Efficacy and Acceptability of Reduced Intensity Constraint-Induced Movement Therapy for Children Aged 9–11 years with Hemiplegic Cerebral Palsy: A Pilot Study

OBJECTIVE: Assess efficacy and acceptability of reduced intensity constraint-induced movement therapy (CIMT) in children with cerebral palsy (CP).

METHODS: Single-subject research design and semi-structured interviews. Children (9-11y) with hemiplegia underwent five baseline assessments followed by two weeks CIMT. Six further assessments were performed during treatment and follow-up phases. The primary outcome was the Melbourne Assessment of Unilateral Upper Limb Function (MUUL). Quantitative data were analysed using standard single-subject methods and qualitative data by thematic analysis.

RESULTS: Four of the seven participants demonstrated statistically significant improvements in MUUL (3-11%, p < .05). Two participants achieved significant improvements in active range of motion but strength and tone remained largely unchanged. Qualitative interviews highlighted limitations of the restraint, importance of family involvement, and coordination of treatment with education.

CONCLUSIONS: Reduced intensity CIMT may be effective for some children in this population; however it is not suitable for all children with hemiplegia.

Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements

Background: Previous studies show that chronic hemiparetic patients after stroke, presents inabilities to perform movements in paretic hemibody. This inability is induced by positive reinforcement of unsuccessful attempts, a concept called learned non-use. Forced use therapy (FUT) and constraint induced movement therapy (CIMT) were developed with the goal of reversing the learned non-use. These approaches have been proposed for the rehabilitation of the paretic upper limb (PUL). It is unknown what would be the possible effects of these approaches in the rehabilitation of gait and balance. Objectives: To evaluate the effect of Modified FUT (mFUT) and Modified CIMT (mCIMT) on the gait and balance during four weeks of treatment and 3 months follow-up. Methods: This study included thirty-seven hemiparetic post-stroke subjects that were randomly allocated into two groups based on the treatment protocol. The non-paretic UL was immobilized for a period of 23 hours per day, five days a week. Participants were evaluated at Baseline, 1st, 2nd, 3rd and 4th weeks, and three months after randomization. For the evaluation we used: The Stroke Impact Scale (SIS), Berg Balance Scale (BBS) and Fugl-Meyer Motor Assessment (FM). Gait was analyzed by the 10-meter walk test (T10) and Timed Up & Go test (TUG). Results: Both groups revealed a better health status (SIS), better balance, better use of lower limb (BBS and FM) and greater speed in gait (T10 and TUG), during the weeks of treatment and months of follow-up, compared to the baseline. Conclusion: The results show mFUT and mCIMT are effective in the rehabilitation of balance and gait. Trial Registration ACTRN12611000411943.

Eficácia dos protocolos modificados de constraint induced movement therapy na função motora e desempenho de atividades diárias

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Art as an educative and social tool

Since remote times, certain sectors of society have been exposed to inequality and vulnerability, where adequate intervention processes have become conspicuous because of their absence. Nowadays, current societies have the responsibility of contributing, based on their experience and knowledge, with more efficient policies and programs that improve the life quality of the most disadvantaged. It is here where art and its different tools play a very important role, not only on a physical level, but also as an education tool that allows the development of emotional, mental and communicative skills. The aim of this paper is to make clear the potential of art as an instrument of social and educational intervention. It starts by showing worldwide-collected experience related to education and arts, and then, it acquaints the reader with two parallel intervention projects that worked with youths under social vulnerability conditions. These interventions were developed based on a qualitative research (Grounded theory), using as methodology “The Artistic Mediation” with emphasis on body language. This methodology helped researchers to get close to the participants and to know their experiences and emotions. At the same time, it was possible to evidence the positive effects of educative interventions through art. These workshops were based on an artistic methodology especially focused on body language. Data in this work is qualitative, and as such, it permits a special approach to the personal and emotional experiences of the participants; clearly showing the positive effects of the referenced practice on them.

Tanztherapie in der Psychoonkologie : Auswirkungen der Intervention auf die gesundheitsbezogene Lebensqualität

Das Ziel der vorliegenden Arbeit ist es zu prüfen, ob Tanztherapie einen Effekt auf dieLebensqualität bei Brustkrebspatientinnen hat. Brustkrebs ist die häufigste Krebserkrankungbei Frauen in Deutschland. Verbesserte Behandlungsformen und Früherkennungsmaßnahmenführen zu einem Anstieg der Überlebensrate. Dennoch bedingen ein langerBehandlungsweg und Unsicherheit über den Verlauf der Krankheit hohe Belastungen undUnsicherheiten. Nebenwirkungen und Langzeitfolgen der Interventionen beeinflussen zudemdie gesundheitsbezogene Lebensqualität. Körper und Psyche werden stark beansprucht undleiden. Die Psychoonkologie stellt dabei einen Teil des Behandlungsweges dar. Sie bildetesich aus der Erkenntnis heraus, dass die Krebserkrankung nicht nur den Körper beeinflusst,sondern den gesamten Menschen mit seiner seelischen und geistigen Verfassung. DieTanztherapie ist eine Maßnahme im Kanon der psychoonkologischen Betreuung. Sie vereintkörperliche Betätigung und kreative Ausdrucksmöglichkeiten. Psyche und Körper werden beidieser Therapieform angesprochen. Im Gruppensetting fließt zudem die soziale Komponentemit ein. Die These lautet demnach, dass Tanztherapie positive Auswirkungen auf diegesundheitsbezogenen Lebensqualität hat. Denn Körper, Psyche und soziales Umfeld sindTeile der Lebensqualität. Das methodische Vorgehen dieser Arbeit setzte sich aus demRecherchieren von relevanten Studien, Reviews und Metaanalysen zusammen. Es wurdendie Datenbanken Google Scholar, PubMed, PsyCONTENT und Springer Link bis zum Jahre2014 durchsucht. Schlüsselworte waren dabei Tanztherapie, Psychoonkologie, Krebspatient,Lebensqualität, gesundheitsbezogene Lebensqualität, künstlerische Therapie,dance/movement therapy, cancer patient, quality of life, health related quality of life.

Impacto de la auto - percepción de imagen corporal en sujetos con VIH y lipoatrofia facial.

La lipoatrofia facial es uno de los efectos secundarios que con más frecuencia se presenta y afecta la calidad de vida del paciente con VIH que recibe tratamiento antiretroviral. Metodología: Estudio observacional de corte transversal que involucró 126 sujetos, a quienes se aplicó una encuesta semi-estructurada para determinar cómo percibe el paciente que la lipoatrofia facial lo afecta en áreas afectiva, social, laboral y ocupacional; evaluar la percepción de la imagen corporal; caracterizar sociodemográficamente; determinar la prevalencia de lipoatrofia facial y establecer si hay diferencias de percepción de la imagen corporal según la caracterización sociodemográfica. Resultados: La Prevalencia de lipoatrofia facial fue del 57.1%. El grado de satisfacción en cuanto a apariencia física tuvo un promedio de 5.01±2.69. El 88.7% y 80.3% de los pacientes evaluados sintieron tristeza y frustración con su apariencia respectivamente. El 53.5% y el 42.9% informaron menos oportunidades laborales y educativas. La orientación sexual reportada con mayor frecuencia fue homosexualidad. No hubo diferencias estadísticamente significativas entre el grado de satisfacción de apariencia con aspectos sociodemográficos excepto en pacientes que recibieron apoyo psicológico. Conclusión: Primer estudio en el país que evalúa el impacto de la lipoatrofia facial en pacientes con VIH y tratamiento antiretroviral. Aunque la presencia de lipoatrofia facial sobre la cotidianidad no es estadísticamente significativa, si resulta trascendental pues existen porcentajes importantes de emociones y alteraciones psicológicas que afectan directamente a estos sujetos en las áreas afectiva, social, laboral y ocupacional. Se hace necesaria la realización de más estudios que permitan obtener mayor de evidencia.

Moviéndonos hacia el final de nuestros días.

Este capítulo presenta algunas de las aventajas que el trabajo de la Danza Movimiento Terapia (DMT) brinda para los cuidados paliativos. A través de dos viñetas clínicas se despliega la importancia de un acompañamiento empático kinestésico, una escucha y presencia más allá de las palabras. Se muestra como la DMT ofrece una posibilidad de una participación activa y constructiva hacía la resiliencia, trabajando así con memoria corporal de la persona. El trabajo corporal permite conectarse con memorias anteriores, rescatando así momentos valiosos de una vida llena y rica, momentos tal vez enterrados por el sufrimiento y dolor de esta última etapa de la vida.

Consideraciones alrededor de la Danza-movimiento Terapia y sus aplicaciones en el ámbito social

El artículo presenta aspectos generales sobre la Danza Movimiento Terapia (DMT). Aborda sus orígenes históricos y su evolución en las últimas décadas. La DMT es un modelo de intervención psicoterapéutica, que comparte numerosos elementos con otras terapias creativas, y cuya singularidad se encuentra en la consideración de las manifestaciones no verbales y el movimiento creativo dentro de un proceso terapéutico. Se hace hincapié en su aspecto multidisciplinar y en su creciente aplicación en entornos sociales y educativos como un modo de promover y potenciar la salud. Finalmente, se presenta brevemente la situación actual de la profesión en España enmarcada en el contexto europeo.

Die Integration von Tanz, Bewegung und Psychotherapie durch den Embodimentansatz

Die AutorInnen diskutieren die Frage der Integration von Tanz und Bewegung in die Psychotherapie. Wenn man die Entwicklungen in der Psychologie und Psychotherapieforschung betrachtet, insbesondere die neuere Forschung zum Embodiment der Kognition und die Wirkfaktorendiskussion in der Psychotherapie, eröffnen sich verschiedene solche Möglichkeiten. Unser Überblick macht deutlich, dass mit Tanz und Bewegung allgemeine psychotherapeutische Wirkmechanismen angesprochen werden können und die Forderungen, die sich aus der Embodimentperspektive ergeben, berücksichtigt würden. Ein Praxisbericht zur integrativen Therapie nach dem Zürcher Ressourcen Modell ZRM belegt die Machbarkeit und das Potenzial einer um Tanz und Bewegung erweiterten Psychotherapie.

"Rebirth: Combined art performance"--Shirin Madg & Sweet Sound Ensemble

Vanessa Mafe-Keane was invited to participate as choreographer in Iranian singer Shirin Madg 's project, Rebirth: Combined art performance. This project integrated singing, music, visual-art, film, dance and is based on the dissident poetry of female Iranian poet, Forough Farrokhzad. The choreographic dance movement focused on simple, lyrical, flowing classical dance forms that also incorporated everyday gestures and actions performed by two Queensland dancers, Caitlin MacKenzie and Abby Johnson. The choreographic intention was not to attempt to re-create Iranian dance practices instead, to draw inspiration and reference specific movement qualities. This was achieved through the subtle inclusion of spinning movements and focusing attention on the dancers’ arms and upper torso. This fusion became an underlying theme reflected throughout the choreographic component. Additionally, this project presented an opportunity to draw on past experiences and problem-solve ways to construct choreographic work where the dancers and the musical assemble group could be staged side by side. This experience highlighted differing approaches to rehearsal protocols within disciplines, the practicalities of staging different artists, understanding musical cues and the diversity of audience engagement. Performances: BEMAC Multicultural Centre, Brisbane 06 February 2015 and Helensvale Cultural Centre, Gold Coast 07 February 2015

Why the Constraints-Led Approach is not teaching games for understanding: A clarification

Background There is some apparent confusion regarding similarities and differences between two popular physical education (PE) pedagogical frameworks, that is, the Constraints-Led Approach (CLA) and Teaching Games for Understanding (TGfU). Purpose Our aim in this commentary is to detail important theoretical and pedagogical concepts that distinguish these approaches, as well as to recognise where commonalities exist. Findings In particular, we note that TGfU had its roots in the 1960s in the absence of a substantial theoretical framework, although several attempts to retrospectively scaffold theories around TGfU have subsequently emerged in the literature. TGfU is a learner-centred approach to PE in which teachers are encouraged to design modified games to develop the learner's understanding of tactical concepts. In contrast, the CLA has arisen more recently from the umbrella of Nonlinear Pedagogy (NLP), emerging from the empirically rich theoretical framework of ecological dynamics. The CLA adopts a ‘learner–environment’ scale of analysis in which practitioners are encouraged to identify and modify interacting constraints (of task, environment and learner) to facilitate the coupling of each learner's perceptual and action systems during learning. The CLA is a broader framework which has been adapted for the design of (re)learning environments in PE, sport and movement therapy. Other key distinctions between the approaches include: the overall goals; the way in which the learner and the learning process are modelled; the use of questioning as a pedagogical tool; the focus on individual differences vs. generic concepts; and how progressions and skill interjections are planned and implemented. Conclusions Despite such distinctions, the two approaches are somewhat harmonious and key similarities include: their holistic perspective of the learner; the proposed role of the teacher and the design characteristics of learning tasks in each. Both TGfU and the CLA have a powerful central focus on the nature of learning activities undertaken by each individual learner. This clarification of TGFU and the CLA is intended to act as a catalyst for more empirical work into the complementarity of these juxtaposed pedagogical approaches to learning design.

Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

Spectres of Shakespeare:Ong Keng Sen’s Search: Hamlet and the Intercultural Myth

Arguably, the myth of Shakespeare is a myth of universality. Much has been written about the dramatic, thematic and ‘humanistic’ transference of Shakespeare’s works: their permeability, transcendence of cultures and histories, geographies and temporalities. Located within this debate is a belief that this universality, among other dominating factors, is founded upon the power and poeticism of Shakespeare’s language. Subsequently, if we acknowledge Frank Kermode’s assertion that “the life of the plays is the language” and “the secret (of Shakespeare’s works) is in the detail,” what then becomes of this myth of universality, and how is Shakespeare’s language ‘transferred’ across cultures? In Asian intercultural adaptations, language becomes the primary site of confrontation as issues of semantic accuracy and poetic affiliation abound. Often, the language of the text is replaced with a cultural equivalent or reconceived with other languages of the stage – song and dance, movement and music; metaphor and imagery consequently find new voices. Yet if myth is, as Roland Barthes propounds, a second-order semiotic system that is predicated upon the already constituted sign, here being language, and myth is parasitical on language, what happens to the myth of Shakespeare in these cultural re-articulations? Wherein lies the ‘universality’? Or is ‘universality’ all that it is – an insubstantial (mythical) pageant? Using Ong Keng Sen’s Search Hamlet (2002), this paper would examine the transference of myth and / as language in intercultural Shakespeares. If, as Barthes argues, myths are to be understood as metalanguages that adumbrate social hegemonies, intercultural imaginings of Shakespeare can be said to expose the hollow myth of universality yet in a paradoxical double-bind reify and reinstate this self-same myth.

'What ever happened to breakdancing?' : transnational b-boy/b-girl networks, underground video magazines and imagined affinities

In 1997, Paul Gilroy was able to write: "I have been asking myself, whatever happened to breakdancing" (21), a form of vernacular dance associated with urban youth that emerged in the 1970s. However, in the last decade, breakdancing has experienced a massive renaissance in movies (You Got Served), commercials ("Gotta Have My Pops!") and documentaries (the acclaimed Freshest Kids). In this thesis, 1 explore the historical development of global b-boy/bgirl culture through a qualitative study involving dancers and their modes of communication. Widespread circulation of breakdancing images peaked in the mid-1980s, and subsequently b-boy/b-girl culture largely disappeared from the mediated landscape. The dance did not reemerge into the mainstream of North American popular culture until the late 1990s. 1 argue that the development of major transnational networks between b-boys and b-girls during the 1990s was a key factor in the return of 'b-boying/b-girling' (known formerly as breakdancing). Street dancers toured, traveled and competed internationally throughout this decade. They also began to create 'underground' video documentaries and travel video 'magazines.' These video artefacts circulated extensively around the globe through alternative distribution channels (including the backpacks of traveling dancers). 1 argue that underground video artefacts helped to produce 'imagined affinities' between dancers in various nations. Imagined affinities are identifications expressed by a cultural producer who shares an embodied activity with other practitioners through either mediated texts or travels through new places. These 'imagined affinities' helped to sustain b-boy/b-girl culture by generating visual/audio representations of popularity for the dance movement across geographical regions.