Hyperarousal and attention problems as a result of posttraumatic stress disorder (PTSD) are being recognized as a risk for offense recidivism. Short-term Music therapy Attention and Arousal Regulation Treatment (SMAART) was designed as a first step intervention to address responsivity and treatment needs of prisoners who were not eligible for or unwilling to undergo eye movement desensitization and reprocessing (EMDR) therapy. This article describes a pilot study of the manualized SMAART protocol in a Penitentiary Psychiatric Center (PPC) and whether there is an increase of focused and sustained attention and a decline of arousal symptoms in prisoners suffering from PTSD, attributable to SMAART. A single case baseline-treatment-design with pre-and post-assessment (N = 13) was used. PTSD prevalence and severity were assessed using the Primary Care-PTSD screen and the PTSD Symptom Scale Interview. Selective and sustained attention was assessed using the Bourdon-Wiersma dot cancellation test. The results show a promising decline of arousal symptoms as well as improved selective and sustained attention levels in the subjects. Also, after the SMAART intervention, five participants no longer met the threshold for a PTSD diagnosis. The results show that the SMAART protocol could be implemented in the PPC-setting. Although the clinical results of the manualized SMAART protocol suggest improvement, this is a small feasibility study so the results must be interpreted with care. Suggestions for future research are offered.
Gait analysis is one aspect of evaluation in ambulatory children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) improve gait and alignment through providing support. An alternative and under-researched orthosis are sensomotoric orthoses (SMotOs). The Edinburgh Visual Gait Score (EVGS) is a valid observational gait analysis scale to measure gait quality. The aim of this study was to use the EVGS to determine what effect AFOs and SMotOs have on gait in children with CP. The inclusion criteria were: mobilizing children with a CP diagnosis, no surgery in the past six weeks, and currently using SMotOs and AFOs. Eleven participants were videoed walking 5 m (any order) barefoot, in SMotOs and AFOs. Of the participants (age range 3–13 years, mean 5.5 ± 2.9), two were female and six used assistive devices. Seven could walk barefoot. Participants had spastic diplegia (4), spastic quadriplegia (6), and spastic dystonic quadriplegia (1). Gross Motor Functional Classification System (GMFCS) levels ranged I–IV. The total score for SMotOs (7.62) and AFOs (14.18) demonstrated improved gait when wearing SMotOs (no significant differences between barefoot and AFOs). SMotOs may be a viable option to improve gait in this population. Additional study is required but SMotOs may be useful in clinical settings.
Ankle–foot orthoses (AFOs) and sensomotoric orthoses (SMotOs) are two—clinically relevant, yet under researched—types of lower limb orthoses used in children with cerebral palsy (CP). Quality of life is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Evaluating the effect of these two types of orthoses on quality of life in children with CP has not been reported on. The aim of this case study series was to synthesise and enrich the volume of evidence reported to inform real world applications of SMotO use in children with CP. Participants recruited were children with CP who performed the Berg Balance Scale, Timed Up-and-Go, the Gross Motor Function Measure and/or the Edinburgh Visual Gait Score in AFOs, SMotOs and barefoot where able. Qualitative data included videos of gait, a questionnaire and pedographs. Eight participants completed 39 quantitative and six qualitative measures, with the Edinburgh Visual Gait Score (EVGS) reporting the highest response. A general improvement was seen in gross motor skills and gait when wearing the SMotOs compared to AFOs and some parents reported that SMotOs were preferred. The reader is able to correlate the quantitative results with the qualitative evidence presented.
Background: Gait analysis is one of the important aspects of evaluation in ambulatory children with cerebral palsy (CP). Typically prescribed for children with CP, ankle-foot orthoses (AFOs) improve gait and alignment through providing support and stability to the ankle complex. An alternative and under-researched orthosis being used in this population is the Sensomotoric orthotic (SMotO), which uses a different approach to correct alignment and improve gait. The Edinburgh Visual Gait Score (EVGS) is a valid, robust, reliable and easy-to-use observational gait analysis scale to measure of gait quality in CP. Improvements to gait could then be attributed to intervention, or regression of gait could be attributed to poor intervention or physical changes. Therefore, the aim of this study was to use the EVGS to determine the effect of SMotOs, AFOs and barefoot on gait pattern in children with CP. Methods: This cross-sectional cohort study investigated the differences in gait quality in children with CP between wearing SMotOs and AFOs through using the EVGS. Video imagery was taken when walking barefoot (where appropriate), in SMotOs and in AFOs for at least 5m at a self-directed pace. Individual scores and averages across the population were recorded. Data was analysed through SPSS statistics software (Version 20) and the Microsoft Office Excel 2007. A one-way ANOVA and post hoc Bonferroni were completed to identify significant differences with the alpha level set at p<.05. Results: One-way ANOVA analyses revealed significant differences between total left (p=0.011) and right (p=0.014) scores between SMotO and AFOs. Overall, results demonstrate improved gait in favour of SMotO vs AFO and that there are no significant differences between being barefoot and wearing AFOs. Conclusions: SMotOs are a viable orthotic option to improve gait in children with CP, but due to small yield of participants, a larger scale, blinded study should be performed to further determine results.
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