Sandra Horn

The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury:

Objective: To develop a behavioural assessment based on observations of patients recovering after severe head injury whereby data could be collected by observation and by testing everyday tasks. Design: A prospective observational study of a cohort of 88 consecutive hospital admissions with severe head injury. Setting: Two district general hospitals in the UK. Patients: Eighty-eight consecutive admissions with severe traumatic head injury. Ages ranged from 14 to 67 years, mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Results: Fifty-eight items of behaviour were identified. Paired preference analysis was used to identify a sequence of recovery of these behaviours. The sequence began with arousal and led on to behaviours signalling recovery of social interaction and communication. Subsequent behaviours indicated increasing cognitive organization and return of orientation and memory. The behaviours on the scale are hierarchical and range from coma to emergence from PTA. Conclusions: A scale to assess patients and monitor cognitive recovery after severe head injury has been developed. While individual patients will show some departures from the sequence identified, the scale helps to make explicit the earliest stages of natural recovery patterns after head injury.

Change in identity and self-concept: a new theoretical approach to recovery following a stroke:

Objective: To determine whether respondents reported a change in identity following stroke. Design: A cross-sectional comparison study of perceived changes in the self-concept of stroke respondents and matched hospital volunteers. A questionnaire was administered to stroke respondents in their own homes and to hospital volunteers in their work setting. Participants: Twenty-six first-time stroke survivors who had no severe communication, cognitive or perceptual difficulties or previous physical disability, and who had returned home from hospital up to two years previously. The comparison group were 26 hospital volunteers matched for age, gender and the time from which past self-concept was considered. Main outcome measures: Included the Hospital Anxiety and Depression Scale, Frenchay Activity Index and the Head Injury Semantic Differential Scale to assess past and present self-concept. Results: Overall, individuals described themselves in more negative terms than prior to their stroke. They saw themselves as less interested, capable and independent, (p < 0.001) and less in control, satisfied and active (p < 0.05). They still saw themselves as friendly, calm, caring, hopeful and talkative. The overall self-concept of the comparison group remained positive and stable over a comparable time period. Conclusions: The stroke respondents reported a negative sense of self, reduced social activity and psychological morbidity despite inpatient and outpatient rehabilitation. Individuals following stroke may settle for a restricted future because of their expectations of life with a disability. Clinicians need to be aware of the meaning of the stroke within the life of each individual.

Adherence to chest physiotherapy in adults with cystic fibrosis

Chest physiotherapy (CP) is seen as a cornerstone of Cystic Fibrosis (CF) treatment. However, previous studies have suggested that adherence to CP is low. This study of adults with CF (N = 563) investigated CP adherence and associated factors. Only 29.5 per cent reported undertaking daily CP. Predictors of adherence included problems with fitting CP into lifestyle, a perception that CP does not help, physical consequences of CP, doing exercises instead and doing CP as and when necessary. These variables accounted for 45 per cent of the variance in adherence. Content analysis revealed a number of themes related to adherence to CP. Future studies should explore the benefits of daily CP and attempt to devise simple interventions to maximize adherence to CP.

A review of behavioural assessment scales for monitoring recovery in and after coma with pilot data on a new scale of visual awareness

Abstract The monitoring of behavioural events during and after coma is important in determining the nature and pace of recovery, in detecting early signs of deterioration, in the evaluation of coma stimulation and other rehabilitation programmes, and in identifying the persistent vegetative state. There are a number of difficulties in constructing objective, reliable, valid measures of significant behavioural events which are also easy to administer by the bedside. This paper reviews the many behavioural scales which have been developed in the search for quantifiable data on recovery, and presents some pilot data on a new scale of visual awareness.

The development of new techniques in the assessment and monitoring of recovery from severe head injury: A preliminary report and case history

The case of a 19-year-old male who sustained a severe brain injury is described. This patient was initially given a very gloomy prognosis, leading to poor expectations for recovery. Additionally, like many such patients in the United Kingdom, he was cared for by a ward team who were without specialized training in head injury rehabilitation. Despite these factors the patient went on to make a good recovery. The issues of specialized care and the need for more appropriate patient assessment procedures are raised. The MRC Head Injury Assessment Project is described.

Treatment of agoraphobia by subliminal and supraliminal exposure to phobic cine film.

Three groups of 5 chronically agoraphobic patients were treated by repeated exposure to cine film at weekly intervals for six weeks. A supraliminal group saw an agoraphobic film specially made for the study illustrating a range of phobic situations. A subliminal group viewed the same film at a level of illumination below the threshold of awareness. A control group saw a blank screen with no filmed material for the same length of time. The films were screened five times at each treatment and were alternated with neutral film shown under normal viewing conditions. Ratings of phobic and other symptoms were made by a separate assessor who was unaware of the patients treatment. The supraliminal and subliminal groups improved significantly more than the control group with regard to phobic fears, avoidance, and overall assessment.

Information provision and problem-solving processes in Japanese breast cancer survivors with Lymphoedema symptoms

Scand J Caring Sci; 2012; 26; 53–60 Information provision and problem-solving processes in Japanese breast cancer survivors with lymphoedema symptoms Background:  In Japan, a high proportion of breast cancer (BC) survivors develop lymphoedema as a consequence of the treatment received. Japanese BC survivors are generally not provided with standardised information about risks, early signs and symptom management. The effects of (in)adequate information on the problem-solving processes among Japanese BC survivors with lymphoedema symptoms have not been investigated. Purpose:  The aim of this study was to explore how the provision of medical information by doctors affected the problem-solving processes of Japanese BC survivors with lymphoedema symptoms. Method:  Ten Japanese BC survivors participated in audio-taped focus group discussions. Transcripts were analysed using an inductive thematic analysis. Results:  Analysis identified two phases during which participants attempted to address problems with managing their lymphoedema symptoms – a help-seeking phase and an evaluation phase. Perceptions of information provision affected emotional responses to the onset and cognitive appraisals of lymphoedema symptoms (seen as accepted or burden). However, perceptions of information provision did not affect help-seeking behaviours from surgeons or adherence behaviours. Participants often perceived compression sleeves as inefficient and not worth continuing. Conclusion:  This study suggests that information provision is a key process in helping BC patients to adjust to symptoms of lymphoedema. In order to promote effective symptom management, doctors and nurses should provide support not only during the help-seeking phase but also the evaluation phase. Further research on the most effective ways to change negative treatment beliefs should be conducted.BACKGROUND In Japan, a high proportion of breast cancer (BC) survivors develop lymphoedema as a consequence of the treatment received. Japanese BC survivors are generally not provided with standardised information about risks, early signs and symptom management. The effects of (in)adequate information on the problem-solving processes among Japanese BC survivors with lymphoedema symptoms have not been investigated. PURPOSE The aim of this study was to explore how the provision of medical information by doctors affected the problem-solving processes of Japanese BC survivors with lymphoedema symptoms. METHOD Ten Japanese BC survivors participated in audio-taped focus group discussions. Transcripts were analysed using an inductive thematic analysis. RESULTS Analysis identified two phases during which participants attempted to address problems with managing their lymphoedema symptoms - a help-seeking phase and an evaluation phase. Perceptions of information provision affected emotional responses to the onset and cognitive appraisals of lymphoedema symptoms (seen as accepted or burden). However, perceptions of information provision did not affect help-seeking behaviours from surgeons or adherence behaviours. Participants often perceived compression sleeves as inefficient and not worth continuing. CONCLUSION This study suggests that information provision is a key process in helping BC patients to adjust to symptoms of lymphoedema. In order to promote effective symptom management, doctors and nurses should provide support not only during the help-seeking phase but also the evaluation phase. Further research on the most effective ways to change negative treatment beliefs should be conducted.

Can patients in coma following traumatic head injury learn simple tasks

Abstract Initial observations that patients in coma showed a variety of responses when a cloth was placed over their faces generated a study investigating whether these patients could learn to remove the cloth. A method of backward chaining was used to teach the patients. Three experiments are reported. In the first study, five patients learned to remove the cloth while still in coma. In the second study, patients with a much lower Glasgow Coma Scale (GCS) score underwent the same procedure and all three removed the cloth while still in coma. The third experiment aimed to develop this procedure and two patients were trained to carry out other tasks using the same backward chaining technique. Both carried out the tasks while still in coma. The results of the study demonstrate that patients in coma following traumatic head injury developed increasingly reliable responses to specific stimuli. The theoretical and practical implications of these results are discussed.

The ten pound note test' : Suggestions for eliciting improved responses in the severely brain-injured patient

The severely brain-injured patient may demonstrate a limited repertoire of responses. Anecdotal accounts suggest that stimuli of personal relevance, or of an unusual or innovatory nature, may sometimes elicit more meaningful responses. Two cases of severe acquired brain injury are described, in whom overall levels of responsiveness had been very low since coma ended. The use of stimuli with personal relevance provoked strong responses and presaged further behavioural change. The implications are discussed.

Positive changes in Japanese breast cancer survivors: a qualitative study

Despite traumatic experiences of cancer, survivors often report positive changes. Since little research has been conducted into such changes among Japanese breast cancer survivors, our knowledge is minimal. This qualitative study aimed to explore the nature of the positive changes among this group. A thematic analysis suggested that participants had experienced seven types of positive change: Attitudinal changes towards life, strengthening trust in family and friends, increased appreciation of life, self-development, future perspectives, education for friends, and efforts towards bodily change. Awareness of vulnerability in life, received social support and social comparisons appear to trigger some of the positive changes.