Occupational therapy assessment of self-awareness following traumatic brain injury

Impaired self-awareness is a common problem following traumatic brain injury. Without adequate self-awareness, a person's motivation to participate in rehabilitation may be limited, which in turn can have an adverse effect on his or her functional outcome. For this reason, it is important that brain injury rehabilitation professionals, including occupational therapists, both understand this phenomenon and use assessment and treatment approaches aimed at improving clients' self-awareness. This article provides an overview of self-awareness, reviewing the distinction between intellectual and online awareness. The current role of occupational therapy in the assessment of self-awareness is highlighted and the guidelines for new assessments of self-awareness suitable for use in occupational therapy are explored.

ATP-dependent K+ channels in renal ischemia reperfusion injury

ATP-dependent K+ channels (K-ATP) account for most of the recycling of K+ which enters the proximal tubules cell via Na, K-ATPase. In the mitochondrial membrane, opening of these channels preserves mitochondrial viability and matrix volume during ischemia. We examined KATP channel modulation in renal ischemia-reperfusion injury (IRI), using an isolated perfused rat kidney (IPRK) model, in control, IRI, IRI + 200 muM diazoxide (a K-ATP opener), IRI + 10 muM glibenclamide (a K-ATP blocker) and IRI + 200 muM diazoxide + 10 muM glibenclamide groups. IRI was induced by 2 periods of warm ischemia, followed by 45 min of reperfusion. IRI significantly decreased glomerular filtration rate (GFR) and increased fractional excretion of sodium (FENa) (p < 0.01). Neither diazoxide nor glibenclamide had an effect on control kidney function other than an increase in renal vascular resistance produced by glibenclamide. Pretreatment with 200 muM diazoxide reduced the postischemic increase in FENa (p < 0.05). Adding 10 muM glibenclamide inhibited the diazoxide effect on postischemic FENa (p < 0.01). Histology showed that kidneys pretreated with glibenclamide demonstrated an increase in injure in the thick ascending limb of outer medulla (p < 0.05). Glibenclamide significantly decreased post ischemic renal vascular resistance (p < 0.05). but had no significant effect on other renal function parameters. Our results suggest that sodium reabsorption is improved by K-ATP activation and blockade of K-ATP channels during IRI has an injury enhancing effect on renal epithelial function and histology. This may be mediated through K-ATP modulation in cell and or mitochondrial inner membrane.

Repetitive brief ischemia: Intermittent reperfusion during ischemia ameliorates the extent of injury in the perfused kidney

Acute renal failure commonly follows reduced renal perfusion or ischemia. Reperfusion is essential for recovery but can itself cause functional and structural injury to the kidney. The separate contributions of ischemia and of reperfusion were examined in the isolated perfused rat kidney. Three groups were studied: brief (5 min) ischemia, 20 min ischemia, and repetitive brief ischemia (4 periods of 5 min) with repetitive intervening reperfusion of 5 min. A control group had no intervention, the three ischemia groups were given a baseline perfusion of 30 min before intervention and all groups were perfused for a total of 80 min. In addition, the effects of exogenous (NO)-N-. from sodium nitroprusside and xanthine oxidase inhibition by allopurinol were assessed in the repetitive brief ischemia-reperfusion model. Brief ischemia produced minimal morphological injury with near normal functional recovery. Repetitive brief ischemia reperfusion caused less functional and morphological injury than an equivalent single period of ischemia (20 min) suggesting that intermittent reperfusion is less injurious than ischemia alone over the time course of study. Pretreatment with allopurinol improved renal function after repetitive brief ischemia-reperfusion compared with the allopurinol-untreated repetitive brief ischemia-reperfusion group. Similarly, sodium nitroprusside reduced renal vascular resistance but did not improve the glomerular filtration rate or sodium reabsorption in the repetitive brief ischemia-reperfusion model. Thus, these studies show that the duration of uninterrupted ischemia is more critical than reperfusion in determining the extent of renal ischemia-reperfusion injury and that allopurinol, in particular, counteracts the oxidative stress of reperfusion.

Electropalatographic assessment of tongue-to-palate contacts exhibited in dysarthria following traumatic brain injury: Spatial characteristics

Consonant imprecision has been reported to be a common feature of the dysarthric speech disturbances exhibited by individuals who have sustained a traumatic brain injury (TBI). Inaccurate tongue placements against the hard palate during consonant articulation may be one factor underlying the imprecision. To investigate this hypothesis, electropalatography (EPG) was used to assess the spatial characteristics of the tongue-to-palate contacts exhibited by three males (aged 23-29 years) with dysarthria following severe TBI. Five nonneurologically impaired adults served as control subjects. Twelve single-syllable words of CV or CVC construction (where initial C = /t, d, S, z, k, g/, V=/i, a/) were read aloud three times by each subject while wearing an EPG palate. Spatial characteristics were analyzed in terms of the location, pattern, and amount of tongue-to-palate contact at the frame of maximum contact during production of each consonant. The results revealed that for the majority of consonants, the patterns and locations of contacts exhibited by the TBI subjects were consistent with the contacts generated by the group of control subjects. One notable exception was one subject's production of the alveolar fricatives in which complete closure across the palate was demonstrated, rather than the characteristic groove configuration. Major discrepancies were also noted in relation to the amount of tongue-to-palate contact exhibited, with two TBI subjects consistently demonstrating increased contacts compared to the control subjects. The implications of these findings for the development of treatment programs for dysarthric speech disorders subsequent to TBI are highlighted.

EMA analysis of tongue function in children with dysarthria following traumatic brain injury

Primary objective : To investigate the speed and accuracy of tongue movements exhibited by a sample of children with dysarthria following severe traumatic brain injury (TBI) during speech using electromagnetic articulography (EMA). Methods and procedures : Four children, aged between 12.75-17.17 years with dysarthria following TBI, were assessed using the AG-100 electromagnetic articulography system (Carstens Medizinelektronik). The movement trajectories of receiver coils affixed to each child's tongue were examined during consonant productions, together with a range of quantitative kinematic parameters. The children's results were individually compared against the mean values obtained by a group of eight control children (mean age of 14.67 years, SD 1.60). Main outcomes and results : All four TBI children were perceived to exhibit reduced rates of speech and increased word durations. Objective EMA analysis revealed that two of the TBI children exhibited significantly longer consonant durations compared to the control group, resulting from different underlying mechanisms relating to speed generation capabilities and distances travelled. The other two TBI children did not exhibit increased initial consonant movement durations, suggesting that the vowels and/or final consonants may have been contributing to the increased word durations. Conclusions and clinical implications : The finding of different underlying articulatory kinematic profiles has important implications for the treatment of speech rate disturbances in children with dysarthria following TBI.

Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months

CONTEXT: Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants. OBJECTIVE: To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants. DESIGN: Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP). SETTING AND PARTICIPANTS: A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks. MAIN OUTCOME MEASURES: Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness. RESULTS: Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury, and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively. CONCLUSION: In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.

Injury related risk behavior - a study of Australian skydivers

Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour - ie, risk assessment and risk acceptance - in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05), gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% Cl; 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1.19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.

Motivations in volunteer work

The objective of this paper is to review and discuss the literature about volunteers’ motivations to donate their time to NGOs (Non Governmental Organisations). According to Parboteeah, Cullenb & Lim (2004) management research has not paid much attention to voluntarism, however, voluntarism is a substantial part of productive work for many societies. Wilson & Pimm (1996) show that in Great Britain about 39% of the adult population has been involved in some volunteer activity for some period of time. In the U.S.A. these values reach 50% (Wilson & Pimm, 1996). Considering the benefits that voluntarism can bring to an organisation, we understand that more attention must be devoted to this phenomenon. The more an organisation knows volunteers, the better this organisation will be able to meet the needs and expectations of these individuals. We present a literature review that illustrates and compares the different motivations associated with volunteer work. The paper includes a bibliographical databases search in specialised journals. The search used the key words “motivations” and “voluntarism” (in the heading and text body) and covered all numbers between 2000 and 2007. We identify the existence of repeated motivations (Holmberg & Söderlung, 2005; Prouteau & Wolff, 2008; Soupourmas & Ironmonger, 2001; Yavas & Riecken, 1997), which allow the establishment of a typology of volunteers’ motivations, based on four categories: altruism, social needs, self-esteem, learning and self-development. Finally we identify three main gaps in the literature that justify further research. First, research focusing on the differences between motivations related to volunteers’ "Attraction" versus "Retention" in NGO’s is nil. Second, the great majority of the studies rely on north American (USA and Canada) and Australian context, which demands for further research in European countries. Third, the majority of NGOs researched are related to sport, art or the environment, and it would be interesting to explore the relationship between motivation and NGO type. These questions may obtain interesting answers for NGO management, in particular with regard to volunteer attraction and retention.

Motivations and management factors of volunteer work in nonprofit organisations: a literature review

The objective of this paper is to review and discuss the literature about volunteers’ motivations to donate their time to NPOs and the management factors that can influence volunteer work. Firstly, the paper illustrates and compares the different types of motivation followed by a presentation of a typology that organises the volunteers’ motivations into four types: (i) altruism, (ii) belonging, (iii) ego and social recognition and (iv) development and learning. Secondly we discuss the key management factors in volunteering: recruitment, training and rewarding. Finally, we present four gaps in the literature that justify the scope for further research: (i) omission of differences between motivations related to volunteers’ "Attraction" versus "Retention"; (ii) focus of the research on the USA, UK and Australia context; (iii) absence of comparative analyses that relate motivations by NPO types and (iv) comprehension of how management factors (recruitment, training and rewarding) influence volunteers’ satisfaction and retention.

Organisational influence on volunteer satisfaction and attitudes towards HRM practices: the case of hospital volunteers

We examine volunteer satisfaction with HRM practices, namely recruitment, training and reward in NPOs and attitudes regarding the appropriateness of these practices. The participants in this study are 76 volunteers affiliated with four different NPOs, who work in hospitals and have direct contact with patients and their families. Analysing aggregate results we show that volunteers are more satisfied with training, and consider the training strategies to be very appropriate. After identifying differences between organisations we discover that in some organisations volunteers are satisfied with rewards but they have negative attitudes regarding the appropriateness of the recognition strategies. We also identify the volunteers who are the most and the least satisfied.

Mapping non-suicidal self-injury in adolescence: Development and confirmatory factor analysis of the impulse, self-harm and sucidal ideation questionnaire for adolescents (ISSIQ-A)

Non-suicidal self-injury (NSSI) is the deliberate, self-inflicted destruction of body tissue without suicidal intent and an important clinical phenomenon. Rates of NSSI appear to be disproportionately high in adolescents and young adults, and is a risk factor for suicidal ideation and behavior. The present study reports the psychometric properties of the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A), a measure designed to comprehensively assess the impulsivity, NSSI behaviors and suicide ideation. An additional module of this questionnaire assesses the functions of NSSI. Results of Confirmatory Factor Analysis (CFA) of the scale on 1722 youths showed items' suitability and confirmed a model of four different dimensions (Impulse, Self-harm, Risk-behavior and Suicide ideation) with good fit and validity. Further analysis showed that youth׳s engagement in self-harm may exert two different functions: to create or alleviate emotional states, and to influence social relationships. Our findings contribute to research and assessment on non-suicidal self-injury, suggesting that the ISSIQ-A is a valid and reliable measure to assess impulse, self-harm and suicidal thoughts, in adolescence.