 closing sequences were fully analyzed with Conversation Analysis. The over-all structure of therapy is unfolded in closings in three ways: i) as a joint activity with ‘audible’ steps, describable as scheme of closing, ii) as alignment organization that reveals three closing types: compact, stretched and commented closings. (These types can be seen as manifest realizations of an implicit communicative problem, the coda dilemma: How to close a session with open topics?) And iii) thirdly, therapist and patient typically display their interactional affiliation towards the therapeutic process with joint evaluation of therapeutic help (JETH). Clinical relevant learnings of this study are: i) closing section is to be unilaterally initiated by the therapist while the patient actively suppresses open topics, ii) therapist has deontic authority only and his action is subject to approval, iii) psychotherapeutic dyad establishes a social relationship by projecting closing and iv) therapy is co-actively and locally produced when expansions after closings are taken as a comment on the therapeutic situation.

Intervención psicoterapéutica integrativa en un caso de celotipia

El presente estudio tiene como objetivo mostrar la intervención en un caso de celotipia desde un enfoque integrativo de técnica de orientación y teórica amplia, donde se conjuntan los enfoques cognitivo– conductual y psicodinámico. El diagnóstico se efectuó utilizando técnicas de ambos enfoques; se incluyeron las pruebas proyectivas Machover y Test de la figura bajo la lluvia y el cuestionario de esquemas mal adaptativos, así como el Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-V (APA, 2013). Se efectuaron 30 sesiones terapéuticas, y se encontraron factores psicógenos que explican la aparición y mantenimiento de síntomas celotípicos. Se realizó la intervención, integrando ambas corrientes al servicio del paciente con resultados positivos, y se consiguió la remisión de la mayoría de los síntomas reportados e inferidos y la toma de conciencia de las causas subyacentes de su celotipia, así como la detección de las cogniciones que la mantenían.

Endoscopic Therapy with Argon Plasma for Radiation Proctitis: Factors Associated to the Number of Therapeutic Sessions

Introduction Radiation proctitis appears as a result of radiotherapy Argon plasma therapy APC is an option for its treatment Objective To describe the results of APC therapy on the radiation proctitis and factors associatedto the number of sessions to achieve resoluteness of bleeding Method An observational study was performed in patients who suffering from radiaton proctitis and rectorrhaegy who received a treatment with APC untill cessation of bleeding and the improvement of their haemoglobin and later follow up treatment to and months of it in the endoscopy Unit from to Values of mean and percentage were calculated different statistical tests were used to evaluate association between some variables Results The mean age was range years female group and cervix cancer predominated in and patients with a mean of radiation sessions range and a mean of months range to start post radiation bleeding sick had severe bleeding The mean hemoglobin was g dl to and cases required transfusion Grade C of proctitis le cm of extension and le of mucosa affected were prevailed in and cases respectively of cases had friability The mean therapeutic sessions to resolution of bleeding was range Mean hemoglobin after APC therapy increased to p lt A higher number of therapeutic sessionswas associated with the highest percentage of affected circumferential mucosa p Proctalgia was found in patients Conclusion APC is a good therapy for radiation proctitis with resolution of bleeding and the improvement of haemoglobin using less therapeutic sessions and few complications The highest percentage of mucosa circumferentially affected with lesions influences the need to apply a greater number of therapeutic sessions

Maltreated Children Use More Grammatical Negations

Many studies reveal a strong impact of childhood maltreatment on language development, mainly resulting in shorter utterances, less rich vocabulary, or a delay in grammatical complexity. However, different theories suggest the possibility for resilience—a positive adaptation to an otherwise adverse environment—in children who experienced childhood maltreatment. Here, we investigated different measures for language development in spontaneous speech, examining whether childhood maltreatment leads to a language deficit only or whether it can also result in differences in language use due to a possible adaptation to a toxic environment. We compared spontaneous speech during therapeutic peer-play sessions of 32 maltreated and 32 non-maltreated children from the same preschool and equivalent in gender, age (2 to 5 years), home neighborhood, ethnicity, and family income. Maltreatment status was reported by formal child protection reports, and corroborated by independent social service reports. We investigated general language sophistication (i.e., vocabulary, talkativeness, mean length of utterance), as well as grammatical development (i.e., use of plurals, tense, grammatical negations). We found that maltreated and non-maltreated children showed similar sophistication across all linguistic measures, except for the use of grammatical negations. Maltreated children used twice as many grammatical negations as non-maltreated children. The use of this highly complex grammatical structure shows an advanced linguistic skill, which shows that childhood maltreatment does not necessarily lead to a language deficit. The result might indicate the development of a negativity bias in the structure of spontaneous language due to an adaptation to their experiences.

Aesthetic Diagnosis in Gestalt Therapy.

The diagnostic process in psychotherapy using the aesthetic evaluation is described in this article. Unlike the classical diagnostic process, which presents a result of comparing clinicians´ observations with a diagnostic system (DSM, ICD, etc.), the aesthetic evaluation is a pre-reflexive, embodied, and preverbal process. A Gestalt Therapy theoretical frame is used to introduce a concept of the aesthetic diagnostic process. During this process, the clinicians use their own here-and-now presence, which takes part in the co-creation of the shared relational field during the therapeutic session. A specific procedure of the aesthetic evaluation is introduced. The clinical work with depressed clients is presented to illustrate this perspective.

Support for students with spelling disorders in Poland, in students’ and parents’ perception

The aim of the study was to analyze how students with spelling disorders use the therapeutic systems offered in Poland, in opinions of themselves and their parents. Two questionnaires were developed, one for parents and one for children with spelling disorder. 621 parents and their 621 children with that disorder participated in the study (online reviews). Almost a half of the group attended therapeutic sessions at their schools and half of them had sessions at psychological-pedagogical counseling centers or other public or private education institutions (typically once a week). Almost half of the group trained their spelling abilities at home with different exercise books with spelling and also reading exercises (twice a week). Only 35 persons had any forms of therapy at all. Available therapeutic methods are not enough effective, interesting, attractive for their users and don’t motivate to work. 84% of study participants need new therapeutic methods. Keywords: Spelling disorder, therapy, home practice.

Pratiques impactant la qualité de l’air intérieur du domicile de l’enfant asthmatique

BackgroundIndoor air pollution can worsen asthma in children. Better knowledge of factors determining parents’ reception of recommendations to limit pollution of indoor air in the homes of asthmatic children would be helpful to improve implementation. MethodA descriptive study evaluating practices known to have an impact on the quality of air in homes was conducted among parents of asthmatic children aged 3 to 16 years. From May to September 2013, parents answered anonymous self-administered questionnaires in waiting rooms of generalist practitioners, in the Nantes University pneumology pediatric outpatient clinic, and as part of therapeutic education sessions conducted by the Asthma-44 Network. ResultsThere were 190 exploitable questionnaires: 88.2% of parents reported never smoking in the home; 48.4% used home fragrance in the living room at least once a week; 77.8% opened their children's bedroom windows more than 10minutes at least once a day; 32.6% used several cleaning products or bleach once or twice a week. Good practices concerning smoking in housing were applied less in homes where the child was monitored only by a general practitioner (OR=0.08; CI[0.02–0.34]). Good practices on the use of perfume were statistically linked to having an intermediate level occupation (OR=2.31; CI[1.01–5.32]) and being followed by the university hospital, by the asthma network or by a general practitioner if the child had already consulted a pneumo-pediatrician or an allergist (OR=0.24; CI[0.07–0.81]). Good ventilation practices forchildren's bedrooms were statistically linked to residing in a rural rather than urban setting (OR=4.72; CI[1.0–22.16]). ConclusionPractices observed in parents of asthmatic children differ little from those of the general population. Recommendations on how to limit sources of chemical pollutants, with the exception of smoking, are still poorly applied. Specialist consultations and specific training for general practitioners should improve the penetration of public health messages to this vulnerable population.