Visual and Motor Recovery After "Cognitive Therapeutic Exercises" in Cortical Blindness: A Case Study.

BACKGROUND AND PURPOSE: Spontaneous visual recovery is rare after cortical blindness. While visual rehabilitation may improve performance, no visual therapy has been widely adopted, as clinical outcomes are variable and rarely translate into improvements in activities of daily living (ADLs). We explored the potential value of a novel rehabilitation approach "cognitive therapeutic exercises" for cortical blindness. CASE DESCRIPTION: The subject of this case study was 48-year-old woman with cortical blindness and tetraplegia after cardiac arrest. Prior to the intervention, she was dependent in ADLs and poorly distinguished shapes and colors after 19 months of standard visual and motor rehabilitation. Computed tomographic images soon after symptom onset demonstrated acute infarcts in both occipital cortices. INTERVENTION: The subject underwent 8 months of intensive rehabilitation with "cognitive therapeutic exercises" consisting of discrimination exercises correlating sensory and visual information. OUTCOMES: Visual fields increased; object recognition improved; it became possible to watch television; voluntary arm movements improved in accuracy and smoothness; walking improved; and ADL independence and self-reliance increased. Subtraction of neuroimaging acquired before and after rehabilitation showed that focal glucose metabolism increases bilaterally in the occipital poles. DISCUSSION: This study demonstrates feasibility of "cognitive therapeutic exercises" in an individual with cortical blindness, who experienced impressive visual and sensorimotor recovery, with marked ADL improvement, more than 2 years after ischemic cortical damage.Video Abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A173).

A qualitative study of parenting stress, coping, and discipline approaches among low-income traumatized mothers.

OBJECTIVE: The use of harsh discipline is a risk factor for child maltreatment and is more common among families in which mothers have previously experienced trauma. We sought to understand the stressors experienced by low-income traumatized mothers and the perceived impact of those stressors on their discipline approaches. METHODS: We conducted 30 in-depth qualitative interviews with low-income mothers with a history of trauma. We triangulated the results with experts in behavioral health, and with a subset of the informants themselves, to ensure data reliability. RESULTS: We identified the following themes: (1) Repetitive child behaviors are the most stressful. (2) Mothers commonly cope by taking time away; this can result in prolonged unsupervised periods for children. (3) Harsh discipline is used deliberately to prevent future behavior problems. (4) Mothers relate their children's negative behaviors to their own past experiences; in particular, those who have suffered domestic violence fear that their children will be violent adults. CONCLUSIONS: Our findings suggest that trauma-informed interventions to promote positive discipline and prevent child maltreatment should help mothers predict and plan for stressful parent-child interactions; identify supports that will allow them to cope with stress without leaving their children for prolonged periods; and explicitly address long-term goals for their children and the impact of different discipline approaches.