Tailoring leisure to suit a wider audience through creative event planning with a multi-sensory approach.

Caregiving for long-term conditions is increasingly focused on holistic "person centred" care [9,34], with leisure and recreation providing an important and essential part of maintaining quality of life. This article documents examples of large leisure events and creative projects. These were adapted for, and considered to be suitable and supportive of, the needs of adults with complex and profound disability as a result of neurological damage or disease.

Access to computer-based leisure for individuals with profound disabilities.

Advances in computer technology and the Internet have meant that more and more occupations can be made available to disabled individuals, including occupations generally considered to be leisure. However, computers and the Internet also provide barriers to access for these individuals. This article discusses some of these barriers, solutions to them and highlights the complexities involved in the provision of a computer-based assistive technology solution for access to leisure for a profoundly disabled young lady.

The role of occupational therapy in leisure adaptation with complex neurological disability: a discussion using two case study examples.

This article looks at the importance of leisure as a key principle within occupational therapy practice. A review of current literature and two in-patient case studies are used to discuss the role of the Occupational Therapist in adapting leisure occupations for individuals with complex neurological disability. The article highlights the use of leisure as an occupation through which therapeutic goals can be achieved.

Using music in leisure to enhance social relationships with patients with complex disabilities.

Acquired and complex disabilities stemming from severe brain damage and neurological illness usually affect communication, cognitive, physical or sensory abilities in any combination. Improved understanding of the care needs of people with complex disabilities has addressed many functional aspects of care. However, relatives and carers can be left at a loss knowing how to provide or share in meaningful activities with someone who can no longer communicate or respond to their environment.

Independent sector dispelling the myths nursing.

Anecdotally, when NHS staff have made career changes, they have traditionally looked elsewhere in the public sector. But, as conditions at the NHS become more turbulent, they may increasingly look to the independent sector instead.

Lotteries, loopholes and luck: misdiagnosis in the vegetative state patient.

Many factors contribute to the alarmingly high rates of misdiagnosis in the Vegetative State (VS) patient. These include the differential diagnosis and definitions, inconsistencies in the assessors' knowledge, expertise and their approaches to the assessment of awareness. Variability in the patient's medical and physical management adds to this confusion, leading to the potential to misdiagnose an aware patient in Minimally Conscious State (MCS) as being in VS.

The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders: a case report.

Purpose: This paper presents a case report of collaborative work between speech and language therapy (SLT) and music therapy (MT) in the case of an individual presenting with complex communication difficulties and lability caused by pseudo-Parkinsonian vascular disease.

Design: MT intervention was used to investigate whether participation could be enabled in a client presenting with complex problems as well as facilitate change in communication parameters which remained unresponsive to conventional SLT intervention. A single case design measured communication and well-being parameters using pre-, during and post-intervention measures.

Abdominal muscle size and symmetry in normal subjects.

This study was undertaken to establish normal reference ranges for abdominal muscle size and symmetry and to examine the effects on these of gender and age. We studied 123 subjects, consisting of 55 men (aged 21-72 years) and 68 women (aged 20-64 years). Real-time ultrasound imaging of the abdominal muscles was performed.

Putney Auditory Single Word Yes/No Assessment (PASWORD). Development of a reliable test of yes/no at a single word level in patients unable to participate in assessments requiring a specific motor response: an exploratory study.

Background: There are very few formal language assessments aimed at the very severely neurologically impaired individual. These individuals often have multiple deficits on top of their communication impairment that demand a novel approach to assessment. The authors set out to devise a tool (PASWORD) to enable professionals in this field to screen their clients' ability to understand and respond to very simple, closed questions by using their preferred modality.

Tryptophan metabolism and oxidative stress in patients with chronic brain injury.

The kynurenine pathway generates the excitotoxic N-methyl-d-aspartate receptor agonist, quinolinic acid and the glutamate antagonist, kynurenic acid, as well as free-radical generators. We investigated the status of the pathway following severe brain injury sustained at least 1 year previously in 15 patients compared with controls. At baseline, patients with brain injury showed increased levels of neopterin, erythrocyte sedimentation rate, C-reactive protein and peroxidation products in the blood compared with controls, indicating persistent inflammation and oxidative stress.

Nutrition and hydration for the vegetative state and minimally conscious state patient.

This paper presents nutritional issues particular to patients in the vegetative state (VS) or minimally conscious state (MCS). It assumes that such patients would be tube fed and it examines suitable ways of assessing and monitoring their nutrition. It covers problems frequently encountered such as undernourishment, high fluid requirements, bowel management, and vomiting.

Music therapy with patients in low awareness states: approaches to assessment and treatment in multidisciplinary care.

This paper outlines the rationale for and role of music therapy as a clinical intervention and diagnostic tool in multidisciplinary (MDT) rehabilitation programmes for patients in low awareness states. A review of the literature indicates that music is a useful clinical tool in stimulating a range of behavioural, physiological and expressive responses in patients in low awareness states. Referral criteria for music therapy with this patient group are provided, along with suggested methods for collaborative multidisciplinary work.

Considerations for the use of assistive technology in patients with impaired states of consciousness.

While there is limited literature addressing the application of assistive technology in patients in persistent vegetative state (PVS) and minimally conscious state (MCS), it is believed that it can assist with the assessment, diagnosis and treatment as well as management of these patients. The use of technology to assist in PVS and MCS is mostly limited to the application of simple binary switch devices to determine whether a motor response is consistent or otherwise. However, the application of such technology is often undermined due to a lack of established protocols for use by the multidisciplinary team (MDT), as well as a lack of available technical resources.

Vegetative and minimally conscious states: how can occupational therapists help?

There is little documentation about the role of occupational therapy specifically for the vegetative and minimally conscious patient. This paper sets out to clarify the role using one model of occupational therapy, namely that of Reed and Sanderson (1992), and proposes occupational therapy assessment and treatment for this patient group. It explores how patients are affected in the performance components of motor, sensory, cognitive, intrapersonal, and interpersonal skills, which are explored through assessment.

Incidence and prevalence of the vegetative and minimally conscious states.

The methodological difficulties of obtaining accurate epidemiological data for vegetative state (VS) and minimally conscious state (MCS) are considered, and prompt the conclusion that published data are of uncertain validity, partly due to variation in the criteria for diagnosis. On the basis of these data, incidence of VS continuing for at least six months arises at a rate of between 5 and 25 per million population (PMP). The prevalence of VS in adults in the US is between 40 and 168 PMP, and may be lower in the UK, but precise figures are not available.

Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique.

This cross-sectional, prospective study aimed to produce normal reference data for measurements of the lumbar multifidus muscle. A total of 120 subjects, 68 females (aged 20-64 years) and 52 males (20-69 years) were studied. Bilateral transverse ultrasound images were made of multifidus at the fourth and fifth lumbar vertebrae (L4 & L5).

Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages.

Measurements of muscle strength or size are valuable indicators of muscle status in health and disease. When force cannot be measured directly, due to a particular muscle being one of a functional group or because of pain, size measurements may be the only option. For such data to be useful, normal values for age and gender are necessary.

Tryptophan metabolism and oxidative stress in patients with Huntington's disease.

Abnormalities in the kynurenine pathway may play a role in Huntington's disease (HD). In this study, tryptophan depletion and loading were used to investigate changes in blood kynurenine pathway metabolites, as well as markers of inflammation and oxidative stress in HD patients and healthy controls. Results showed that the kynurenine : tryptophan ratio was greater in HD than controls in the baseline state and after tryptophan depletion, indicating increased indoleamine dioxygenase activity in HD.

Medical decision making in the vegetative state: withdrawal of nutrition and hydration.

Withdrawal of nutrition and hydration, is a difficult and sensitive issue for all those working with people in the vegetative state. There are arguments against the decision to withdraw any treatment that might result in the patient deteriorating or dying. These arguments include the view that all life is worth having, that we can never be certain that the patient is not aware, and concerns that there may be new scientific developments in the future from which the patient would benefit.

The Sensory Modality Assessment and Rehabilitation Technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients.

Primary Objective: To establish the reliability and validity of the Sensory Modality Assessment and Rehabilitation Technique (SMART) as a tool for discriminating awareness in patients with profound brain damage.

Research Design: A comparative prospective study was conducted.

Method And Procedures: Sixty subjects diagnosed in vegetative state (VS) on admission were assessed at 2-monthly intervals.

Effects of knee joint angle and tilt table incline on force distribution at the feet and supporting straps.

Objective: To investigate the effects of tilt table incline and knee flexion angle on the degree of weight bearing and forces exerted across the supporting straps.

Design: A quantitative and exploratory study to investigate the effects of a mechanical procedure.

Setting: Physiotherapy gymnasium.

Learning to control brain activity: a review of the production and control of EEG components for driving brain-computer interface (BCI) systems.

Brain-computer interface (BCI) technology relies on the ability of individuals to voluntarily and reliably produce changes in their electroencephalographic (EEG) activity. The present paper reviews research on cognitive tasks and other methods of generating and controlling specific changes in EEG activity that can be used to drive BCI systems. To date, motor imagery has been the most commonly used task.

Effects of multisensory stimulation in people with Huntington's disease: a randomized controlled pilot study.

Objective: To investigate whether behavioural, motor and physiological responses of individuals with Huntington's disease (HD) to a controlled multisensory environment (MSE) are effective as a therapeutic (sustained effects) or leisure (immediate effects) activity.

Design: Pilot study--a randomized, controlled, two-group design.

Setting: Specialist residential unit for people with mid-late stage HD.

Monocyte/macrophage initiation of organ-specific autoimmunity: the ultimate 'bystander' hypothesis?

It is postulated that organ-specific autoimmune diseases could be initiated by dysregulated peripherally activated monocytes/macrophages penetrating into target organs nonspecifically. Failure of regulation of pro-inflammatory monocytes/macrophages might then result in autoimmune disease if secondary over-expansion of pre-existing autoantigen-specific T cell populations occurs in genetically predisposed individuals.