The clinical effectiveness of a multisensory therapy on clients with developmental disability

Many clients in Hong Kong with developmental disabilities stay in mental hospitals because of mental disorders and behavioural problems. There is a need to identify strategies that promote psychological well-being and reduce problem behaviours in this group of clients. This study evaluates the impact of multisensory therapy on participants’ emotional state, level of relaxation, challenging behaviour, stereotypic self-stimulating behaviour (SSB) and adaptive behaviour (AB). Using an experimental design, 89 participants were recruited from a developmental disability unit in a hospital in Hong Kong and randomly assigned to either an experimental (n = 48) or a control group (n = 41). Multisensory therapy sessions (n = 36) were conducted with experimental group and activity sessions (n = 36) were conducted with controls for 12 weeks. Multisensory therapy promoted participants’ positive emotions and relaxation. However, there was no evidence that multisensory therapy was superior to activity therapy in reducing aggressive behaviour and stereotypic self-stimulating behaviour or promoting adaptive behaviour. The key variables that influence clients’ behaviours in the multisensory therapy may be related to the relationship with the carer, constant environment, relaxation and freedom from demands rather than sensory input. Multisensory therapy could be used to provide leisure and promote psychological well-being, rather than for reducing problem behaviour.

Involuntary glottal closure during inspiration in muscle tension dysphonia

Objective/Hypothesis: The purpose of this study was to examine respiratory function in a group of patients with muscle tension dysphonia (MTD) Design: Cross-sectional analytical study. Methods: Participants included 15 people with a diagnosis of MTD referred to speech pathology for management of their voice disorder, fiberoptic evidence of glottal or supraglottic constriction during phonation with or without posterior chink, or bowing combined and deviation in perceptual voice quality. A second group of 15 participants with no history of voice disorder served as healthy controls,. Baseline pulmonary function test measures included forced expiratory volume in the first second (FEV1), FVC, FEF25 to 75, FIF50, FEV1/FVC, ratio and FEF50/FIF50 ratio. Hypertonic saline challenge test measures included FEV1 and FIF50 after provocation, close response slope, and provocation dose. Results: Compared with healthy controls, participants with MTD demonstrated a higher prevalence of glottal constriction during inspiration after provocation with nebulized hypertonic saline as demonstrated by a reduction in FIF50 after the hypertonic saline challenge. There was no significant difference between the MTD and healthy control groups in baseline pulmonary function testing. Participants with MTD demonstrated a higher prevalence than healthy controls of abnormal glottic closure during inspiration similar to paradoxical vocal fold movement (PVFM). This suggests that they either had previously undiagnosed coexisting PVFM or that the condition of MTD could be expanded to include descriptions of aberrant glottic function during respiration. This study enhances the understanding of PVFM and MTD by combining research advances made in the fields of otolaryngology and respiratory medicine.

Discrepancy between older clients' ability to read and comprehend and the reading level of written educational materials used by occupational therapists

OBJECTIVE. The match between the reading level of occupational therapy education materials and older clients' reading ability and comprehension was determined. The sociodemographic and literacy characteristics that influenced clients' reading ability and comprehension were investigated. METHOD. The reading level of 110 written education materials (handouts, brochures, and information leaflets), distributed to older clients (65 years of age and older) by occupational therapists working in Queensland hospitals, was analyzed using the Flesch formula. The reading ability of 214 older persons (mean age 77 years, 63% female) was assessed using the Rapid Estimate of Adult Literacy in Medicine. Participants' comprehension of information of increasing reading difficulty was measured using the Cloze procedure. RESULTS. The written materials required a mean reading level between the ninth and tenth grades. Participants' mean reading ability was seventh to eighth grade. Therefore some materials may have been too difficult for participants to read and understand. Participants with a managerial or professional or clerical background (p = 0.001) and those who perceived they read well (p = 0.001) had a significantly higher reading ability, Older age was significantly related to poorer comprehension (p = 0.018), with participants 75 years of age and over having a mean comprehension score of 25.6 compared to 30.3 for those 65 to 74 years of age. CONCLUSION. Occupational therapists must analyze the reading level of the written education materials they develop for and use with clients by applying readability formulas. There should be a match between the reading level of written materials and clients' reading ability. Clients' reading ability may be assessed informally by discussing years of education and literacy habits or formally using reading assessments. Content and design characteristics should be considered when developing written education materials for clients.

Feel it and deal with it: mental health practitioners' experiences of exposure to the trauma of survivor clients

Empathic engagement by the trauma therapist with another person's traumatic experiences is believed to create risks for the helping professional. Much attention has been focused upon the mental health professional experiencing symptoms of distress as a result of their exposure to the material of clients who survive traumatic incidents. This thesis contains the findings of a qualitative study that centres on a group of male mental health professionals and their experiences of exposure to the trauma material of survivor clients. The participants of the study practise within an internal Employee Assistance Program that provides, among other duties, a 24 hour, 7 day response to critical incidents to a heavy transport industry. Using semi-structured, in-depth interviews, the effects on the trauma therapists are explored by analysing their reactions to their survivor clients' accounts, the impact of these experiences upon their psychological schema, the organisational culture in which they practise and its influence upon their experiences and the methods participants use to cope with the psychological effects of exposure to trauma material. Participants' experiences are closely examined for critical comparisons with vicarious traumatization. Therapists' responses reveal their continued ability and motivation to empathically engage with the trauma material of survivor clients despite the potential risks.

Marital counselling: follow-up study of marriage guidance clients: perceptions of the agency, the process and outcomes. Available in 2 volumes.

This study is a consumer-survey conducted with former Marriage Guidance Council clients. The objectives were to identify and examine why they chose the agency, what their expectations and experiences were of marital counselling and whether anything was achieved. The material was derived from tape recorded interviews with 51 former M.G. clients (17 men and 34 women) from 42 marriages and with 21 counsellors; data from written material and a card-sort completed by the research sample; and the case record sheets of the research population (174 cases). The results from the written data of clients showed that 49% were satisfied with counselling, 25.5% were satisfied in some ways but not in others, and 25.5% were dissatisfied. Forty-six percent rated they had benefited from counselling, either a great deal or to some degree, 4% were neutral and 50% recorded they had not benefited. However the counsellors' assessments were more optimistic. It was also ascertained that 50% of the research sample eventually separated or divorced subsequent to counselling. A cross-check revealed that the majority who rated they were satisfied with counselling were those who remained married, whilst dissatisfied clients were the ones who unwillingly separated or divorced. The study then describes, discusses and assesses the experiences of clients in the light of these findings on a number of dimensions. From this it was possible to construct a summary profile of a "successful" client describing the features which would contribute to "success". Two key themes emerged from the data. (1) the discrepancy between clients expectations and the counselling offered, which included mis­ match over the aims and methods of counselling, and problem definition; and (2) the importance of the client/counsellor relationship. The various implications for the agency are then discussed which include recommendations on policy, the training of counsellors and further research.

Empowerment through education : enhancing quality of life of clients on anticoagulant therapy

This particular study was a sub-study of an on-going investigation by Porter and Kazcaraba (1994) at the Veterans Administration Medical Center in Miami. While the Porter and Kazcaraba study utilizes multiple measures to determine the impact of nurse patient collaborative care on quality of life of cardiovascular patients receiving anticoagulant therapy, this study sought to find whether health education could empower similar clients to improve their quality of life. A health education program based on Freire's belief that shared collective knowledge empowers individuals to improve their lives and their community and Porter's nurse patient collaborative care model was used. Findings on a sample of thirty-eight subjects revealed strong correlations between self-esteem and life satisfaction as well as a trend towards increased power post-treatment. No group comparisons were made at posttest because the sample size was too small for meaningful statistical analysis.

A postcolonial queer analysis of aboriginal queer clients' experiences of health care services in St. John's, Newfoundland

This thesis examines the gaps between health care services aimed at Aboriginal queer individuals living in St. John’s, Newfoundland and their health care needs. I used a multi-methods research design that includes interviews and demographic surveys, unobtrusive observation and qualitative content analysis. I conducted semi-structured interviews with institutional representatives from selected health related organizations – Eastern Health, Planned Parenthood Newfoundland and Labrador, the AIDS Committee of Newfoundland and Labrador, and St. John’s Native Friendship Center; as well as a transgender activist and three people who identify as Aboriginal and queer. I conducted observational research at two public seminars on Aboriginal people and health. Finally, I carried out qualitative content analysis of organizational reports and webpages of the selected community organizations. Using a postcolonial queer framework that analyzes how Newfoundland and Labrador’s colonial history is reflected in current health care realities I argue that the lack of appropriate services and culturally insensitive delivery of services reproduce the historical marginalization of an already vulnerable group.