Nicola J. Starkey

Examination of the Accuracy and Applicability of Information in Popular Books on Dog Training

There is a wealth of popular literature available on dog behavior and training; sourcing reliable and trustworthy advice is important to achieving successful training. The aim of this study was to select five best-selling (at that time) dog training books, and review their general content and references to basic learning theory and human communicative cues. An Internet search was performed on three online bookstores’ websites for “best selling” “dog training” books. The books were by Millan and Peltier (2006), Fennell (2002), Stilwell (2005), Pryor (1999), and Monks of New Skete (2002). The results showed marked differences across all books, including inconsistencies in the depth of information provided, and some starkly contrasting training methods were advocated. Overall, these books were not all considered to function as instructional manuals. The persistent popularity of these books suggests that they have likely contributed appreciably to the type of information accessed by dog guardians.

Living life after traumatic brain injury: phase 1 of a longitudinal qualitative study

Objective: To explore what helps and hinders recovery and adaptation after disabling traumatic brain injury (TBI) and make recommendations for improving service responsiveness. Design: A longitudinal qualitative descriptive study across all TBI severities. Setting: Community. Participants: Forty people with TBI, and 22 significant others, 6 to 9 months following a TBI. Main Measures: Semistructured interviews, analyzed using qualitative description, focused on (a) key areas of importance or concern and (b) strategies or actions that people found helpful or that hindered recovery. Results: Traumatic brain injury produced a complex set of challenges in keeping up with life, and understanding what having a TBI means for, and to, me. This period encompassed a tangled fit and misfit in life as brain injury did not occur in isolation. People had to actively change some aspects of life and yet allow other changes to happen. Valued supports from others included being looked out for and having someone to help drive the process. Conclusion: Improved services delivery and better outcomes may result if we respond to the person within his or her context; listen, believe, and acknowledge the persons story through our actions; and avoid assumptions about aspects of life that mean most to people and who/what may help best.

Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence

ABSTRACT Objective: Mild traumatic brain injury (mTBI) is common injury during childhood and adolescence but the long-term outcomes are poorly understood. This study examined post-concussive symptoms and behavioural outcomes in children and adolescents up to 24 months post-mTBI. Method: Parents of children aged 8–15 years with mTBI completed the BASC-2 and Rivermead Post-Concussion Symptoms Questionnaire at baseline, 1-, 6-, 12- and 24 months post-injury. An age-matched traumatic brain injury-free cohort was recruited and assessed at 12- and 24 months. Results: PCSs decreased significantly over the first 12 months post-injury. At 12- and 24 months post-injury, the mTBI group reported more PCSs and behavioural symptoms compared to controls. Parents of children with mTBI were more likely to report ≥4 problematic PCS symptoms (28% at both time points) compared to controls (7.7% and 1.7% at 12 and 24 months, respectively). The mTBI group was 4.63 times more likely to have four or more ongoing PCS symptoms at 12 months post-injury compared to controls. Headache was the most common acute post-injury symptom (55%), while the most commonly reported persistent symptoms were irritability, frustration, forgetfulness and fatigue. Conclusions: PCSs are common 2 years post-mTBI in childhood or adolescence. Given this, additional intervention and support is needed for families post-injury.

Factor structure of the Rivermead Post-Concussion Symptoms Questionnaire over the first year following mild traumatic brain injury

ABSTRACT Background: We examined the factor structure of the Rivermead Post-Concussion Symptom Questionnaire (RPQ), the most commonly used measure of post-concussive symptoms, over the first year post-injury. Method: Factor analysis (orthogonal rotation) was used to examine the RPQ items that form coherent subsets/factors within 2-weeks, and 1, 6, and 12-months post-mTBI in 527 adults (age >16 years). Results: At baseline, three factors accounted for 63.95% of the variance; factor 1 reflected cognitive and physiological disturbances; factor 2 included items reflecting mood, sleep, and nausea/vomiting; and factor 3 included visual/auditory disturbances, dizziness, and headaches. At 1 month, three factors were again extracted (63.26% variance). Factor 1 reflected cognitive and mood symptoms, factor 2 reflected mood with headache, nausea, and dizziness; and factor 3 reflected visual disturbances. Two factors were obtained at 6 and 12 months (63.7% and 63.38% of variance): factor 1 included mood/cognitive items, restlessness, sleep disturbance, and noise sensitivity; whereas, factor 2 included physiological symptoms. Conclusions: The factor structure of the RPQ changes over time; however, it was relatively stable from 6 to 12-months post-injury. Subject to further evaluation, assessments conducted from 6 months could consider using these two factors as subscales. Changing the factor structure of RPQ before 6 months suggests that timing of assessment should be considered in applying these factors.

Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury

There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longer-term impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged ≥16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation.

Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children: findings from the BIONIC Study

INTRODUCTION There is growing consensus that adverse child outcomes may be evident in the early recovery phase following mild traumatic brain injury (TBI). However, controversy remains around the nature of childrens longer-term recovery. AIM To examine child cognitive, behavioural and quality-of-life outcomes over 12 months following mild injury, and to identify prognostic factors associated with outcomes. METHODS A prospective sample of 222 children (aged 2-15 years at injury) with mild TBI was assessed using a cognitive testing battery and parent-report questionnaires at ≤ 14 days, 1, 6 and/or 12-months post-injury. RESULTS Parents reported significant improvements in their childs behavioural adjustment between baseline and 6 months (P = 0.003), with further improvements at 12 months following injury (P = 0.001). Cognitive recovery and quality-of-life improvements were more gradual with minimal changes in the first month (P > 0.05), but significant improvements by 12-months post-injury (P = 0.03, P = 0.02, respectively). Time since injury, male gender, living rurally and parent anxiety were associated with extent of recovery beyond the acute period. CONCLUSIONS Childrens recovery from mild TBI continues beyond the initial 6 months following injury. Health-care providers need to be vigilant about the varying trajectories in childrens recovery from TBI. On-going monitoring of children following injury will enable timely and proactive responses to persistent difficulties, with a view to minimising longer-term adverse consequences.

Mymemory: A mobile memory assistant for people with traumatic brain injury

Abstract Traumatic Brain Injury (TBI) is a major cause of disability in young people in New Zealand, and has long-term effects on memory and other cognitive functions. This article introduces MyMemory, a mobile augmented memory system that aims to assist TBI survivors in coping with their memory impairments. We here present an exploration of design requirements for mobile memory aids for people with TBI, the MyMemory conceptual design and high-level details of the prototype implementation. We report on the results of our A-B-A-B study with six TBI survivors and three caregivers. The participants with TBI all reported improvements when using MyMemory with regards to their well-being, memory function and autobiographical memory. The caregivers confirmed these observations of TBI participants, however, the results regarding possible reductions of caregiver burden are mixed.

Unmoving and unmoved: experiences and consequences of impaired non-verbal expressivity in Parkinson’s patients and their spouses

Abstract Purpose: Hypomimia, or facial masking, is a decrease in voluntary control and spontaneous movement of the muscles of the face, which may occur in Parkinson’s disease. Little is known about the psychosocial consequences or management of this symptom. The aim of this study was to provide an initial overview of patient & spousal experiences of living with an acquired nonverbal expressive impairment in Parkinson’s disease. Method: This qualitative study involved a community sample of individuals with Parkinson’s who experienced facial masking, and their close romantic partners. Nine people who had Parkinson’s and nine of their spouses or partners participated in separate (individual) semi-structured interviews. Results: A descriptive thematic approach was used to analyze the interview data. Key themes relevant to rehabilitation included the misidentification of masking as negative affect, poor symptom recognition, and unmet health resource needs. Conclusions: The results indicate masking can have an adverse impact on close relationships and psychological well-being. This study presents an initial basis for clinicians working with Parkinson’s populations to recognize of the needs of people who experience masking and better support such individuals and their families to live satisfying social and emotional lives. Implications for Rehabilitation People who have Parkinson’s and their families are often unaware facial masking is a symptom of Parkinson’s disease. Masking may be confused with negative affect and become a barrier to satisfying close relationships. Masking related health resources and support are perceived to be of poor availability and quality. This qualitative study suggests masking be considered as an etiology of interpersonal and psychological difficulties in Parkinson’s disease, and encourages better recognition of this unique population’s health education needs.

Parent and child ratings of child behaviour following mild traumatic brain injury

ABSTRACT Background: Mild traumatic brain injury (mTBI) in children is most commonly associated with parent-reported child behaviour problems. The extent to which parent and child ratings align is unknown. Objectives: To examine differences in child behaviour and patterns of recovery over the first 12 months following mTBI based on parent and child self-report. Methods: Ninety-nine children (8–15 years) with mTBI and one of their parents completed the Behavioural Assessment Scale for Children – version 2 to assess child hyperactivity, anxiety and depression at baseline, 1, 6 and 12 months post-injury. Differences between ratings from parents and children were evaluated using Bland–Altman limits of agreement analyses. Child recovery over time was examined using mixed models repeated measures analyses. Results: Parent and child ratings for child hyperactivity, anxiety and depression differed significantly at baseline and these differences remained constant at each follow-up. Parents tended to report more child hyperactivity, anxiety and depression. Over time, parents and children reported fewer child hyperactivity and anxiety problems. Conclusions: Parents and children have poor agreement in ratings of child behaviour yet there is general agreement in patterns of recovery in the year following mTBI. Findings show the importance of considering both parent and self-report of child behaviour.

How am I, really? Perceptions of health and distress by women and their midwives

Abstract Objective: This study examined agreement between ratings of health and emotional distress by women and their midwives. Background: Physical complaints and medical complications during pregnancy can significantly impact a woman’s experience of pregnancy. Previous studies have found that women and their healthcare providers may have differing perceptions of their condition and how they are coping with the challenges of pregnancy. Methods: This study used questionnaires completed by women and their midwives to assess perceptions of health and emotional distress in two contexts. Sixty-eight of the women were on an antenatal unit, hospitalised for complications of their pregnancy; 33 women were a comparison group in community maternity care. Findings: Many women in the hospital experienced high levels of emotional distress and worry about their pregnancy; 45% scored in the clinical range on state anxiety, and 28% screened positive for depression. However, midwives rating emotional distress did not pick up on this consistently, and women and hospital midwives often viewed their health status differently. In the community, women’s ratings of their health were more consistent with the ratings of their midwives, and midwives were attuned to acute anxiety, but had more difficulty picking up on cues to depression. Conclusion: It is challenging, particularly in the unfamiliar and stressful environment of the antenatal unit, for midwives to assess emotional distress and needs for health information. Deliberate screening for antenatal distress might provide the opening for midwives to empower women to identify their options, strengths, and strategies for self-care and emotional resilience.