"You're the only thing he comes out [of his room] for": A qualitative study of engagement between Laughter Care Specialists and families of people with dementia in long-term care.

OBJECTIVES: Family involvement in the lives of people who have dementia and live in long-term care is important, but family members may face challenges communicating and connecting with their loved one as dementia progresses. A type of therapeutic humor (Laughter Care) delivered by trained specialists aims to engage people with dementia who reside in long-term care through creative play and laughter. This study aimed to explore the perceptions of Laughter Care Specialists (LCSs) regarding families' engagement with the program. METHODS: Semi-structured interviews were conducted with LCSs (n = 8) and analyzed inductively using thematic analysis. RESULTS: Family members were reported to initially have varied degrees of openness toward Laughter Care, but often become more accepting after observing positive engagement with the person with dementia. Family members were perceived to benefit from the program through witnessing the person with dementia enjoy joyous and light interactions, learn new ways of communicating and connecting with the person with dementia, and engage in positive interactions at end of life. SIGNIFICANCE OF RESULTS: Laughter Care may provide family members with novel ways of communicating and connecting with people who have dementia at end of life as well as comfort into bereavement.

Eccentric strain at long muscle length evokes the repeated bout effect.

The repeated bout effect (RBE) is a phenomenon characterized by less delayed onset muscle soreness (DOMS) and torque deficit after the second of 2 separate eccentric exercise bouts. Previous investigators have reported that shifting of optimum angle after an initial bout of eccentric exercise mediates the RBE. We hypothesized that an RBE for elbow extensor exercise occurs after an initial bout performed at long (starting position of 50 degrees to an end position of 130 degrees) but not short (starting position of 0 degrees to an end position of 80 degrees) muscle length because strain at long length evokes a shifting of the optimum angle to a longer length. Untrained women performed an initial bout at either long or short length (n = 9 per group) followed 1 week later by a repeated bout (RB) through the full ROM (0-130 degrees). Extensor torque and optimum angle was evaluated before, immediately after, and 2 days after each bout. A mechanical transducer depressed on the triceps brachii quantified DOMS. Torque deficits were 3% and 7% after exercise at short vs. long length, respectively. Two days after the RB, torque deficit was 8% and 1% for those previously exercising at short vs. long length (group x bout, p < 0.05). Greater DOMS (N) was observed after exercise at long (16 +/- 3) vs. short (23 +/- 2) length; whereas greater DOMS occurred for the short-length (17 +/- 2) vs. long (26 +/- 3) group after the RB (group x bout, p < 0.05). Optimum angle shifted to a longer length after exercise at long (+10 +/- 4 degrees) vs. short (+1 +/- 3 degrees) length (group x bout, p < 0.05). After the RB, those exercising previously at short length experienced a shift of +15 +/- 4 degrees (main effect, p < 0.05). The findings of this study indicate that the repetitive strain at long but not short muscle length evokes both immediate and sustained shifts in optimum angle to longer lengths, and that this shifting mediates (r(2) = 0.71) the RBE.