Identifying constraints on children with movement difficulties : implications for pedagogues and clinicians

A constraints- based framework for understanding processes of movement coordination and control is predicated on a range of theoretical ideas including the work of Bernstein (1967), Gibson (1979), Newell (1986) and Kugler, Kelso & Turvey (1982). Contrary to a normative perspective that focuses on the production of idealized movement patterns to be acquired by children during development and learning (see Alain & Brisson, 1986), this approach formulates the emergence of movement co- ordination as a function of the constraints imposed upon each individual. In this framework, cognitive, perceptual and movement difficulties and disorders are considered to be constraints on the perceptual- motor system, and children’s movements are viewed as emergent functional adaptations to these constraints (Davids et al., 2008; Rosengren, Savelsbergh & van der Kamp, 2003). From this perspective, variability of movement behaviour is not viewed as noise or error to be eradicated during development, but rather, as essentially functional in facilitating the child to satisfy the unique constraints which impinge on his/her developing perceptual- motor and cognitive systems in everyday life (Davids et al., 2008). Recently, it has been reported that functional neurobiological variability is predicated on system degeneracy, an inherent feature of neurobiological systems which facilitates the achievement of task performance goals in a variety of different ways (Glazier & Davids, 2009). Degeneracy refers to the capacity of structurally different components of complex movement systems to achieve different performance outcomes in varying contexts (Tononi et al., 1999; Edelman & Gally, 2001). System degeneracy allows individuals with and without movement disorders to achieve their movement goals by harnessing movement variability during performance. Based on this idea, perceptual- motor disorders can be simply viewed as unique structural and functional system constraints which individuals have to satisfy in interactions with their environments. The aim of this chapter is to elucidate how the interaction of structural and functional organismic, and environmental constraints can be harnessed in a nonlinear pedagogy by individuals with movement disorders.

The pursuit of thinness : an outcome study of anorexia nervosa

INTRODUCTION: Anorexia nervosa (AN) is a growing problem among young female Singaporeans. We studied the demographics and follow-up data of AN patients referred to dietitians for nutritional intervention. METHODS: A retrospective nutritional notes review was done on 94 patients seen from 1992 to 2004. All patients were given nutritional intervention, which included individualised counselling for weight gain, personalised diet plan, correction of poor dietary intake and correction of perception towards healthy eating. We collected data on body mass index (BMI), patient demographics and outcome. RESULTS: 96 percent of the patients were female and 86.2 percent were Chinese. The median BMI at initial consultation was 14.7 kilogramme per square metre (range, 8.6-18.8 kilogramme per square metre). 76 percent were between 13 and 20 years old. 83 percent of the patients came back for follow-up appointments with the dietitians in addition to consultation with the psychiatrist. Overall, there was significant improvement in weight and BMI from an average 37 kg to 41 kg and 14.7 kilogramme per square metre to 16.4 kilogramme per square metre, respectively, between the fi rst and fi nal consultations (p-value is less than 0.001). The average duration of followup was about eight months. Among the patients on follow-up, 68 percent showed improvement with an average weight gain of 6 kg. Patients that improved had more outpatient follow-up sessions with the dietitians (4.2 consultations versus 1.6 consultations; p-value is less than 0.05), lower BMI at presentation (14.2 kilogramme per square metre versus 15.7 kilogramme per square metre; p-value is less than 0.01) and shorter duration of disease at presentation (one year versus three years; p-value is less than 0.05) compared with those who did not improve. Seven patients with the disease for more than two years did not show improvement with follow-up. CONCLUSION: We gained valuable understanding of the AN patients referred to our tertiary hospital for treatment, two-thirds of whom improved with adequate follow-up treatment. Patients that had suffered AN longer before seeking help appeared more resistant to improvement.

Neuronal nicotinic acetylcholine receptors as pharmacotherapeutic targets for the treatment of alcohol use disorders

Alcohol use disorders (AUDs) are complex and developing effective treatments will require the combination of novel medications and cognitive behavioral therapy approaches. Epidemiological studies have shown there is a high correlation between alcohol consumption and tobacco use, and the prevalence of smoking in alcoholics is as high as 80% compared to about 30% for the general population. Both preclinical and clinical data provide evidence that nicotine administration increases alcohol intake and nonspecific nicotinic receptor antagonists reduce alcohol-mediated behaviors. As nicotine interacts specifically with the neuronal nicotinic acetylcholine receptor (nAChR) system, this suggests that nAChRs play an important role in the behavioral effects of alcohol. In this review, we discuss the importance of nAChRs for the treatment of AUDs and argue that the use of FDA approved nAChR ligands, such as varenicline and mecamylamine, approved as smoking cessation aids may prove to be valuable treatments for AUDs. We also address the importance of combining effective medications with behavioral therapy for the treatment of alcohol dependent individuals.

Health professionals' recognition of co-occurring alcohol and depressive disorders in youth: a survey of Australian general practitioners, psychiatrists, psychologists and mental health nurses using case vignettes

Objective: To examine whether health professionals who commonly deal with mental disorder are able to identify co occurring alcohol misuse in young people presenting with depression. Method: Between September 2006 and January 2007, a survey examining beliefs regarding appropriate interventions for mental disorder in youth was sent to 1710 psychiatrists, 2000 general practitioners (GPs), 1628 mental health nurses, and 2000 psychologists in Australia. Participants within each professional group were randomly given one of four vignettes describing a young person with a DSM-IV mental disorder. Herein is reported data from the depression and depression with alcohol misuse vignettes. Results: A total of 305 psychiatrists, 258 GPs, 292 mental health nurses and 375 psychologists completed one of the depression vignettes. A diagnosis of mood disorder was identified by at least 83.8% of professionals, with no significant differences noted between professional groups. Rates of reported co-occurring substance use disorders were substantially lower, particularly among older professionals and psychologists. Conclusions: GPs, psychologists and mental health professionals do not readily identify co-occurring alcohol misuse in young people with depression. Given the substantially negative impact of co-occurring disorders, it is imperative that health-care professionals are appropriately trained to detect such disorders promptly, to ensure young people have access to effective, early intervention.

Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings

Objective: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. Conclusions: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need.

Classifying Socially-Valued Role Functioning Among Community Residents with Psychiatric Disorders

An increased emphasis on community-based care has not ensured that people recovering from psychiatric disorders return to active and valued roles in their local communities. Although clinical recovery remains a priority for mental health services there is increasing recognition of the need for functional recovery to be attained and demonstrated in roles valued by the wider community. With this need in mind, a method for classifying socially-valued role functioning among people with schizophrenia or schizoaffective disorder was developed and trialed. Participants (n = 104) were recruited via mental health, psychosocial rehabilitation, and other community support services. Socially-valued roles were investigated via participation in five categories: (1) self-care and home duties; (2) caring for others; (3) self-development, voluntary work or rehabilitation; (4) formal education or training; and (5) employment. Activities were classified by primary role type and role status level at baseline, six, and 12 months. Current role status was assessed along with highest and lowest status in the previous year. Preliminary psychometric results were favorable. Research applications are now recommended for monitoring socially-valued role functioning in community settings.

Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: A systematic review

Abstract OBJECTIVE: Depression, anxiety and alcohol misuse frequently co-occur. While there is an extensive literature reporting on the efficacy of psychological treatments that target depression, anxiety or alcohol misuse separately, less research has examined treatments that address these disorders when they co-occur. We conducted a systematic review to determine whether psychological interventions that target alcohol misuse among people with co-occurring depressive or anxiety disorders are effective. DATA SOURCES: We systematically searched the PubMed and PsychINFO databases from inception to March 2010. Individual searches in alcohol, depression and anxiety were conducted, and were limited to 'human' published 'randomized controlled trials' or 'sequential allocation' articles written in English. STUDY SELECTION: We identified randomized controlled trials that compared manual guided psychological interventions for alcohol misuse among individuals with depressive or anxiety disorders. Of 1540 articles identified, eight met inclusion criteria for the review. DATA EXTRACTION: From each study, we recorded alcohol and mental health outcomes, and other relevant clinical factors including age, gender ratio, follow-up length and drop-out rates. Quality of studies was also assessed. DATA SYNTHESIS: Motivational interviewing and cognitive-behavioral interventions were associated with significant reductions in alcohol consumption and depressive and/or anxiety symptoms. Although brief interventions were associated with significant improvements in both mental health and alcohol use variables, longer interventions produced even better outcomes. CONCLUSIONS: There is accumulating evidence for the effectiveness of motivational interviewing and cognitive behavior therapy for people with co-occurring alcohol and depressive or anxiety disorders.

Philosophy, behaviour disorders, and the school

The recent exponential rise in the number of behaviour disorders has been the focus of a wide range of commentaries, ranging from the pedagogic and the administrative, to the sociological, and even the legal. This book will be the first to apply, in a systematic and thorough manner, the ideas of the foundational discipline of philosophy. A number of philosophical tools are applied here, tools arising through the medium of the traditional philosophical debates, such as those concerning governance, truth, logic, ethics, free-will, law and language. Each forms a separate chapter, but together they constitute a comprehensive, rigorous and original insight into what is now an important set of concerns for all those interested in the governance of children. The intention is threefold: first, to demonstrate the utility, accessibility and effectiveness of philosophical ideas within this important academic area. Philosophy does not have to be regarded an arcane and esoteric discipline, with only limited contemporary application, far from it. Second, the book offers a new set of approaches and ideas for both researchers and practitioners within education, a field is in danger of continually using the same ideas, to endlessly repeat the same conclusions. Third, the book offers a viable alternative to the dominant psychological model which increasingly employs pathology as its central rationale for conduct. The book would not only be of interest to mainstream educators, and to those students and academics interested in philosophy, and more specifically, the application of philosophical ideas to educational issues, it would also be an appropriate text for courses on education and difference, and due to the breadth of the philosophical issues addressed, courses on applied philosophy.

Teachers' recognition and referral of anxiety disorders in primary school children

This study investigated the ability of primary school teachers to recognise and refer children with anxiety symptoms. Two hundred and ninety-nine primary school teachers completed a questionnaire exploring their recognition and referral responses to five hypothetical vignettes that described boys and girls with varying severity of anxiety symptoms. Results revealed that teachers were generally able to recognise and make the decision to refer children with severe levels of anxiety. However, they had difficulty distinguishing between children with moderate anxiety symptoms and a severe anxiety disorder. Female teachers were more likely to refer children than were male teachers. The implications and future research are discussed.

Beef carcasses with larger eye muscle areas, lower ossification scores and improved nutrition have a lower incidence of dark cutting

This study evaluated the effect of eye muscle area (EMA), ossification, carcass weight, marbling and rib fat depth on the incidence of dark cutting (pH u > 5.7) using routinely collected Meat Standards Australia (MSA) data. Data was obtained from 204,072 carcasses at a Western Australian processor between 2002 and 2008. Binomial data of pH u compliance was analysed using a logit model in a Bayesian framework. Increasing eye muscle area from 40 to 80 cm 2, increased pH u compliance by around 14% (P < 0.001) in carcasses less than 350 kg. As carcass weight increased from 150 kg to 220 kg, compliance increased by 13% (P < 0.001) and younger cattle with lower ossification were also 7% more compliant (P < 0.001). As rib fat depth increased from 0 to 20 mm, pH u compliance increased by around 10% (P < 0.001) yet marbling had no effect on dark cutting. Increasing musculature and growth combined with good nutrition will minimise dark cutting beef in Australia.