Self-Reported Quality of Life Outcomes in Aphasia Using Life Participation Approach Values: 1-Year Outcomes.

OBJECTIVE: To evaluate the effectiveness of a newly initiated aphasia center program using Life Participation Approach to Aphasia (LPAA) values. DESIGN: Evidence-based practice quality improvement project. SETTING: Ambulatory care aphasia center part of a larger health care system. PARTICIPANTS: Participants included 41 clients with aphasia and 40 primary caregivers of clients with aphasia. Participants included all clients and caregivers that were enrolled in the aphasia center within the first year of opening. All participants were enrolled in 1-4 eleven-week sessions of the aphasia center program. Participants with aphasia included 19 women and 22 men with a mean age of 65.2 years (range, 33-84 years). INTERVENTIONS: Group therapy was provided using the LPAA statement of values with each client receiving 3 hours of treatment once per week for 11 weeks. Clients were provided with the opportunity to complete multiple 11-week enrollment sessions if they chose to do so. MAIN OUTCOME MEASURES: Client-reported outcomes included the Stroke and Aphasia Quality of Life Scale, and caregiver-reported outcomes included the Modified Caregiver Strain Index. Both measures are self-reported and scale based. Client satisfaction data were also collected via a self-reported program evaluation upon completion of each 11-week session. RESULTS: Results indicated statistically significant improvements in quality of life scores for clients with aphasia following initial participation of an 11-week aphasia center program (P≤.0001) and following 1-year participation (P≤.0001). Additionally, caregiver's level of burden decreased significantly following initial participation of the family member (P=.003) and following completion of three 11-week sessions (P≤.0001). Self-reported client satisfaction program evaluation results also demonstrated improved quality of life (100%) and improved language skills (average=89.75%). CONCLUSIONS: The project provided further evidence supporting the use of LPAA values with clients experiencing chronic aphasia.

Clinical Studies of Biofield Therapies: Summary, Methodological Challenges, and Recommendations.

Biofield therapies are noninvasive therapies in which the practitioner explicitly works with a client's biofield (interacting fields of energy and information that surround living systems) to stimulate healing responses in patients. While the practice of biofield therapies has existed in Eastern and Western cultures for thousands of years, empirical research on the effectiveness of biofield therapies is still relatively nascent. In this article, we provide a summary of the state of the evidence for biofield therapies for a number of different clinical conditions. We note specific methodological issues for research in biofield therapies that need to be addressed (including practitioner-based, outcomes-based, and research design considerations), as well as provide a list of suggested next steps for biofield researchers to consider.

Pregait balance rehabilitation in acute stroke patients.

Rehabilitation interventions designed to enhance balance control in individuals with acute stroke are quite limited. The goal was to develop and assess a technique of early pregait balance training involving the use of a combination of force platform visual feedback and the unweighting system in individuals with recent stroke. A total of 28 individuals with acute stroke were randomly divided into the experimental and control groups: individuals included in the experimental group received 1 week of treatment on the basis of retraining balance utilizing visual biofeedback (Balance Master) while provided with a body weight support harness system, whereas the individuals in the control group received conventional treatment. Both the groups undertook identical tests (Fugl-Meyer Balance test, Functional Independence Measure test for gait, and Fugl-Meyer lower extremity assessment) before the start of treatment and after its completion. Individuals in the experimental group showed larger gains as seen in the increased scores of the Fugl-Meyer Balance test and the Functional Independence Measure test for gait as compared with the control group. The outcome of the study provides a basis for future investigations of the applicability of the intervention in early balance rehabilitation of individuals with neurological disorders.

Predictors of returning to oral feedings after feeding tube placement for patients poststroke during inpatient rehabilitation.

OBJECTIVES: To identify the frequency and characteristics of patients admitted to inpatient rehabilitation (IPR) following a stroke who are able return to oral feedings and have their feeding tube (FT) removed prior to discharge from IPR, the timing of FT removal, and implications for outcomes. METHODS: Medical records were identified by admission rehabilitation impairment code (RIC) for stroke (RIC 01), and reviews were completed by two physiatrists and two speech language pathologists. At random, 25% of the charts were reviewed by a second rater for data quality control. Measures collected during the chart review included the following: age, gender, onset of stroke, rehabilitation length of stay (LOS), admission and discharge FIM, discharge destination, diet level, and feeding tube status. RESULTS: One hundred forty-three patients were identified as subjects for this investigation who had an FT and were NPO upon IPR admission. Overall, 46.9% (67/143) of the patients returned to three meals daily prior to discharge from IPR. The mean days post stroke onset until returning to three meals daily was 38.43 days (SD=26.36). Twenty percent (30/143) of the patients were able to have their FT tube removed prior to discharge from IPR. Factors associated with returning to three meals included gender (ie, female), longer IPR LOS, and higher admission FIM scores at IPR. Factors associated with removal of the feeding tube included a longer IPR LOS and younger age. Patients who were able to have their FT removed were more likely to be discharged to home. CONCLUSION: Individuals with longer IPR LOS were more likely to return to three meals daily and have their feeding tubes removed prior to discharge.

Solar simulator-induced phototoxicity of the furoquinoline alkaloid dictamnine compared to 8-methoxypsoralen and 5-methoxypsoralen.

Dictamnine, a furoquinoline alkaloid of the Rutaceae plant family, has been shown to be mutagenic and phototoxic in bacteria and yeasts. Here, we have investigated the phototoxic effect of dictamnine in human Jurkat T cells and HaCaT keratinocytes. Dictamnine was isolated from the roots of DICTAMNUS ALBA L. and was photoactivated with solar simulated radiation, delivered from a 1000-W xenon arc lamp with a maximal output between 300 - 800 nm. Dictamnine displayed concentration- and light-dependent phototoxic effects in both cell lines. In comparison to the structurally related furocoumarins 5-methoxypsoralen and 8-methoxypsoralen, dictamnine was less phototoxic. Nevertheless, it may play a major role in the elicitation of phytophotodermatitis because of its abundance in plants of the Rutaceae family.

Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study.

BACKGROUND: Data from a pilot study suggested that noetic therapies-healing practices that are not mediated by tangible elements-can reduce preprocedural distress and might affect outcomes in patients undergoing percutaneous coronary intervention. We undertook a multicentre, prospective trial of two such practices: intercessory prayer and music, imagery, and touch (MIT) therapy. METHODS: 748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centres were assigned in a 2x2 factorial randomisation either off-site prayer by established congregations of various religions or no off-site prayer (double-blinded) and MIT therapy or none (unmasked). The primary endpoint was combined in-hospital major adverse cardiovascular events and 6-month readmission or death. Prespecified secondary endpoints were 6-month major adverse cardiovascular events, 6 month death or readmission, and 6-month mortality. FINDINGS: 371 patients were assigned prayer and 377 no prayer; 374 were assigned MIT therapy and 374 no MIT therapy. The factorial distribution was: standard care only, 192; prayer only, 182; MIT therapy only, 185; and both prayer and MIT therapy, 189. No significant difference was found for the primary composite endpoint in any treatment comparison. Mortality at 6 months was lower with MIT therapy than with no MIT therapy (hazard ratio 0.35 (95% CI 0.15-0.82, p=0.016). INTERPRETATION: Neither masked prayer nor MIT therapy significantly improved clinical outcome after elective catheterisation or percutaneous coronary intervention.