Therapist Interventions Research Articles

Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester.

The objectives of this Perspective paper are to educate physical therapists on their important role in assessing and treating common pregnancy- and delivery-related health conditions and to advocate for their routine inclusion in postpartum care during the fourth trimester. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are 2 examples of musculoskeletal disorders associated with pregnancy and childbirth that can have negative physical, social, and psychological consequences. This paper reviews evidence from 2010 through 2021 to discuss the efficacy of physical therapist intervention in the fourth trimester for PFD and DRA. The role of physical therapy in the United States is compared with its role in other developed nations, with the intent of illustrating the potential importance of physical therapy in postpartum care. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for PFD and DRA; however, physical therapists in the United States currently have a peripheral role in providing postpartum care. Lack of awareness, social stigma, and policy barriers prevent women from receiving physical therapist care. Recommendations are made regarding ways in which physical therapists can increase their involvement in the fourth trimester within their community, stimulate policy change, and promote improved postpartum care practices. This Perspective highlights the valuable role of physical therapist assessment and treatment during the postpartum period for some common musculoskeletal conditions associated with pregnancy and delivery.

The Role of Patient Recovery Expectations in the Outcomes of Physical Therapist Intervention: A Systematic Review.

The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. Evidence supports measuring baseline patient expectations as part of a holistic examination process.

Patients’ and therapists’ experiences of CBT videoconferencing in anxiety disorders

Abstract Cognitive behavioural therapy (CBT) videoconferencing has been demonstrated to be an effective treatment for anxiety disorders and an equal alternative to face-to-face CBT. However, qualitative patient and therapist experiences of CBT videoconferencing have been less researched. Due to COVID-19, mental health services have shifted to remote therapy methods; thus, understanding patient and therapist experiences are crucial to better inform service policies and best practices. The current study focused on patient and therapist experiences of CBT videoconferencing at the Centre for Anxiety Disorders and Trauma (CADAT). Researchers used qualitative content analysis to explore patients’ (n = 54) and therapists’ (n = 15) responses to an online survey. Results yielded four themes: behavioural experiments work well if the problem lends itself to videoconferencing, overall practicalities but some home environment implications, privacy and technical issues, high telepresence and the negative impact on the therapeutic alliance, and COVID-19 influences attitude positively. The findings have clinical implications for CBT videoconferencing, including a need for specific training in assessment and intervention for therapists using videoconferencing. Key learning aims Readers of this paper will be able to: (1) Describe patient and therapist qualitative experiences of CBT videoconferencing. (2) Identify areas to consider when delivering CBT videoconferencing in anxiety disorders. (3) Understand therapist training needs for CBT videoconferencing in anxiety disorders. (4) Inform own service protocols and best practices for the delivery of CBT videoconferencing.

Digital Technology Supports Therapeutic Singing for Cognitive Health & Well being

Given the public health issue of growing cognitive Given the public health issue of growing cognitive impairment and mental health conditions in the United States, there is a need for scalable interventions to improve neurological functioning. Engagement in singing and music interventions has been shown to improve cognitive functioning and support neuroplasticity for those with cognitive impairment. Growing research shows singing is beneficial for many neurological rehabilitation outcomes—from improving cognition to elevating mood and reducing agitation in those with dementia. However, with fewer than 10,000 music therapists nationwide, accessibility to music-based interventions is limited. The SingFit digital platform was designed by music therapists to address this problem by providing a scalable digitized singing intervention for caregivers and therapists to use with those experiencing cognitive impairment. SingFit uses a multidimensional approach to create a therapeutic music session that includes singing, reminiscing, trivia, and guided exercise, which have been shown to improve cognitive function, mood, and social engagement. It is currently being used in 437 long term facilities with a 94.5% average retention rate speaking to its acceptability and feasibility by long term care staff. While empirical research is needed to assess its full clinical utility, SingFit is a promising solution to individuals being treated for cognitive and mood-related symptoms.

A Social Anxiety Mobile-Based Cbt Intervention for College Students and Therapists: Theoretical Framework

A Social Anxiety Mobile-Based Cbt Intervention for College Students and Therapists: Theoretical Framework

A network perspective on marital satisfaction among older couples

It will be helpful for older people to maintain good mental health by improving their marital satisfaction. The present study investigates how the elements of marital satisfaction among older couples are related to each other and reveal the key elements. Four hundred ninety-four older people participated in the study. Marital satisfaction was assessed by the 10-item marital satisfaction subscale of the ENRICH scale. Network analysis was adopted to estimate the network structure of these 10 items and the strength centrality of each item was calculated. The results showed that all edges in the final network were positive. Four edges with the strongest regularized partial correlations appeared between “ leisure activities and spending time together” and “ emotional expression”; “ personality and habits” and “ communication and understanding”; “ economic status and the manner of determining economic affairs” and “ relationship with relatives and friends”; and “ make decisions and resolve conflict” and “ emotional expression.” In addition, “ emotional expression” had the highest node strength value in the network. “ Communication and understanding” and “ views are consistent” had the second and third highest node strength values, respectively. “ Views are consistent” was more central in males than females and was the second central node in male networks. In conclusion, the present study offers a new perspective to deepen the understanding about the internal structure of marital satisfaction among older couples via network analysis. The results might provide potential targets of intervention for social workers or family therapists to greatly improve marital satisfaction among older couples.

Clinical Practice Guidelines for Pelvic Girdle Pain in the Postpartum Population

Background: Pelvic girdle pain (PGP) is defined as pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint. Pelvic girdle pain is common postpartum, may result from pregnancy-related factors, and is a leading cause of disability postpartum. The purpose of this clinical practice guideline is to provide evidence-based recommendations for physical therapist management of PGP in the postpartum population. Key Points: Postpartum individuals may experience PGP beginning during pregnancy, immediately after childbirth, or up to 2 years after delivery. Although most cases of PGP in pregnancy resolve spontaneously, a subset of postpartum individuals may experience persistent pain. Based upon critical appraisal of literature and expert opinion, 23 action statements for risk factors, systems screening, examination, diagnosis, prognosis, theoretical models of care, and intervention for postpartum individuals with PGP are linked with explicit levels of evidence. A significant body of evidence exists to support physical therapist intervention with postpartum clients with PGP to reduce pain and disability. Emerging evidence suggests that further investigation of biopsychosocial factors is warranted, especially factors that influence the development of persistent pain in the postpartum population. Future research is needed in several areas to optimize examination and intervention strategies specific to postpartum individuals and guided by a classification system for PGP that includes elements of pain, movement, and biopsychosocial factors. The authors provide clinical practice guidelines for providing physical therapy to postpartum individuals with PGP.

Therapists' Perspectives: The Impact of COVID-19 on Implementation of Early Intervention Services in Illinois, Florida, and the United Kingdom

As COVID-19 changed daily lives, early intervention therapists in the US and UK continued to provide services to children. This report illustrates the anxiety that therapists and families experienced and the opportunities and challenges of teletherapy. Temporary approval of video intervention sessions provided ways to meet child and family needs while preventing the spread of COVID-19, reaching remote areas, and accommodating those who had been on the waiting list for services. This report provides strategies, recommendations, and reflections advocating the choice of teletherapy services in early intervention.

Interaction Structures in Psychodynamic Psychotherapy for Adolescents

Despite advances in psychotherapy research showing an evidence-base for psychodynamic psychotherapy (PDT) in adolescents, developmentally specific treatment characteristics are under-researched. We aimed to identify interaction structures (IS: reciprocal patterns of in-session interactions involving therapist interventions, patient behaviors, and the therapeutic relationship) and assess associations between IS and outcome. The study cohort comprised 43 adolescents (Mage = 13.02 years) with nonclinical, internalizing, and comorbid internalizing–externalizing problems in PDT. A total of 123 sessions from different treatment phases were rated based on the Adolescent Psychotherapy Q-Set (APQ). Outcome was assessed with the Brief Problem Monitor-Youth (BPM-Y) administered repeatedly over the treatment course. Principal component analysis of APQ items resulted in five IS, named “Negative Therapeutic Alliance”, “Demanding Patient, Accommodating Therapist”, “Emotionally Distant Resistant Patient”, “Inexpressive Patient, Inviting Therapist”, and “Exploratory Psychodynamic Technique” (EPT). Multilevel modeling analyses with Bayesian Markov chain Monte Carlo (MCMC) estimations indicated a two-way interaction effect between EPT and problem levels at baseline such that patients with lower problems at baseline showed good outcome in the context of EPT, whereas an inverse relationship was found for patients with higher problems. Findings provide empirical evidence for characteristic components of PDT for adolescents and preliminary answers about who benefits from psychodynamic techniques.

Occupational Therapy Theory and School-Based Filial Therapy: Intervention Rationale and Formulation.

Background: Emotional-behavioural problems in children present a barrier to engagement and participation in school occupations. Applying practice theory is an essential process to explore the impact of clinical problems and to orient clinical thinking to the domain of occupation. Purpose: Occupational therapy practice theory and frameworks are applied to the formulation of School-Based Filial Therapy, a viable treatment response to emotional-behavioural problems in children. Key issues: Bowen family systems theory, the Occupational Therapy Practice Framework IV and the Canadian Model of Occupational Performance and Engagement are applied to intervention formulation. Implications: School-Based Filial Therapy engages the dynamic interaction of the person, the occupations he/she engages in and the environment via therapeutic medium of play. It is consistent with the Occupational Therapy Practice Framework IV and the Canadian Model of Occupational Performance and Engagement and provides new possibilities as an intervention for occupational therapists working in children's mental health.

Effect of Positive Expiratory Pressure Therapy on Lung Volumes and Health Outcomes in Adults With Chest Trauma: A Systematic Review and Meta-Analysis.

The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery. Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach. Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI = 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported. PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma. There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered.

The relationship between therapist interventions and couples' emotional injury resolution in emotion focused couples therapy.

The primary purported change process in emotion-focused couples therapy (EFT-C) occurs as therapists assist one partner to access and reveal vulnerable emotions and needs and promotes a subsequent compassionate responding from the other partner. This study aimed to examine the association between therapists' views regarding their interventions during a given session and the degree to which partners reported the session as helpful in resolving their unfinished business. Data from 22 couples who took part in the York Emotional Injury Project and received 10-12 EFT-C sessions were analyzed using multilevel models. The primary findings revealed that when therapists reported using interventions that promoted acceptance of feelings and needs in a given session, both partners reported higher resolution levels in relation to their partner. Our results suggest that interventions that facilitate responsiveness between partners are particularly important in EFT-C, and perhaps in couples therapy in general.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study

ObjectiveThe authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.MethodsFifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.ResultsPsychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance.ConclusionPsychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.ImpactAccording to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.Lay SummaryWith Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Effectiveness of Supplemental Upper Extremity Training With Specialty Therapist for Patients With Stroke in Inpatient Rehabilitation

<h3>Research Objectives</h3> To investigate the potential benefits of supplemental training for the upper extremity on patient's arm and hand function during subacute stroke recovery. <h3>Design</h3> Retrospective cohort study over 6 month duration. <h3>Setting</h3> Inpatient Rehabilitation Hospital. <h3>Participants</h3> All participants received conventional occupational therapy (COT) during their inpatient rehabilitation for an admitting diagnosis of stroke. The control group consisted of 34 participants that were not referred to a specialty therapist. The 33 patients in the study group were referred by primary therapist to a specialty therapist for upper extremity motor recovery. <h3>Interventions</h3> Patients treated 1-3x weekly, 60 minute sessions. - Clinical consultation including plan of care recommendations specific to upper extremity impairments. - Treatment by specialty therapist including: 1. Upper extremity robotics 2. Gravity eliminated motor retraining 3. Virtual reality 4. Functional electrical stimulation 5. Constraint induced movement therapy <h3>Main Outcome Measures</h3> Fugl Meyer Assessment - Upper Extremity (FMA-UE), Box and Blocks Test (BBT). <h3>Results</h3> Patients in both groups were stratified into severe, moderate and mild impairment categories using the FMA-UE score collected at inpatient admission. Patients in control group with a severe impairment had an average change score of 8 on FMA-UE and 2 on BBT. Comparatively, the severe experimental group achieved an average change score of 21.9 on FMA-UE and 13.7 on BBT. Effects of supplemental training on mild impairment groups were not seen in FMA-UE. However, the BBT change score for mild control group was 8 versus 16.8 for experimental group. The supplemental training failed to show a significant increase for moderate group in FMA-UE or BBT. <h3>Conclusions</h3> Supplemental upper extremity training along with COT in the subacute phase of stroke recovery may improve gross and fine motor functioning for patients with severe impairment. For patients with mild impairment, supplemental training may serve to improve fine motor function. The effect of specialty therapist intervention on upper extremity function warrants further study due to current small sample size and interaction of selection bias due to reliance on therapist's referral for consultation. <h3>Author(s) Disclosures</h3> None.

Treatment components in behavioral versus nondirective telephone-assisted self-help interventions for parents of children with externalizing behavior problems.

The aim of this study was to analyze treatment differentiation in a behavioral and a nondirective telephone-assisted self-help intervention for parents of children with externalizing behavior problems, including the development and evaluation of a rating scale. In a randomized controlled trial, 149 parents of children aged 4-11 years with externalizing behavior problems were allocated to a behavioral or a nondirective guided self-help intervention. Parents in both conditions received eight self-help booklets and ten telephone consultations. To analyze the content of the interventions, we developed the Therapist Intervention Scale (TIS). In order to evaluate the scale and analyze treatment differentiation, parent booklets and recorded telephone consultations were rated. Item selection and scale development were based on predefined psychometric criteria. The subscales Guidance & Structures and Relationship & Emotions were developed based on exploratory factor analyses. Interrater reliability and internal consistency were found to be acceptable to excellent. Analyses of construct validity demonstrated positive correlations for corresponding and negative correlations for non-corresponding subscales of therapist ratings. Therapists and booklets in the behavioral intervention showed higher scores on the subscale Guidance & Structures, while therapists and booklets in the nondirective intervention showed higher scores on the subscale Relationship & Emotions. The analyses of the TIS support its reliability and validity. The subscale Guidance & Structures contains mainly cognitive-behavioral treatment components, while the subscale Relationship & Emotions contains mainly nondirective treatment components. The implemented telephone-assisted self-help interventions demonstrated distinct treatment profiles which match their intended therapeutic approaches.

Resistance & Recovery in the #MeToo Era

This special issue aims to amplify the voices of those who were and continue to be at the frontlines resisting and responding to sexual violence. In order to frame this special issue, we first outline the current socio-political landscape, including increased visibility of movements such as #NoMore, #TimesUp, and most notably #MeToo, and the public showcase of accused perpetrators becoming elected to the highest offices in the United States (e.g., Brett Kavanaugh’s election to the Supreme Court, Donald Trump’s election to the Presidency). We offer note to how this political landscape has impacted survivors and therapists, alike. We then provide a critique of the silencing of survivors who are marginalized (e.g., women of color, trans, and queer survivors) within the current movements and offer recommendations for how to center their experiences through an intersectional approach. Finally, we explore the role of technology and digital feminisms on survivor’s experience and its influence on therapist and therapeutic interventions.

When Are Therapists' Efforts to Bring about Cognitive Change Effective? Considering Interpersonal Vulnerabilities as Contextual Factors.

We examined interpersonal variables as moderators of the relation between therapists' use of cognitive change (CC) strategies and CC in a sample of 125 adults who participated in cognitive behavioral therapy for depression. We measured self-reported maladaptive personality characteristics, interpersonal problems, and social skills at intake. Observers rated therapist adherence to cognitive methods for the first five sessions. Patients reported in-session CC following each session. Cognitive methods predicted greater CC. The relation between cognitive methods and CC was moderated by maladaptive personality traits; this relation was stronger for patients with greater maladaptive personality traits. We encourage future research investigating moderators of therapist interventions of putative therapeutic mechanisms.

A process-outcome study of school-based art therapy

ABSTRACT Background Only a few studies in the arts therapies in general and in the field of visual art therapy in particular have begun to address process variables and their relationship to outcome variables. Aim The present study thus aimed to contribute to this literature by examining the relationship between process variables and outcome variables in the school-based art therapy setting. Method The process-outcome relationship was examined in a school-based art therapy setting in a sample of 32 art therapists and 44 clients aged 7–13. Hypothesis 1 predicted that over the course of art therapy, client involvement and client productive behaviours would increase whereas resistance would decrease. Hypothesis 2 predicted that increases in client involvement and client productive behaviours and decreases in client resistance would be linked to decreases in behavioural problems. Results Both hypotheses were partially supported in that cognitive–behavioural exploration and emotional exploration differed significantly during therapy. In addition, there was a significant correlation between improvement in client involvement and cognitive–behavioural exploration and improvement in internalising problems. Conclusions The present study provides initial support for the claim that the processes in art therapy with children are more complex than is typically assumed for art therapy. For example, the results showed that an increase in resistance and a decrease in insight were associated with positive outcomes. Implications for practice The findings indicated that in the education system, cognitive–behavioural exploration is an important variable. Models such as the cognitive–behavioural approach thus may be useful in school-based art therapy. Plain-language summary Recent studies have attested to the positive impact of art therapy on children and adolescents. However, little is known about what happens during the process of therapy and how it can lead to a positive outcome. The present study examined the relationship between process variables and outcome variables in the school-based art therapy setting. For this purpose, it focused on two process variables. The first was the art therapist's assessment of the client's degree of involvement in therapy. The second process variable was the therapist's assessment of the client's productive behaviours as well as resistance to therapy. This assessment can shed light on the ways in which the client responds to the therapist's interventions. The outcome variable was Child Behaviour Checklist that is designed to evaluate changes in children's behaviour and functioning over time or before/after therapy. Thirty-two art therapists employed by the Israel Ministry of Education and 44 clients participated in the present study. At the beginning of the school year, each art therapist selected one or two of her clients, who were in grades 1–7. Consent was obtained from both the clients and their parents. Parents and teachers filled out the outcome measure, at the beginning (September) and end of the year (June). The art therapists were asked to fill in the process measures after each treatment session (once a week). The results showed that cognitive–behavioural exploration and emotional exploration differed significantly across time. In addition, an association was found between improvement in client involvement and cognitive–behavioural exploration and improvement in internalising problems. The present study provides initial support for the claim that the processes in art therapy with children in general and within the school setting in particular are more complex than is typically assumed for art therapy.

Outcomes of Dysphagia Following Stroke: Factors Influencing Oral Intake at 6 Months After Onset

PurposeThis study aimed to describe recovery of dysphagia after stroke. We determined the proportion of stroke survivors with dysphagia on admission, discharge, and 6 months after stroke. Additionally, the factors affecting oral feeding 6 months after stroke were explored. MethodsA total of 427 acute stroke patients were recruited prospectively. Presence of dysphagia was evaluated on admission, weekly until recovery was achieved, and at discharge. We compared stroke survivors with dysphagia who had complete recovery, who had dysphagia but achieved oral feeding, and who required tube feeding. Patient-reported eating ability was evaluated at 6 months. Patients who achieved oral feeding by 6 months were compared to those who had persistent tube feeding need. ResultsFifty-five percent of stroke survivors had dysphagia on initial evaluation (3.1 ± 1.4 days after admission) and 37% at discharge (21.1 ± 12.4 days). At 6 months, 5% of patients required tube feeding. Among those who had dysphagia at initial evaluation, 32% had resolution of dysphagia within two weeks, 44% had dysphagia but started oral feeding before discharge, and 23% required alternative means of alimentation (nasogastric tube feeding, percutaneous endoscopic gastrostomy, parental nutrition) throughout hospitalization. At 6 months, 90% of stroke survivors who achieved oral feeding by discharge continued with oral feeding. Patients who achieved oral feeding after discharge had less cognitive impairments on admission and a higher speech therapist intervention rate after discharge. ConclusionsMore than half of stroke survivors had dysphagia but the vast majority were able to return to oral feeding by 6 months. Cognitive function and dysphagia rehabilitation interventions were associated with return to oral feeding after hospital discharge.

Transference-Focused Psychotherapy for Adolescents With Personality Disorders.

This article presents a conceptualization of personality disorders in adolescence and the adaptation of transference-focused psychotherapy (TFP) for personality disordered adolescents (TFP-A). The model of assessment and treatment presented is based on contemporary psychoanalytic object relations theory developed by Otto F. Kernberg and supported by findings from current evidence-based outcome research. We present a method of assessing personality disorders in adolescents that addresses the variability of personality disorder symptoms and traits among adolescents and their instability over time. We then present the goal of TFP-A and its major phases of implementation. A major focus is therapist interventions.