Training with computer-supported motor imagery in post-stroke rehabilitation.

Converging lines of evidence suggest that motor imagery (the mental simulation of a motor act within working memory) is associated with subliminal activation of the motor system. This observation has led to the hypothesis that cortical activation during motor imagery may affect the acquisition of specific motor skills and help the recovery of motor function. In this paper, we describe a clinical protocol in which we use interactive tools to stimulate motor imagery in hemiplegic stroke patients, thereby helping them to recover lost motor function. The protocol consists of an inpatient and an outpatient phase, combining physical and mental practice. In the inpatient phase, patients are trained in a laboratory setting, using a custom-made interactive workbench (VR Mirror). After discharge, patients use a portable device to guide mental and physical practice in a home setting. The proposed strategy is based on the hypotheses that: (a) combined physical and mental practice can make a cost-effective contribution to the rehabilitation of stroke patients, (b) effective mental practice is not possible without some form of support, from a therapist (as in our inpatient phase) or from technology (as in the outpatient phase), (c) the inclusion of an outpatient phase will allow the patient to practice more often than would otherwise be possible, therefore increasing the speed and/or effectiveness of learning, and (d) the use of interactive technology will reduce the patient's need for skilled support, therefore improving the cost-effectiveness of training.     

Application of a family systems approach to working with people affected by HIV disease – two case studies

HIV infection, with its particular modes of transmission, affects relationships, interrupts the normal life-cycle and brings different challenges to patients and their contacts as they pass through the asymptomatic and symptomatic phases to the terminal stages of illness. This paper describes a family systems approach to therapy with people affected by HIV disease, illustrated by two case examples.     

Short-term forgetting and the articulatory loop

Two experiments explored the role of subvocal articulatory rehearsal in the Peterson short-term forgetting task. In the first of these, subjects recalled consonant trigrams after an interval of 0, 5 or 15 s during which they either counted backwards in threes, suppressed articulation by continuously uttering the word “the”, or in a third control condition continuously tapped on the table. While counting backwards caused the usual dramatic forgetting, tapping caused no forgetting, and articulatory suppression only minimal forgetting at the longest delay. A second study used the same procedure but included only two conditions, articulatory suppression during the retention interval and articulatory suppression during both input and retention. Neither showed evidence of forgetting over the 15 s delay. These results suggest that covert speech is not necessary for rehearsal in short-term verbal memory. As such they call for a re-evaluation of the nature and function of rehearsal.     

Suicidal behaviors and personality structure

In this paper we suggest the potential clinical usefulness of two projective tests (Rorschach and Object Relation Technique) and of a clinical interview focused on the pathway to suicide, life events, and major life difficulties to better define subtypes of patients attempting suicide. Thirty-three hospitalized subjects who had attempted suicide in the previous 6 months were examined using an in-depth assessment of the pathway to suicide. The aims of this study were: (1) to compare, within a clinical sample of suicidal attempters, the psychopathological, personality, and psychosocial characteristics of subjects with mood disorders alone, personality disorders and dysfunctional personality alone, and mood disorders with personality disorders and/or dysfunctional personality; and (2) to analyze the relationship between the method chosen and the clinical characteristics of the subgroups.     

Frontal lobe dementia and subcortical vascular dementia: a neuropsychological comparison

We compared the performance of 40 patients with frontal lobe dementia to that of 40 patients with subcortical vascular dementia (80 patients including, 46 men and 34 women) in a set of tasks assessing attentional, executive, and behavioural tasks. The frontal lobe dementia represents an important cause for degenerative disruption and is increasingly recognised as an important form (up to 25%) of degenerative dementia among individuals of late-middle-age. The main involvement is the frontal-subcortical pathway, which is the final target of impairment even in subcortical vascular dementia. A wider involvement of the cortical (decisional) layers in frontal dementia, in contrast with the prominent and widespread involvement of the subcortical pathways (refinement and corrections programs) creates the different profiles of the two groups. Frontal patients have more difficulties in abstract reasoning, focusing attention, and implementing strategies to solve problems. They exhibit more profound behavioural alterations in personality and social conduct and show only moderate depression, and a total lack of insight concerning their dinical condition. In contrast, the patients with subcortical vascular dementia have poor general cognitive functions, high insight, and important depression and apathy as the principal and most salient characteristic of their behavioral conduct.     

Counselling children and adults about AIDS/HIV: The ripple effect on haemophilia care settings

Haemophilia and HIV/AIDS are life-long, life-threatening conditions for which there is treatment but no cure. Both affect not only the patient but all members of the family. This paper focusses on how the counselling of those with AIDS/HIV has been affected by dilemmas such as treatment, infectious aspects, blood donation, sex, the media and having children. The impact of haemophilia and AIDS on the family and the ripple effect on health care staff is addressed.