Therapy Sessions Research Articles

A genetic algorithm-based method to modulate the difficulty of serious games along consecutive robot-assisted therapy sessions

Background and Objective:One of the biggest challenges during neurorehabilitation therapies is finding an appropriate level of therapy intensity for each patient to ensure the recovery of movement of the affected limbs while maintaining motivation. Different studies have proposed adapting the difficulty of exercises based on psychophysiological state, based on success rate, or by modeling the user’s skills. However, all studies propose solutions for a single session, requiring a calibration process before using it in each session. We propose a dynamic adaptation method that can be used during different rehabilitation sessions, without the need for recalibration between sessions. Methods:The adaptation architecture is based on a genetic algorithm that aims to maintain a certain score level and to motivate the user to move. The method has been evaluated with two serious games for five sessions using a rehabilitation robot. A common initial evaluation was made for all the users involved in the study, and the game parameters that best suited each user from the previous session were introduced as the starting point of the next session. In addition, the desired score rate was lowered between sessions to increase the difficulty level. The psychophysiological state of the users was measured based on the Self-Assessment Manikin test, as well as different cardiorespiratory and galvanic skin response signals were analyzed. Results:The adaptation architecture proposed can find those game parameters that maximize the user movement for both games. In one of the games, the score rate set for each session is followed with high fidelity. The degree of personalization in the games increases between sessions as the dispersion of the game parameters grows. The Self-Assessment Manikin test and the physiological signals results would indicate that the psychophysiological state remains equal between sessions despite an increase in game difficulty. Conclusions:The genetic algorithm-based game adaptation has proven efficacy in maximizing the therapy performance through the sessions without needing recalibration. It also can be concluded that the design of the game influences the adaptation performance. Additionally, adaptive game design facilitated by our method does not significantly impact players’ emotional or physiological states.

Assessment of the Short-Term Efficacy of a Wet-Cupping Therapy Session in Alleviating Symptoms of Fibromyalgia Syndrome: A Single-Arm Clinical Trial

Fibromyalgia holds significant importance in both primary care and physical treatment settings due to its high prevalence and the challenges associated with its diagnosis and management. This study aims to assess the short-term efficacy of a wet-cupping therapy session in alleviating symptoms of Fibromyalgia Syndrome (FMS). This study employed a prospective, single-arm intervention design. Baseline and post-treatment evaluations encompassed a comprehensive battery of assessment tools: Socio-Demographic Questionary, Visual Analog Scale (VAS) for Pain, Fatigue Severity Scale (FSS), Beck Depression Scale (BDS), Fibromyalgia Impact Questionnaire (FIQ). A total of 20 eligible individuals were enrolled in the study. Significant alterations in pain perception, as measured by the VAS, were evident both prior to treatment and at the end of the first week of treatment (p < 0.001). Additionally, significant favorable effects of the treatment were observed on FSS and BDS levels during the initial week of therapy (p = 0.001, p = 0.01; respectively). Moreover, a marked improvement was identified in FIQ scores after treatment compared to baseline (p < 0.001). Across all evaluated clinical indicators, cupping therapy exhibited a significant positive influence on FMS. In conclusion, wet cupping therapy yields favorable outcomes in terms of pain perception, fatigue reduction, mood enhancement, and the overall impact of fibromyalgia syndrome. Thus, it offers a promising avenue for therapeutic intervention among individuals afflicted by this condition.

Introduction to Guitar Techniques and Genres for the Utilization in Improvised Active Music Therapy

Abstract Guitar is a popular instrument for music therapy clinicians and students because it is portable and musically versatile. Guitar training is increasingly shared through music therapy literature, professional conferences, and workshops. However, there is still a lack of literature regarding the use of guitar improvization techniques for beginner and intermediate-level music therapists. The purpose of this manuscript is to provide the first simplified and standardized guitar methodological system for beginner and intermediate-level music therapy students and clinicians for the use in Improvised Active Music Therapy sessions in neurological rehabilitation. Improving guitar skills is important to increase confidence among students and clinicians and to enhance clinical outcomes. The manuscript is divided into two groups of exercises. The first group consists of four exercises with chord progressions. The second group consists of six strumming exercises. The strumming exercises should be combined with the chord progressions in the first group to expand upon the first position and aesthetic qualities. The exercises incorporate extended, chromatic, and suspended chords in Rock & Roll, Blues, Hip-Hop and rap, Reggae, folk, country, Latin American, and Spanish styles in key of E major. The goal is to stimulate the skill of music therapy students and clinicians, and perhaps add some extra motivation and ideas for guitar improvization skills to enhance clinical outcomes.

THE EFFECTIVENESS OF COGNITIVE-BEHAVIORAL THERAPY IN ADOLESCENTS WITH SOCIAL ANXIETY DISORDER

Social anxiety disorder (SAD) is a prevalent condition among adolescents, characterized by an intense and persistent fear of social situations or performance, which results in significant distress and impairment in daily activities. Adolescents with SAD often avoid social interactions, which can negatively affect their academic, social and emotional development. Cognitive-behavioral therapy (CBT) has been widely recognized as an effective approach to treating SAD, offering practical strategies to reduce anxiety symptoms and improve social functioning. This abstract will explore the effectiveness of CBT in adolescents with social anxiety disorder, highlighting the main techniques used and the clinical outcomes observed. The aim of this paper is to review and evaluate the effectiveness of cognitive-behavioral therapy in the treatment of adolescents with social anxiety disorder. The aim is to analyze the main techniques of CBT, the mechanisms by which it promotes anxiety reduction and the results of clinical studies that show its effectiveness. In addition, the challenges and specific considerations in applying CBT to this age group will be discussed. This literature review aims to analyze the effectiveness of Cognitive-Behavioral Therapy (CBT) in the treatment of social anxiety in adolescents. To this end, references from relevant studies and meta-analyses were selected and reviewed, covering various approaches and results related to the topic. The selection of references was based on the relevance and impact of the publications in the field of psychotherapy and social anxiety. CBT is a form of psychotherapy based on identifying and modifying dysfunctional patterns of thought and behavior. In the context of SAD in adolescents, CBT aims to help patients recognize and restructure irrational beliefs about themselves and social situations, develop appropriate social skills and reduce avoidance of social interactions. With this in mind, the main CBT techniques include cognitive restructuring, gradual exposure and social skills training. Cognitive restructuring involves helping adolescents to identify negative automatic thoughts and replace them with more realistic and balanced interpretations. Gradual exposure consists of exposing adolescents, in a controlled and progressive way, to feared social situations, allowing them to face their fears and reduce the associated anxiety response. Social skills training focuses on developing social competencies, such as initiating and maintaining conversations, asking and answering questions, and dealing with criticism and rejection in an assertive manner. Clinical studies have demonstrated the effectiveness of CBT in reducing SAD symptoms in adolescents. Research indicates that adolescents who receive CBT show a significant decrease in levels of social anxiety, improved quality of life and greater participation in social and school activities. For example, a study conducted by Masia Warner et al. (2005) showed that adolescents who participated in a group CBT program had a notable reduction in social anxiety symptoms compared to a control group. Another study by Beidel, Turner and Morris (2000) showed that individual CBT resulted in substantial improvements in adolescents’ social anxiety and social functioning. Despite the promising results, the application of CBT to adolescents with SAD presents specific challenges. Adherence to treatment can be hampered by adolescents’ resistance to engaging in therapy sessions and facing feared social situations. In addition, parental involvement and coordination with schools are important components for successful treatment, as social and environmental support is crucial for the generalization of therapeutic gains. Therefore, cognitive-behavioral therapy has proven to be an effective approach for treating adolescents with social anxiety disorder. Cognitive restructuring techniques, gradual exposure and social skills training are key to helping adolescents overcome their fears and improve their social functioning. Clinical studies provide robust evidence that CBT can significantly reduce SAD symptoms and improve quality of life for adolescents. However, it is essential to consider the challenges specific to this age group, including resistance to treatment and the need for support from parents and schools. With a careful and collaborative approach, CBT can provide lasting benefits for adolescents with social anxiety disorder, promoting their emotional and social well-being.

Effectiveness of Physiotherapy for Improving Functionality, Participation, and Quality of Life after a Stroke: Study Protocol for a Randomized Controlled Clinical Trial.

Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of the alterations. Therefore, the aim of this study is to assess the effectiveness of a Physical Therapy intervention based on a goal-oriented approach with task-specific training for improving functionality, participation, and quality of life for people with Stroke. A single-blinded randomized controlled clinical trial will be developed. Adults over 50 years old diagnosed with Stroke over 6 months will be included in this study. Participants (n = 62) will be randomly allocated into two groups: The experimental group (n = 31) will receive 30 sessions, three per week during 10 weeks, of Physical Therapy sessions of goal-directed and task-specific training. The control group (n = 31) will follow the same intervention intensity of their usual Physical Therapy treatment. The primary outcome variables quality of life (NewsQol), participation (Ox-PAQ), and gait functionality (FAC) and the secondary outcome variables functional disability (BI), postural control (PASS), dynamic trunk balance (TIS), and functional goals (GAS) will be measured at baseline, after group interventions (10 weeks), and 6 months after the baseline. Statistical analyses will include repeated-measures ANOVA, Student's t-test, or the Mann-Whitney U-test, with a 95% confidence interval and significance level of p < 0.05. Person-centered approaches in Physical Therapy interventions may yield better outcomes in functionality, participation, and quality of life for Stroke patients compared to standardized interventions. ClinicalTrials.gov: NCT06165666 (December 2023).

Nursing intervention in older adults with insomnia

Introduction. Aging is loosely related to the chronological age of the person and in turn to the loss of physical, functional, psychological and social capacities. Sleep is a physiological process of fascination and of vital importance for the comprehensive health of the human being, the aging process alters the stages of sleep, which in the long term has side effects and represents economic costs for those older adults who are prescribed with pharmacological treatments. The amount of sleep remains constant throughout adult life, which is why doctors recommend that older adults sleep 7 to 8 hours a day to meet their sleep needs. There are sleep problems in older adults and one of them is insomnia, which is reflected in their daily lives, which is why music therapy appears as a non-pharmacological treatment to help reduce insomnia. Objetive. To evaluate the effect of nursing intervention in older adults with insomnia. Methodology. This research is quantitative, quasi-experimental in design, longitudinal and descriptive in scope. It was carried out in a period between April 2024-June 2024, in the province of Tungurahua, Canton Ambato, Parroquia La Matriz, Neighborhood Ciudadela España. The sample was 21 older adults from the Hogar de Ancianos Sagrado Corazón de Jesús, who met the inclusion and exclusion criteria. Results. The results obtained in this research demonstrate that music therapy as a nursing intervention has positive effects on older adults with insomnia. Conclusion. With the application of the Athens Test before and after the music therapy sessions, a significant improvement was shown in various aspects of sleep, such as difficulty falling asleep, nocturnal awakenings and total sleep duration.

Nurses Supporting Nurses: A Model for Providing Mental Health Services During War.

Nurses routinely face psychological challenges as part of their work, acutely so during times of crises when nurses may treat many severely injured and dying patients. While the need for such support is well documented in the literature, mental health support programmes aimed at healthcare workers, even when available, are often underutilised, especially by nurses. To gain insights about needed mental health supports for nurses and programme implementation, this study examines a programme launched following a surprise attack on Israel on 7 October, 2023, resulting in thousands of deaths and injuries and precipitating a war. The programme deployed 30 volunteer nurses trained in cognitive behavioural therapy, trauma support and mental health first aid to offer up to three, anonymous, 30-min online therapy sessions to nurses around Israel in December 2023. Using a qualitative descriptive design, we engaged 22 of these volunteers in one of the three focus groups lasting 60-90 min each. Our findings highlight a range of mental health issues-among both the volunteers and therapy recipients-as well as barriers to providing mental health support to nurses. The importance of normalising the pursuit of mental health support in nursing education and ensuring the availability of support in healthcare organisations was emphasised.

Diabetic Patients with Chronic Pain After Lumbar Surgery Experienced Fewer Analgesic Effects of Laser Therapy

Background: Recent studies indicate that several factors are associated with different responses to pain relief and alteration in reactions to non-pharmacological modalities and pharmacological medications. Biological processes appear to be contributory factors to these outcomes. Objectives: The purpose of this study is to examine how laser therapy can help as a conservative approach for chronic pain after back surgery in patients with diabetes mellitus (DM). Methods: This research included 22 diabetic patients and 26 non-diabetic patients with chronic pain after back surgery. Points of laser irradiation were determined by an ultrasound examination, specifically targeting bilateral sacroiliac joints, L2 - L3 through L5 - S1 facet joints, and the area of cluneal nerves. The duration of laser therapy was three weeks, with treatment sessions using an 808 nm diode laser at a power of 0.5W, performed every other day. Individuals were evaluated using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) before and after treatment, and again six months later. Results: Oswestry Disability Index and Numeric Rating Scale scores decreased significantly after treatment and six months later. Furthermore, analysis of the data showed that diabetic patients experienced less therapeutic effect during and after laser therapy sessions. Conclusions: Although laser therapy can reduce pain, diabetic patients reported a lower level of effectiveness compared to non-diabetic patients.

Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility

Purpose Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. Methods A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. Analysis Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. Results The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). Conclusions The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.

Developing reflexivity and self-compassion in group psychotherapy: A dialogical and narrative approach

ABSTRACT In this paper, we apply dialogical concepts to understand the development of self-reflexivity and self-compassion during psychotherapy. Specifically, we present a study that mapped clients’ voices and explored their changes in group psychotherapy. Thematic narrative analysis was used to study 20 two-hour group therapy sessions of a systemic informed approach. The analysis involved mapping of the voices of each group member, categorizing them as compassionate and/or reflexive and a sequential depiction of the group voices through timelines. The last step of the analysis included studying the development of self-reflexive and self-compassionate voices through time. It showed an important change, not on the number of clients’ self-reflexive voices that appeared during psychotherapy, but mostly on the quality of the self-reflexive voices in favor of voices that were both self-reflexive and self-compassionate. This change seems to take place as a result of the internalization and “rehearsal” of more kind and compassionate voices that appear in the group dialogues. Hence, this study suggests that, in parallel with focusing on the presence and amount of the reflexive processes that occur in psychotherapy, psychotherapy research should also focus on the changes in the quality of these processes, and particularly the development of self-compassion in psychotherapy.

"Virtual reality fixed me": A case report of the use of virtual reality during intensive interdisciplinary pain treatment.

Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients' experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes.

The Effects of Mindfulness-Based Breathing on Strain, Burden, and Burnout in Family Caregivers of Palliative Care Patients: Randomized Controlled Study.

The aim of this study was to assess the effects of online mindfulness-based breathing therapy combined with music on the levels of perceived strain, caregiver burden and burnout in caregivers of palliative care patients. This was a prospective, single-blind, randomized-controlled study. A total of 100 caregivers were randomly assigned to the intervention group (n = 50) and the control group (n = 50). Participants in the intervention group agreed to 3 sessions of mindfulness-based breathing therapy per week. Participants in the control group agreed to sit in a comfortable position in a quiet environment for 30 minutes for 3 consecutive days. We found statistical differences in groups in strain (P < .001), burden (P = .015) and burnout (P = .039) when comparing intervention and control groups. Mindfulness-based breathing therapy combined with music is a non-pharmacological approach that may reduce perceived strain, caregiver burden and burnout in caregivers.

Clinical and Haematological Study of Hijama-Bi’l-Shart (Wet Cupping) In the Management of Pain

Background: This randomized clinical and haematological study evaluated the effect of Hijama-Bil-Shart (Wet Cupping) on musculoskeletal pain and inflammatory markers in venous and cupped blood. Materials and Methods: 110 patients with musculoskeletal pain were screened, with 90 diagnosed and included. After 30 subjects were lost to follow-up, 60 completed the study. Participants received 4 weekly sessions of wet cupping therapy over 4 weeks. Pain intensity was measured using VAS and KOOS scores, and inflammatory markers (Serum uric acid &amp; CRP) were assessed in venous and cupped blood. Results: Pain relief, measured by VAS, showed significant improvement across various musculoskeletal conditions: cervical spondylosis, frozen shoulder, low backache, sciatic pain, knee osteoarthritis, gout, and rheumatoid arthritis. KOOS scores for knee osteoarthritis improved significantly. Serum uric acid levels in venous blood were suggestively insignificant, while CRP levels decreased gradually but were not statistically significant. No adverse effects were reported. Conclusion: Hijama-Bil-Shart (wet cupping) therapy is effective in relieving musculoskeletal pain and improving quality of life. It shows long-term benefits with sustained pain relief and gradual reduction in CRP levels. However, it is not effective in significantly reducing raised serum uric acid levels. Keywords: Musculoskeletal pain, Wet cupping, VAS, KOOS, Hijama-Bil-Shart, CRP

Factor Structure and Psychometric Properties of the ED-15 in People With an Eating Disorder.

This study examines the factorial structure and psychometric properties of the Eating Disorder-15 questionnaire (ED-15) in a large clinical sample, as well as the instrument's sensitivity to early clinical change in therapy and ability to measure remission. Participants with eating disorders (N = 278) referred to the Flinders University Services for Eating Disorders in South Australia completed the ED-15 as well as other measures of eating disorder symptoms and co-occurring psychopathology, including depression, anxiety, and stress. Confirmatory factor analysis (CFA) revealed a two-factor model for the ED-15. The ED-15 had good internal consistency. It showed satisfactory concurrent validity with moderate correlations with the EDE-Q global score and contribution of unique variance to that score. Correlations indicated good convergent validity with clinical impairment and good divergent validity from depression, anxiety, and stress. The ED-15 showed a significant medium effect size change within the first four sessions of therapy. Good discriminant validity was indicated by cut-off scores used for remission, with significantly different levels of ED psychopathology and other impairments between the two groups. This study adds to the four previous psychometric studies of the ED-15, confirming robustness of the English version in a clinical sample. The brevity and psychometric robustness of the ED-15 makes it a preferable measure to the Eating Disorder Examination for sessional assessment of progress in treatment.

Patients' perspective on the therapeutic relationship and session quality: the central role of alliance.

In this study, we examined how four components of the therapeutic relationship-working alliance, real relationship, and positive and negative affective reactions of the patient toward their therapist-relate to each other and to the psychotherapy session outcome, from the patient's point of view. Our simple comprised 700 adult patients in individual psychotherapy who were recruited and participated online. They underwent a baseline evaluation of their most recent therapy session, which encompassed a series of validated self-report measures focused on specific elements of the therapeutic relationship. The results revealed that, from the patient's perspective, working alliance, real relationship, and positive affective reactions toward the therapist were positively correlated with session outcome, while negative affective reactions were negatively correlated. All components predicted session outcome when simultaneously included in a regression model. Collectively, these four components accounted for 30% of the variance in session outcome. Factor analysis revealed four distinct factors, underlying perceptions of the therapeutic relationship. Notably, the bond dimension of the alliance was sufficiently different from the task and goal dimensions, warranting consideration as a distinct construct. These findings, although cross-sectional, lay the groundwork for a more nuanced investigation of multiple dimensions of the therapeutic relationship.

Unraveling the optimal balance of problem-related affective experiences and need satisfaction in cognitive-behavioral therapy: A response surface analysis

Objective: Although therapists are encouraged to balance emotionally involving work on the patient’s problems with need satisfaction in therapy sessions, effects of this balance have rarely been studied empirically. Hence, we examined congruence effects between problem-related affective and need-satisfying experiences in cognitive–behavioral therapy (CBT). Method: 165 distressed family caregivers rated problem-related affective experiences, need-satisfying experiences comprising self-esteem, positive interpersonal, and control experiences, as well as coping experiences after 12 CBT sessions. We examined within-person congruence effects of problem-related affective and need-satisfying experiences on subsequent coping in multilevel response surface analysis. Further, we included between-person problem-related affective and need-satisfying experiences and pretreatment depression and anxiety as moderators of within-person effects. Results: A slight predominance of self-esteem over problem-related affective experiences as well as exact correspondence between problem-related affective and both interpersonal and control experiences was most predictive of coping. Between-person moderators supported a cross-level balance heuristic of problem-related affective and self-esteem experiences. Finally, a stronger emphasis on self-esteem and interpersonal over problem-related affective experiences proved more beneficial for patients with high anxiety and low depression. Conclusions: The findings highlight the importance of balancing problem-related affective and need-satisfying experiences in CBT and provide insights into how balancing may be tailored to specific patients.

Electroconvulsive Therapy for Psychogenic Polydipsia and Hyponatremia in Chronic Schizophrenia: A Case Report and Literature Review.

Compulsive drinking of excessive quantities of water, called psychogenic polydipsia (PP), is a challenging complication of chronic psychotic disorders, which can lead to hyponatremia and downstream morbidity or mortality. Treatments include behavioral modifications such as free water restriction, medications to modify free water excretion, and psychotropic medications to target psychotic symptoms. However, in many cases, these options remain ineffective and/or intolerable, necessitating chronic institutionalization with poor patient quality of life. Here we report the use of an acute course of 8 sessions of bilateral electroconvulsive therapy (ECT) in a 57-year-old man with chronic schizophrenia, PP, and moderate hyponatremia refractory to standard treatments in an inpatient psychiatric setting. Serum sodium normalized and remained stable during and immediately following his ECT course, despite chronic hyponatremia with high variability for months prior to ECT initiation. A literature review found remarkably few reported cases of ECT for PP in chronic schizophrenia, a surprising result given the use of this modality for patients with psychotic illness in many countries. Our findings support future investigation into the clinical utility and mechanism of ECT for PP in this patient population.

Enriched music-supported therapy for individuals with chronic stroke: a randomized controlled trial.

Many stroke survivors still present with upper-limb paresis six months post-stroke, impacting their autonomy and quality of life (QoL). We designed an enriched Music-supported Therapy (eMST) program to reduce disability in this population. We evaluated the eMST's effectiveness in improving functional abilities and QoL in chronic stroke individuals compared to the conventional motor program Graded Repetitive Arm Supplementary Program (GRASP). We conducted a pragmatic two-arm parallel-group randomized controlled trial with a 3-month follow-up and masked assessment. The eMST involved playing instruments during individual self-administered and group music therapy sessions. The GRASP consisted of self-administered motor exercises using daily objects. Both interventions were completed at home with telemonitoring and involved four one-hour weekly sessions for 10weeks. The primary outcome was upper-limb motor function measured with the Action Research Arm Test. Secondary outcomes included motor impairment, daily life motor performance, cognitive functions, emotional well-being, QoL, self-regulation, and self-efficacy. Intention-to-treat (ITT)and per-protocol(PP) analyses were conducted including participants who discontinued the intervention and those who completed it entirely, respectively. Fifty-eight chronic stroke patients were randomized to the eMST-group (n = 26; age: 64.2 ± 12.5; 6[23.1%] females; 2.8 ± 2.9years post-stroke), and the control group (n = 32; age: 62.2 ± 12; 8[25%] females; 1.8 ± 6.2years post-stroke). The eMST-group had more participants achieving a clinically relevant improvement in motor impairment post-intervention than the control group for the ITT (55% vs 21.6%; OR = 4.5 (95% CI 1.4-14); p = .019) and PP analyses (60% vs 20%; OR = 6 (95% CI 1.5-24.7); p = .024), sustained at follow-up. The eMST-group reported greater improvements in emotion (difference = 11.1 (95% CI 0.8-21.5; p = 0.36) and participation (difference = 10.3 (95% CI 0.6-25.9); p = 0.41) subscales of QoL, and higher enjoyment during the sessions (difference = 1 (95% CI 0.3-1.5); p = 0.12). No changes were found in other outcomes. eMST demonstrated superiority over conventional motor rehabilitation program in enhancing upper-limb functions and QoL in chronic stroke individuals. ClinicalTrials.gov (ID: NCT04507542).

Effect of vagus nerve stimulation (taVNS) on anxiety and sleep disturbances among elderly health care workers in the post COVID-19 pandemic.

Healthcare workers (HCWs) have been significantly impacted by the pandemic. Elderly health care workers carry out a variety of duties at work and have years of clinical expertise. Anxiety and insomnia are among the more commonly encountered problems in senior physicians and other geriatric medical professional populations. The study aims to determine the effect of vagal nerve stimulation on anxiety and sleep disturbances among geriatric medical professionals. 42 participants were enrolled in this study based on the inclusion and exclusion criteria. The participants were divided into two groups using the closed envelope approach, and they took part in therapy sessions lasting 30 minutes, three times per week for a period of four weeks. The Experimental group A received non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) and Control group A received Jacobson's progressive muscle relaxation technique. With a p value of 0.001, taVNS stimulation significantly improved sleep quality and reduced anxiety after 4 weeks. The post-intervention assessment revealed a highly significant improvement in Group A, with a T value of 251 (p < 0.001). The findings suggest that taVNS may be an effective intervention for addressing anxiety and sleep issues in geriatric medical professionals. These results contribute to the exploration of non-invasive strategies to enhance the well-being of healthcare professionals working in demanding environments.

PSYCHODYNAMIC PSYCHOTHERAPY FOR TIME DISTORTION IN ATTENTION DEFICIT HYPERACTIVITY DISORDER

Psychodynamic psychotherapy does not feature in current treatment guidelines for attention‐deficit hyperactivity disorder (ADHD) in the United Kingdom. However, there is some psychoanalytic understanding of the disorder, which is corroborated in current neuroscientific theory, and supports clinicians in thinking beyond the behaviourally biased diagnosis and treatment models. One of the core features of ADHD is distortions in chronoception. This clinical paper therefore explores the psychoanalytic and neuroscientific theories of time perception as a way of exploring a discrete element of the complex idea of executive functioning more generally. It supports therapists approaching such executive dysfunction and to reconsider the treatment guidelines. A case example is used to explore how a transference‐, affect‐ and relationally‐focussed therapy can effect lasting change for people with ADHD in a way that behavioural and medication approaches do not. It is argued that such an intervention can improve oscillatory attention between subjective‐ and objective‐time and increase the capacity to self‐contain emotions. This brings patients into alignment with reality and restarts their psychic development towards themselves, others, the parental couple and grieving, which stalled in infancy. The internalised schema of the 50‐minute therapy session also provides a frame of reference for future tasks.