Posts Tagged behavior

[Guidance Sheet] Disability language and etiquette – PDF file

This guidance sheet offers tips and advice from people who have disabilities to help put everyone at ease.  Because no two people with disabilites are exactly alike, it is best to ask the person and follow the person’s lead when it comes to what works best for them.

Comic panel featuring a man who is blind standing at a street corner.  A woman next to him asks "May I help you to cross." The man replies "No thanks, I'm waiting for my ride."  The caption at the bottom says Offer assistance, listen for response, and follow any specific directions.

Respectful Language

People-first language is based on the idea that the person is not identified by their disability.  An example of this is “People who are blind” instead of “Blind people.”

Identity-first language means that the person feels that the disability is a strong part of who they are and they are proud of their didsability.  For example “Disabled person,” versus “person who has a disability.”

Ultimately, people with disabilities decide how their disability should be stated.  Some may choose people first language, while others use identity first language.  At this time, people-first language is recommended for use by anyone who doesn’t have a disability and for professionals who are writing or speaking about people with disabilities.

Respectful Language

Terms generally discouragedTerms generally preferred
The disabled/A disabled personPeople with disabilities/An individual with a disability
suffers from, afflicted by, victim ofhas a disability
normaltypical
The handicapped, handi-capable, differently-abledPeople with disabilities
Mental retardationIntellectual disability
Wheelchair boundPerson who uses a wheelchair; person with a mobility disability
Hearing impairedPeople who are deaf or hard of hearing; people with a hearing disability
Mental illness, mental disorder, crazy, insanepsychiatric disability
Midget or DwarfPerson of short stature, little person
EpilepticPerson who has epilepsy
fits, spells, attacksseizures
Brain damagedPeople with brain injuries
Slow learnerPerson with a learning disability
DiabeticsPeople who have diabetes

It is ok to use phrases such as “Want to go for a walk?” to a person who uses a wheelchair; “Have you seen…?” to an individual who is blind; or “Did you hear about…?” to an individual who is deaf.  If you do not understand something an individual has said, perhaps because they have a communication disability, do not pretend to understand.  Instead ask them to repeat it or to write it down.

Comic panel featuring three men.  The man on the far left is introducing his brother Bob, who stands in the middle of the scene, to Jim, who stands on the right side of the screen.  Bob does not have a right hand and is extending his left hand to Jim who is giving him a handshake.  The panel caption says use common sense and extend common courtesies to everyone.

General Etiquette

Treat people with disabilities as you would anyone else, while making reasonable accommodations.  Consider universal design when planning activities.  For example, dimmable room lighting, choice of large and small meeting rooms, scheduling more time for breaks, and offering information in different formats and handouts, written at the 7th grade reading level, can be very helpful to people with all types of disabilities.  Before you hold an event, be sure to ask each guest what accommodation is needed (if any).  Ask new employees if their work space gives them full access.

Comic panel featuring a man using a wheelchair who has a service dog. They are in a park and the man's hat was blown off his head by wind, the dog is picking up the hat while a young girl is reaching out to pet the dog.  The girl's mom is saying Honey, he's a working dog. We shouldn't pet him.

Do not use “baby-talk.”  Speak directly to the individual, no their companion, interpreter, or personal care attendant (PCA).

Do no touch, address, or feed a service animal unless you have the person’s permission.

People who have a physical disability

A mobility device is a part of the individual’s personal space.  Do not lean on the device, use it as a coat hanger, or kick it.  When speaking with a person who uses a wheelchair, stand back, kneel, or sit down to help alleviate their neck strain.  Even if an individual does not have an arm or hand, hold out your own for a handshake.  The individual will be used to this situation, and you may simply follow their lead.

People who are blind or have low vision

Identify yourself as you enter or leave a small work area.  Use descriptive language when giving directions.  instead of “the restrooms are over there,” say “if you turn around, the restrooms are located down the second hallway, about 20 feet on the left.”  Let the individual know if you are holding out a pen to them, or similar.  Put a card down at signature lines, so an individual can feel where to sign when needed.  Identify paper money when handling it to a customer with a visual disability.  Offer to read printed materials aloud.

For mor information, visit Northwest ADA Center videos on YouTube(link is external)

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[WEB SITE] What Disabilities Can Result From a TBI? – BrainLine

What Disabilities Can Result From a TBI?

National Institute of Neurological Disorders and Stroke
¿Qué discapacidades pueden resultar de un traumatismo cerebral?

 

Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the patient. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).

Within days to weeks of the head injury approximately 40 percent of TBI patients develop a host of troubling symptoms collectively called postconcussion syndrome (PCS). A patient need not have suffered a concussion or loss of consciousness to develop the syndrome and many patients with mild TBI suffer from PCS. Symptoms include headache, dizziness, vertigo (a sensation of spinning around or of objects spinning around the patient), memory problems, trouble concentrating, sleeping problems, restlessness, irritability, apathy, depression, and anxiety. These symptoms may last for a few weeks after the head injury. The syndrome is more prevalent in patients who had psychiatric symptoms, such as depression or anxiety, before the injury. Treatment for PCS may include medicines for pain and psychiatric conditions, and psychotherapy and occupational therapy todevelop coping skills.

Cognition is a term used to describe the processes of thinking, reasoning, problem solving, information processing, and memory. Most patients with severe TBI, if they recover consciousness, suffer from cognitive disabilities, including the loss of many higher level mental skills. The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones. Some of these patients may experience post-traumatic amnesia (PTA), either anterograde or retrograde. Anterograde PTA is impaired memory of events that happened after the TBI, while retrograde PTA is impaired memory of events that happened before the TBI.

Many patients with mild to moderate head injuries who experience cognitive deficits become easily confused or distracted and have problems with concentration and attention. They also have problems with higher level, so-called executive functions, such as planning, organizing, abstract reasoning, problem solving, and making judgments, which may make it difficult to resume pre-injury work-related activities. Recovery from cognitive deficits is greatest within the first 6 months after the injury and more gradual after that.

Patients with moderate to severe TBI have more problems with cognitive deficits than patients with mild TBI, but a history of several mild TBIs may have an additive effect, causing cognitive deficits equal to a moderate or severe injury.

Many TBI patients have sensory problems, especially problems with vision. Patients may not be able to register what they are seeing or may be slow to recognize objects. Also, TBI patients often have difficulty with hand-eye coordination. Because of this, TBI patients may be prone to bumping into or dropping objects, or may seem generally unsteady. TBI patients may have difficulty driving a car, working complex machinery, or playing sports. Other sensory deficits may include problems with hearing, smell, taste, or touch. Some TBI patients develop tinnitus, a ringing or roaring in the ears. A person with damage to the part of the brain that processes taste or smell may develop a persistent bitter taste in the mouth or perceive a persistent noxious smell. Damage to the part of the brain that controls the sense of touch may cause a TBI patient to develop persistent skin tingling, itching, or pain. Although rare, these conditions are hard to treat.

Language and communication problems are common disabilities in TBI patients. Some may experience aphasia, defined as difficulty with understanding and producing spoken and written language; others may have difficulty with the more subtle aspects of communication, such as body language and emotional, non-verbal signals.

In non-fluent aphasia, also called Broca’s aphasia or motor aphasia, TBI patients often have trouble recalling words and speaking in complete sentences. They may speak in broken phrases and pause frequently. Most patients are aware of these deficits and may become extremely frustrated. Patients with fluent aphasia, also called Wernicke’s aphasia or sensory aphasia, display little meaning in their speech, even though they speak in complete sentences and use correct grammar. Instead, they speak in flowing gibberish, drawing out their sentences with non-essential and invented words. Many patients with fluent aphasia are unaware that they make little sense and become angry with others for not understanding them. Patients with global aphasia have extensive damage to the portions of the brain responsible for language and often suffer severe communication disabilities.

TBI patients may have problems with spoken language if the part of the brain that controls speech muscles is damaged. In this disorder, called dysarthria, the patient can think of the appropriate language, but cannot easily speak the words because they are unable to use the muscles needed to form the words and produce the sounds. Speech is often slow, slurred, and garbled. Some may have problems with intonation or inflection, called prosodic dysfunction. An important aspect of speech, inflection conveys emotional meaning and is necessary for certain aspects of language, such as irony. These language deficits can lead to miscommunication, confusion, and frustration for the patient as well as those interacting with him or her.

Most TBI patients have emotional or behavioral problems that fit under the broad category of psychiatric health. Family members of TBI patients often find that personality changes and behavioral problems are the most difficult disabilities to handle. Psychiatric problems that may surface include depression, apathy, anxiety, irritability, anger, paranoia, confusion, frustration, agitation, insomnia or other sleep problems, and mood swings. Problem behaviors may include aggression and violence, impulsivity, disinhibition, acting out, noncompliance, social inappropriateness, emotional outbursts, childish behavior, impaired self-control, impaired self awareness, inability to take responsibility or accept criticism, egocentrism, inappropriate sexual activity, and alcohol or drug abuse/addiction. Some patients’ personality problems may be so severe that they are diagnosed with borderline personality disorder, a psychiatric condition characterized by many of the problems mentioned above. Sometimes TBI patients suffer from developmental stagnation, meaning that they fail to mature emotionally, socially, or psychologically after the trauma. This is a serious problem for children and young adults who suffer from a TBI. Attitudes and behaviors that are appropriate for a child or teenager become inappropriate in adulthood. Many TBI patients who show psychiatric or behavioral problems can be helped with medication and psychotherapy.

 

via What Disabilities Can Result From a TBI? | BrainLine

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[Abstract] Cognitive Implications in Epilepsy.

Abstract

Cognitive dysfunction is one of the major contributors to the burden of epilepsy. It can significantly disrupt intellectual development in children and functional status and quality of life in adults. There is major evidence confirms that cognitive impairment can appear or worsen with early and chronic progressive neurologic changes in epilepsy. It has been increasingly accepted that comorbidity does not indicate causality. Certainly, cognitive impairment in epileptic patients warrant crucial evaluation and mitigation from the time of diagnosis and treatment of epilepsy. The concept of a bidirectional nature of cognitive impairment in epilepsy represents a change in the paradigm of neuropsychology of epilepsy. It has been suggested that both behavioral and cognitive dysfunction associated with epilepsy are not necessarily the consequence of active epilepsy but in fact can dominate and be associated with factors before emergence of epilepsy. This review discusses different etiologies of cognitive and behavioral comorbidities in epilepsy and tries to clarify the nature of relation between epilepsy and cognition.

via Cognitive Implications in Epilepsy.

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[BLOG POST] Perfectly Imperfect For The Holidays – TBI Survivor Tips and Observations

By Bill Herrin

Living with a TBI is a reality all its own, and as I reiterate in many posts – it’s different for everyone, including how people around you act, react, overact, act up, or don’t react to you at all. With the Holidays now “officially” here, and Thanksgiving already passed – it’s the time of year that many people dread, and for many good reasons.

The way some people celebrate seems so perfectly “normal” from the outside – the whole family gets together, they have dinner together, or they open gifts, or they have a wonderful party…and that can happen, but from the outside it seems much more “perfect” than anything that we experience in our life. Why is that? Well, living with TBI overshadows a lot of our being, and it’s no wonder…it’s changed who we are in some ways.

It can change us immensely and visibly, or it can change us in a less obvious way – and sometimes, people don’t see what it’s done to a survivor at all. Either scenario can be very frustrating for the survivor of TBI, stroke, concussion, mild TBI, acquired brain injuries, etc.

Making The Holidays More Positive

On one hand, getting together with family and friends during the Holidays after TBI can be an annual test of wills due to lack of patience or empathy for one another, misread intentions, disagreements, or just a lack of understanding for each other.

On the other hand, all families, no matter how perfect things appear on the surface, can have similar issues. Yes, some actual families do get along great, and the Holidays are a positive experience for them – but don’t be dismayed, because (at the end of the day) we’re all perfectly imperfect people. Brain injury or no brain injury!

The point being made is plain and simple – although TBI survivors bear a load of issues in situations with people around, many times they still are left to shoulder the weight of inconsideration, improper actions, comments and more. Being the bigger person is hard to do (especially under the circumstances) but it’s worth the effort!

A Little Empathy Goes A Long Way…

Whether you’re reading this as a TBI Survivor, a caregiver, or as a friend or family member – it’s important to always work toward being empathetic toward each other.

As a survivor, knowing that everyone hasn’t experienced what you have been through is a good rule of thumb for overlooking things that could easily get under your skin. As a friend or family member, remember that you have no clue what it’s like to have a TBI is a good starting point, and overlooking things (that are said) can keep things on an even keel.

The same goes for a TBI survivor that fields negative comments or verbal jabs…working to focus on being together is the point! Enjoying each other’s company is a rarity and should be treated that way – as perfectly imperfect as any of us are.

Some Suggestions

Here are some suggestions to help make the Holidays less frustrating, and hopefully a better experience for a TBI Survivor (and their friends & family):

• Avoid alcoholic drinks (especially when using medications)

• Noise-canceling headphones or earplugs to bring noise levels down to a manageable level

• Bring someone with you that understands your needs when you go shopping, to a party, or for dinner at home (or elsewhere) with others

• Be careful to avoid sensory overload, and act accordingly at an event if necessary (retreat for a bit, leave early if needed, etc.)

• Be rested before any Holiday party, gathering, parade, etc. – if you know that a Holiday parade or program is going to be overwhelming, you may be better off skipping it altogether

• Do your Holiday shopping (along with a friend or family member, etc.) when crowds are at a minimum

• If blinking or bright holiday lights bother you, plan (in advance) to have sunglasses handy, or even a place that you can retreat to if necessary

• Unless you’re certain that a fireworks display is ok to attend, it may be best to skip it (New Year’s Eve, etc.)

• Movies, concerts, outdoor events with lots of lights can all cause issues for Survivors…base your decisions to go on previous experience when possible. If not, do you best to plan in advance on how you (with a friend or loved one) will have an action plan to deal with it

• Try to avoid situations that may overstimulate your senses. Noise, crowds, lights, etc. can trigger anxieties (fear, panic, etc.) and even fatigue – when your brain is overloaded by too many things going on at once

• Another good thing to keep in mind is to ask for assistance if you need it – taking on too much by yourself is asking for trouble, and if you have someone willing and able to help you, let them!

In closing…

In closing, if you’re a TBI Survivor – try to pace yourself during the holidays when there’s so much going on, and not get too overloaded with things to do, places to go, and people to see. As a friend, family member, or caregiver of a person with TBI – keep this in mind as well!

Helping advocate for a TBI Survivor is very important, and they will do much better with you as their “overload avoidance” point person (or team). Happy Holidays to all, and we’ll see you in 2020.

 

via Perfectly Imperfect For The Holidays – TBI Survivor Tips and Observations

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[ARTICLE] Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury – Full Text

Many patients with moderate to severe traumatic brain injury have deficits in social cognition. Social cognition refers to the ability to perceive, interpret, and act upon social information. Few studies have investigated the effectiveness of treatment for impairments of social cognition in patients with traumatic brain injury. Moreover, these studies have targeted only a single aspect of the problem. They all reported improvements, but evidence for transfer of learned skills to daily life was scarce. We evaluated a multifaceted treatment protocol for poor social cognition and emotion regulation impairments (called T-ScEmo) in patients with traumatic brain injury and found evidence for transfer to participation and quality of life.

In the current paper, we describe the theoretical underpinning, the design, and the content of our treatment of social cognition and emotion regulation (T-ScEmo).

The multifaceted treatment that we describe is aimed at improving social cognition, regulation of social behavior and participation in everyday life. Some of the methods taught were already evidence-based and derived from existing studies. They were combined, modified, or extended with newly developed material.

T-ScEmo consists of 20 one-hour individual sessions and incorporates three modules: (1) emotion perception, (2) perspective taking and theory of mind, and (3) regulation of social behavior. It includes goal-setting, psycho-education, function training, compensatory strategy training, self-monitoring, role-play with participation of a significant other, and homework assignments.

It is strongly recommended to offer all three modules, as they build upon each other. However, therapists can vary the time spent per module, in line with the patients’ individual needs and goals. In future, development of e-learning modules and virtual reality sessions might shorten the treatment.

Traumatic brain injury refers to a brain lesion caused by an external mechanical force, leading not only to physical impairments and cognitive deficits, but also to changes in behavior and personality.1,2 Especially after damage to orbitofrontal and ventromedial prefrontal brain areas, deficits in social cognition can occur.3,4

According to Adolphs,5 social cognition consists of three stages: (1) the ability to perceive social information (i.e. emotional facial expressions, bodily language), (2) the capacity to process and interpret social information (i.e. theory of mind, perspective taking), and (3) the ability to adapt behavior in accordance with the situation. Babbage et al.6 estimated that 13%–39% of individuals with moderate to severe traumatic brain injury experienced emotion perception deficits and up to 70% reported low empathy.79

Deficits in social cognition often appear in the shape of socially inadequate behavior, such as disinhibited or indifferent emotional behavior.1012 Such behaviors have detrimental consequences for the ability of patients to establish and maintain social relationships, to hold jobs, and to participate in society.1,13,14 It has been found that poor theory of mind and behavioral problems significantly predict poor participation and community integration.15,16For all these reasons, it is important to provide a tailored rehabilitation treatment, in order to prevent an unfavorable outcome.

In their review of cognitive rehabilitation, Cicerone et al.17 stressed the need to provide detailed information about the theoretical base, the protocol design, and the ingredients of a treatment, as a prerequisite to analyze its effectiveness. In the current paper, we give a comprehensive description of the treatment of social cognition and emotion regulation protocol (T-ScEmo). The effectiveness of T-ScEmo was evaluated in 59 patients with traumatic brain injury. It was compared with a computerized control treatment in a randomized controlled trial.18 Compared to the control treatment, T-ScEmo resulted in significant improvements in emotion recognition, theory of mind, emphatic behavior, quality of life partner relationship, quality of life and societal participation, up to five months posttreatment. Patients with traumatic brain injury as well as their life partners were satisfied with the treatment.18 A detailed description of the T-ScEmo protocol is relevant for researchers and clinical therapists; they can use, replicate, or expand this newly developed treatment.[…]

 

Continue —-> Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury – Herma J Westerhof-Evers, Annemarie C Visser-Keizer, Luciano Fasotti, Jacoba M Spikman, 2019

 

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Figure 1. Thoughts–feelings–behavior scheme (module 2).

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[Abstract] Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool

Highlights

  • Behavioral problems (e.g., depression) in epilepsy are common but usually of mild severity.
  • 30 AED-sensitive items were discerned from the BDI-I, NDDI-E, and FPZ.
  • Items were classified into six scales, constituting the new screening tool “PsyTrack”.
  • PsyTrack subscale scores differed as a function of drug load and presence of AEDs with negative psychotropic effects.
  • Generally, monotherapy seems to be favorable in terms of behavioral adverse effects.

Abstract

Objective

Behavioral problems and psychiatric symptoms are common in patients with epilepsy and have a multifactorial origin, including adverse effects of antiepileptic drugs (AEDs). In order to develop a screening tool for behavioral AED effects, the aim of this study was to identify behavioral problems and symptoms particularly sensitive to AED drug load and the presence/absence of AEDs with known negative psychotropic profiles.

Methods

Four hundred ninety-four patients with epilepsy were evaluated who had been assessed with three self-report questionnaires on mood, personality, and behavior (Beck Depression Inventory, BDI; Neurological Disorders Depression Inventory for Epilepsy extended, NDDI-E; and Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen, FPZ). Drug-sensitive items were determined via correlation analyses and entered into an exploratory factor analysis for scale construction. The resulting scales were then analyzed as a function of drug treatment.

Results

Analyses revealed 30 items, which could be allocated to six behavioral domains: Emotional LabilityDepressionAggression/IrritabilityPsychosis & SuicidalityRisk- & Sensation-seeking, and Somatization. Subsequent analysis showed significant effects of the number of AEDs on behavior, as in Emotional Lability (F = 2.54, p = .029), Aggression/Irritability (F = 2.29, p = .046), Psychosis & Suicidality (F = 2.98, p = .012), and Somatization (F = 2.39, p = .038). Affective and behavioral difficulties were more prominent in those patients taking AEDs with supposedly negative psychotropic profiles. These effects were largely domain-unspecific and primarily manifested in polytherapy.

Conclusion

Drug-sensitive behavioral domains and items were identified which qualify for a self-report screening tool. The tool indicates impairments with a higher drug load and when administering AEDs with negative psychotropic profiles. The next steps require normalization in healthy subjects and the clinical validation of the newly developed screening tool PsyTrack along with antiepileptic drug treatment.

via Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool – Epilepsy & Behavior

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[ARTICLE] Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another – Full Text

Abstract

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee’s hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.

Introduction

Physical practice is the most efficient form of training. Although this approach is well established1, it is very challenging in cases where the basic motor capability of the training hand is limited2. To bypass this problem, a large and growing body of literature examined various indirect approaches of motor training.

One such indirect training approach uses physical practice with one hand to introduce performance gains in the other (non-practiced) hand. This phenomenon, known as cross-education (CE) or intermanual transfer, has been studied extensively 3,4,5,6,7,8,9 and used to enhance performance in various motor tasks 10,11,12. For instance, in sport skill settings, studies have demonstrated that training basketball dribbling in one hand transfers to increased dribbling capabilities in the other, untrained hand 13,14,15.

In another indirect approach, motor learning is facilitated through the use of visual or sensory feedback. In learning by observation, it has been demonstrated that significant performance gains can be obtained simply by passively observing someone else perform the task16,17,18,19,20. Similarly, proprioceptive training, in which the limb is passively moved, was also shown to improve performance on motor tasks 12,21,22,23,24,25,26.

Together, these lines of research suggest that sensory input plays an important role in learning. Here, we demonstrate that manipulating online sensory feedback (visual and proprioceptive) during physical training of one limb results in augmented performance gain in the opposite limb. We describe a training regime that yields optimal performance outcome in a hand, in the absence of its voluntary physical training. The conceptual novelty of the proposed method resides in the fact that it combines the three different forms of learning – namely, learning by observation, CE, and passive movement. Here we examined whether the phenomenon of CE, together with mirrored visual feedback and passive movement, can be exploited to facilitate learning in healthy subjects in the absence of voluntary physical movement of the training limb.

The concept in this setup differs from direct attempts to physically train the hand. At the methodological level – we introduce a novel setup including advanced technologies such as 3D virtual reality, and custom built devices that allow manipulating visual and proprioceptive input in a natural environmental setting. Demonstrating improved outcome using the proposed training has key consequences for real-world learning. For example, children use sensory feedback in a manner that is different from that of adults27,28,29 and in order to optimize motor learning, children may require longer periods of practice. The use of CE together with manipulated sensory feedback might reduce training duration. Furthermore, acquisition of sport skills might be facilitated using this kind of sophisticated training. Finally, this can prove beneficial for the development of a new approach for rehabilitation of patients with unilateral motor deficits such as stroke.[…]

Continue —> Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another

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[ARTICLE] Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events – Full Text

Abstract

Background

Psychiatric and behavioral side effects (PBSEs) are a major cause of antiepileptic drug (AED) withdrawal. Levetiracetam (LEV) is a recognized first-line AED with good seizure outcomes but recognized with PBSEs. Eslicarbazepine (ESL) is considered to function similarly to an active metabolite of the commonly used carbamazepine (CBZ). Carbamazepine is used as psychotropic medication to assist in various psychiatric illnesses such as mood disorders, aggression, and anxiety.

Aim

The aim was to evaluate the psychiatric profile of ESL in people who had LEV withdrawn due to PBSEs in routine clinical practice to see if ESL can be used as a possible alternative to LEV.

Methods

A retrospective observational review was conducted in two UK epilepsy centers looking at all cases exposed to ESL since its licensing in 2010. The ESL group was all patients with treatment-resistant epilepsy who developed intolerable PBSEs to LEV, subsequently trialed on ESL. The ESL group was matched to a group who tolerated LEV without intolerable PBSEs. Psychiatric disorders were identified from case notes. The Hamilton Depression Scale (HAM-D) was used to outcome change in mood. Clinical diagnoses of a mental disorder were compared between groups using the Fisher’s exact test. Group differences in HAM-D scores were assessed using the independent samples t-test (alpha = 0.05).

Results

The total number of people with active epilepsy in the two centers was 2142 of whom 46 had been exposed to ESL. Twenty-six had previous exposure to LEV and had intolerable PBSEs who were matched to a person tolerating LEV. There was no statistical differences in the two groups for mental disorders including mood as measured by HAM-D (Chi-square test: p = 0.28).

Conclusion

The ESL was well tolerated and did not produce significant PBSEs in those who had PBSEs with LEV leading to withdrawal of the drug. Though numbers were small, the findings suggest that ESL could be a treatment option in those who develop PBSEs with LEV and possibly other AEDs.


1. Background

Epilepsy is a neurological condition with an enduring predisposition to generate seizures and is associated with cognitive, psychological, and social issues [1]. Neuropsychiatric disorders are also more prevalent in people with epilepsy than in the general population [2] ;  [3]. There is, however, still ambiguity as to whether these comorbidities are the result of a direct link such as a genetic predisposition or structural cause leading to seizures and psychiatric problems or if seizures over time lead to psychiatric symptoms [4].

Treatment strategies in epilepsy need to be tailored to the individual and in particular, clinicians when choosing the appropriate antiepileptic drug (AED) medication need to pay attention not only to seizure patterns but also to a number of different parameters such as age, gender, comorbidities, and cognitive state.

Up to 75% of people with epilepsy may at some point have mental health issues. Antiepileptic drugs also have the potential to impact on mental health and cognition [5] ;  [6], and treatment with some AEDs is associated with the occurrence of psychiatric and behavioral side effects (PBSEs) while other may have beneficial psychotropic effects [7][8][9] ;  [10]. The PBSEs are often overlooked in epilepsy management and, withdrawal of an AED occurs only if the impact of these symptoms is significant and usually a risk to self or others.

Understanding psychotropic effects of (AEDs) is crucial but knowledge is limited. Carbamazepine (CBZ)-purported mode of action is via the modulation of voltage-sensitive sodium channels. Apart from antiepileptic action, CBZ is also used as a mood stabilizer and has proven efficacy in affective disorders. Oxcarbazepine (OXB) is structurally related to CBZ and is a prodrug that is converted into licarbazepine. The active form licarbazepine is the S enantiomer, known as eslicarbazepine (ESL). The presumed mechanism of action is as for CBZ. Conversely, OXB has never been proven to work as a mood stabilizer. In view of similarities of the postulated mechanism of action but a better tolerability profile, OXB has been used “off label” in mood management.

Levetiracetam (LEV), a commonly prescribed AED in the UK, is associated with PBSEs including irritability, depression, and anxiety [9] ;  [11]. A study suggested that PBSEs occurred in around 17% of people exposed to commonly used AEDs. Nearly 1 in 5 study participants on LEV reported PBSEs to LEV. However for CBZ the reported PBSEs were significantly lower [11]. The ESL did not figure in this study. Another study suggested that PBSEs with ESL were < 2.5%. While side effects such as irritability, anxiety, and aggressive behavior have been associated with other AEDs, rates of aggression and agitation were comparable between ESL and placebo [12]. […]

Continue —> Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events

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[BLOG] Your Behavior—How to Understand and Change It!

Richard Pfau, who holds a doctorate in science education and an undergraduate degree in psychology, wrote Your Behavior: Understanding and Changing the Things You Do as a reaction to what he sees as the current state of psychology. In his own words, the psychology field today is “scattered and speculative”.

Pfau’s goal with Your Behavior is to synthesize work from various fields including psychology, sociology, anthropology, and biology into a coherent explanation of why we do the things we do, and to do so in a way that is accessible to both laypeople and professionals. Throughout the book, he draws from perceptual control theory (PCT) to help readers understand their own behavior and how to change it.

Pfau does an excellent job of ordering and organizing his work. He begins with establishing the reader as an “autopoietic being,” which includes the assertion that we are wired to survive. As such, he asserts that most of our behaviors are done to ensure survival and often occur without conscious thought.

Pfau examines the origins of behavior from the cellular level up to all possible environmental levels and discusses how the different levels interact with each other in a system that is not strictly linear.

In life, most of us have “references,” or things like goals, plans, or how we think things ought to be. We change our behaviors based on our perceptions of how congruent they are with our references. A basic example could be something as simple as putting on a jacket when it is cold. Our body’s reference is to maintain its optimum temperature and homeostasis. But it can also be much more complicated. For instance, the references a person may have in his or her political or religious beliefs may lead to behaviors to bring the references for those beliefs into being.

We behave in such a way that our perceptions give us feedback to ensure we are in congruence with our references, whether our behavior is or is not a conscious thing. At times, we may mistakenly attribute a behavior to one level when it is a result of a different level. We are in constant interaction with our environment in terms of our perceptions of our references. Pfau offers a truly intriguing look at human behavior.

The first ten chapters offer a comprehensive overview of perceptual control theory (PCT) and why people behave the way they do, which includes a look at both ourselves and others. Pfau has organized the book in a way so that the reader can delve as deeply as they want.

Each chapter begins with a brief overview and contains multiple boxed highlights that give examples of topics in the chapter, or more in-depth information about concepts. These were very helpful as refreshers of what concepts mean throughout the book. I do not recall ever coming across PCT or autopoiesis before reading Your Behavior.

Each chapter ends with a preview of the following chapter, which gives a sense of the intentional continuity of the educational process of this book. There is an extensive list of references for further reading at the end of each chapter, as well as endnotes that give further information on the covered material. The organization and presentation are very straightforward, well thought out, and excellently presented.

I am still debating Pfau’s critique of current behavioral theory. He says that the term “culture” is abstract, and therefore a statement such as “culture causes behavior” is meaningless or misleading, and cannot be verified. But just as humans evolve in the interplay with their environment to survive, cultures also evolve, and generally due to the shortness of our lives, cultures (our interplay with our environment in a systems way) evolve outside of our awareness.

I think it may come down to “abstract” versus “construct.” There are arguments that the self is a construct, which I don’t think is addressed in this work. While reading this, I became curious as to how PCT would address the self, and perhaps culture, as a construct.

After providing a very thorough understanding of PCT and why we and others behave the way we do, the final two chapters guide us through analyzing our own behaviors, and how to systematically change them.

Pfau calls upon the works of several individuals for this, but one that stood out to me was John Norcross, who has been involved in the transtheoretical model of change over the years. (Curiously, I didn’t find any reference to the model here.)

There are very useful appendices including checklists and forms with cues to help readers analyze and develop a way to change their own behavior. Pfau even discusses his own change process with weight and smoking.

This is a very comprehensive work that is clearly presented. Your Behavior is a good book for anyone interested in behavioral change with a theory backing it that encompasses a comprehensive system from the cellular level up.

This guest article appeared on PsychCentral.comYour Behavior: Understanding & Changing the Things You Do and was originally posted on Psych Central by Richard H. Pfau and reviewed by Stan Rockwell, PsyD.

References

Richard H. Pfau (2017) Your Behavior: Understanding and Changing the Things You Do. Paragon House.

via Your Behavior—How to Understand and Change It! | Brain Blogger

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[Abstract] Traumatic Brain Injury and Behavior: A Practical Approach

Source: Traumatic Brain Injury and Behavior: A Practical Approach

  • Traumatic brain injury,
  • Psychosis,
  • Suicide,
  • Behavioral abnormalities,
  • Seizures,
  • Mania,
  • Depression,
  • Sleep-wake disorder

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