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BACKGROUND Routine preclinical interventions for patients with chronic periodontitis such as supragingival cleaning and subgingival curettage, establishing a balanced occlusal relationship, and irrigation with 3% hydrogen peroxide can relieve the symptoms to some extent. However, there is room for improvement in the overall effect. For example, Er:YAG lasers can quickly increase the temperature of the irradiated tissue, effectively eliminate dental plaque and calculus, reduce periodontal pockets, adjust periodontal microecology, and reduce the gingival sulcus. The content of factors in the liquid, and then achieve the purpose of treatment. AIM The aim was evaluate the effect of Er:YAG laser-assisted routine therapy on the periodontal status in chronic periodontitis. METHODS Between October 2018 and January 2020, 106 patients with chronic periodontitis in our hospital were randomly assigned to either the study or control group, with 53 patients in each group. The control group underwent routine therapy, and the study group underwent Er:YAG laser therapy in addition to routine therapy. We evaluated the treatment outcome in both groups. Periodontal status was determined by clinical attachment loss (CAL), gingival index (GI), periodontal probing depth (PD), dental plaque index (PLI), and sulcular bleeding index (SBI), inflammatory factors in the gingival crevicular fluid, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8], and colony forming units (CFUs). RESULTS Total effectiveness in the study group (94.34%) was higher than that in the control group (79.25%, P < 0.05). The clinical parameters in the study group (PD, 5.28 ± 1.08 mm; CAL, 4.81 ± 0.79 mm; SBI, 3.37 ± 0.59; GI, 1.38 ± 0.40; PLI, 2.05 ± 0.65) were not significantly different from those in the control group (PD, 5.51 ± 1.14 mm; CAL, 5.09 ± 0.83 mm; SBI, 3.51 ± 0.62; GI, (1.41 ± 0.37; PLI, 1.98 ± 0.70) before treatment (P > 0.05). However, after treatment, the parameters in the study group (PD, 2.97 ± 0.38 mm; CAL, 2.71 ± 0.64 mm; SBI, 2.07 ± 0.32; GI, 0.51 ± 0.11; PLI, 1.29 ± 0.34) were lower than those in the control group (PD, 3.71 ± 0.42 mm; CAL, 3.60 ± 0.71 mm; SBI, 2.80 ± 0.44; GI, 0.78 ± 0.23; PLI, 1.70 ± 0.51) (P < 0.05). Differences in crevicular TNF-α, IL-6, and IL-8 levels in the study (TNF-α, 7.82 ± 3.43 ng/mL; IL-6, 11.67 ± 2.59 ng/mL; IL-8, 12.12 ± 3.19 pg/mL) and control groups (TNF-α, 9.06 ± 3.89 ng/ml, IL-6, 12.13 ± 2.97 ng/mL, IL-8, 10.99 ± 3.30 pg/mL) before therapy (P > 0.05) were not significant. Following treatment, the parameters were significantly lower in the study group (TNF-α, 2.04 ± 0.89 ng/mL; IL-6, 4.60 ± 1.26 ng/mL; IL-8, 3.15 ± 1.08 pg/mL) than in the control group (TNF-α, 3.11 ± 1.07 ng/mL; IL-6, 6.25 ± 1.41 ng/mL; IL-8, 4.64 ± 1.23 pg/mL, P < 0.05). The difference in the CFU of the study group [(367.91 ± 74.32) × 104/mL and control group (371.09 ± 80.25) × 104/mL] before therapy was not significant (P > 0.05). The CFU decreased in both groups following therapy, however, the CFU values were lower in the study group [(36.09 ± 15.26) × 104/mL] than in the control group [(45.89 ± 18.08) ×104/mL] (P < 0.05). CONCLUSION Combining Er:YAG lasers with routine measures significantly improved the overall periodontal therapy outcomes by improving periodontal status and reducing oral levels of inflammatory factors and CFUs.

The recently published Imperial College study of a Phase II, double-blind, randomized, controlled trial comparing psilocybin-assisted therapy to a six-week titration of escitalopram for Major Depressive Disorder (MDD) should raise concerns for this illness category as a target of early psychedelic research given a goal of FDA approval. There are three reasons why MDD is the wrong target at this stage of research development. Firstly, the psychiatric category of MDD is heterogeneous, vaguely-defined, and overdiagnosed in a way that will problematize finding a reliable signal with psychedelic interventions (or any intervention), particularly within non-severe cases. Secondly, current rating scales for MDD (QIDS used in the Imperial College trial, but also HAM-D) are limited in approximating the kinds of things we ultimately care most about with depressive states, namely functional status, quality of life, and well-being: measures that seem more salient for psychedelic interventions and which are not adequately captured by these rating scales used in a majority of clinical trials. And thirdly, there are inherent conflicts between psychiatric conceptualizations of MDD (and its symptom amelioration) and the kinds of perspectives on one’s suffering often occasioned by psychedelic experiences themselves: while these kinds of psychedelic-catalyzed openings may lead to a form of acceptance or equanimity with regards to one’s life circumstances this could be in many ways orthogonal to reductions in HAM-D scores. We argue that for these reasons MDD is a non-ideal target at this stage of the science and propose alternative directions.

Platelet-rich plasma (PRP) therapy has been used in different medical fields, but its effectiveness in burn wound healing remains debatable. In this study, we performed a systematic review and meta-analysis of the available evidence on burn patients treated with PRP to evaluate the safety and efficacy of the treatment.Randomized controlled trials evaluating the efficacy of PRP in patients with burn injuries were selected. Eligible retrospective studies were abstracted and assessed for the risk of bias by two reviewers and results of mean time to complete epithelization and wound closure rate in the included studies were analyzed. Studies on the correlation between PRP and burn wound healing published in English or Chinese before March 2020 were retrieved from PubMed.Eight studies (including 449 patients) met our inclusion criteria. Qualitative analysis revealed that compared with the control group, the PRP group had significantly better wound closure rates at weeks 2 (mean difference (MD): 12.79 [95% confidence interval (CI): 7.08, 18.49]; I2: 0%; p0.0001) and 3 (MD: 12.66 [95% CI: 5.97, 19.34]; I2: 55%; p = 0.0002) and time to complete epithelialization (MD: -3.45 [95% CI: -4.87, -2.04] (days); I2: 0%; p0.00001). There was no significant difference in infection rate or graft take rate.PRP application can accelerate wound closure, however, it has no effect on the rates of wound infection and graft take rate.

Psychedelics are a class of psychoactive substances that were studied extensively between 1943 and 1970 as potential therapies for treating a host of mental health disorders, including addiction. Despite promising early results, U.S. psychedelic research was halted in the early 1970s with the enactment of the Controlled Substances Act. As the field of psychedelic-assisted therapy develops, nurses can decide the role they will play in the continuing clinical and scholarly research of these substances, which may soon be used in controlled settings to treat some of the most widespread mental health disorders. To prepare for this task, this article proposes that nurses become familiar with the history, relevant language, and scientific findings related to the field of psychedelic research. learn about existing psychedelic-assisted therapy and research resources. examine their thoughts, judgments, and opinions about therapeutic psychedelic use. consider the potential role of nursing in psychedelic-assisted therapies going forward.

This report describes Rapid Access to Medication Assisted Therapy (RAM), an innovative, cross-system intervention, piloted in Central Vermont to address the opioid overdose epidemic, building on em...

Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support.To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level.We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis.We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities.People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response.

DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, The Donaghue Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan ...

The gold-standard cognitive–behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.

Background: Increasing rates of opioid-related overdose have been identified globally. Treatment for opioid use disorders (OUD) includes medications for opioid use disorder (MOUD) alongside behavio...

The aim of this systematic review was, first, to determine whether or not individuals with cognitive deficits after stroke were enrolled in trials that investigated upper limb robot-assisted therapy effectiveness, and, second, whether these trials measured cognitive outcomes. We retrieved 6 relevant systematic reviews covering, altogether, 66 articles and 2214 participants. Among these 66 clinical trials, only 10 (15%) enrolled stroke participants with impaired cognition, whereas 50 (76%) excluded those with impaired cognition. The remaining six trials (9%) were classified as unclear as they either excluded individuals unable to understand simple instructions or did not specify if those with cognitive disorders were included. Furthermore, only 5 trials (8%) used cognitive measures as outcomes. This review highlights a lack of consideration for individuals with cognitive impairments in upper limb robotic trials after stroke. However, cognition is important for complex motor relearning processes and should not be ignored.

A holistic intervention is needed for individuals who suffer from autism spectrum disorders. Our objective was to work with these individuals in a multidisciplinary manner through the use of animal-assisted therapy, finding improvements in the experimental group as compared with the control group in the different evaluated areas.

Background Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. Objectives This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. Methods Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. Results In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4–11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37–638)) reps and 8 (2–14) reps/minute, with the duration of therapy unchanged. Conclusions This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff. IMPLICATIONS FOR REHABILITATION Robotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practice Robotics were able to be implemented within the existing organisational structures with only basic training of therapy staff

Contains fulltext : 225794.pdf (Publisher’s version ) (Open Access) Social communication and self-esteem are often affected in adults with autism spectrum disorder. Implementation and evaluation of interventions targeting social skills are challenged due to specific characteristics of autism. Intensive, valid evaluation of social skills programs is needed. In this explorative multiple case study, we examined effects and working mechanisms of dog-assisted therapy on social communication and self-esteem, by analyzing detailed observations with Monte Carlo permutation tests (testing against 10,000 random samples) and using self- and other-reports in N=6 high-functioning adults with ASD. Results showed significant positive effects on secure body posture. There was an indication of improved self-esteem and more spontaneous touching of the dog, while no convincing increase was found for verbal initiatives. Cross-correlation analyses revealed that touching the therapy dog may be an important determinant to elicit social development in Animal Assisted Therapy (AAT). Considering preliminary results, we recommend exploring underlying mechanisms more thoroughly with real-time observations, accounting for possible gender-effects.

Objetivo: Confirmar la factibilidad y analizar los cambios ocurridos en el equilibrio y la motricidad fina de un grupo de personas con discapacidad física tras un programa de rehabilitación física realizado con perros de terapia. Método: Un total de 10 personas adultas con discapacidad física participaron en un programa de terapia asistida con perros durante un trimestre, a razón de una sesión mensual de dos horas de duración. La muestra se dividió en dos grupos en función de su nivel de afectación física y se establecieron objetivos distintos para los mismos: mejora del equilibrio estático, dinámico y riesgo de caídas, valorado mediante la escala Tinetti (Grupo 1), mejora de la motricidad fina y coordinación valorada mediante la batería MABC-2 (Grupo 2). Resultados: El programa se mostró factible sin registro de efectos adversos ni abandonos. En el grupo-1 se observaron cambios pre-post en todas las variables de equilibrio y marcha evaluadas. En todos los casos fueron cambios interpretables como mejora y estadísticamente significativos. En el grupo-2 se observaron también cambios pre-post se observó un modesto porcentaje de ensayos fallidos y mientras que en el 49.6% restante se documentaron ensayos fallidos. Las 2/3 partes de los cambios observados en el grupo-2 fueron interpretables como mejora, pero ninguno estadísticamente significativo. Conclusiones: El empleo de perros como estrategia de terapia asistida en personas con discapacidad física es una opción rehabilitadora factible y de interés, que puede conllevar mejoras en su equilibrio, si bien tiene un impacto de poca magnitud en su nivel de motricidad fina y coordinación Objective: To confirm the feasibility and analyze the changes occurred in the balance and fine motor function of a group of people with physical disability after a physical rehabilitation program performed with therapy dogs. Methods: A total of 10 adult people with physical disability took part in a program of assisted therapy with dogs during a trimester through a 2-hours monthly session. The sample was divided into two groups according to their level of physical involvement, and different objectives were established for each of the groups: static balance enhancement, dynamic and falling risk valued with Tinetti scale (Group 1), fine motor function enhancement and coordination valued with battery MABC-2 (Group 2). Results: The program was shown to be feasible with no record of adverse effects or dropouts. In group 1, pre-post changes were observed in all balance and gait variables evaluated. In all cases these were changes that could be interpreted as improvements and were statistically significant. In group 2, prepost changes were observed in only half of the cases (51.4%), while in the remaining 49.6% failed trials were documented. Two-thirds of the changes observed in group-2 were interpretable as improvement, but none were statistically significant. Conclusions: Using dogs as strategy of assisted therapy in people with physical disability is a feasible and interesting rehabilitation option, which can carry improvements in their balance, while it has a small impact in their fine motor function and coordination

Background Neurological injuries cause persistent upper extremity motor deficits. Device-assisted therapy is an emerging trend in neuro-rehabilitation as it offers high intensity, repetitive practice in a standardized setting. Objective To investigate the effects of therapy duration and staff-participant configuration on device-assisted upper limb therapy outcomes in individuals with chronic paresis. Methods Forty-seven participants with chronic upper extremity weakness due to neurological injury were assigned to a therapy duration (30 or 60 min) and a staff-participant configuration (1-to-1 or 1-to-2). Therapy consisted of 3 sessions a week for 6 weeks using the Armeo®Spring device. Clinical assessments were performed at three timepoints (Pre, Post, and 3 month Follow up). Results Improvements in upper limb impairment, measured by change in Fugl-Meyer score (FM), were observed following therapy in all groups. FM improvement was comparable between 30 and 60 min sessions, but participants in the 1-to-2 group had significantly greater improvement in FM from Pre-to-Post and from Pre-to-Follow up than the 1-to-1 group. Conclusions Device-assisted therapy can reduce upper limb impairment to a similar degree whether participants received 30 or 60 min per session. Our results suggest that delivering therapy in a 1-to-2 configuration is a feasible and more effective approach than traditional 1-to-1 staffing.

Introduction The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice. Methods A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention. Findings The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation. Conclusion Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake.

Psychedelic-assisted therapy is based on the premise that psychedelic substances can act as catalysts or adjuncts to psychotherapeutic processes. Recent clinical trials involving psychedelic-assisted therapy have generally employed a similar three-part structure consisting of preparation, support during the dosing sessions, and subsequent “integration.” However, the content of these sessions and the frame through which the therapists approach participants and understand the clinical process has thus far been inconsistent among studies. In designing a manualized therapy protocol for a small clinical trial of psilocybin-assisted therapy for major depressive disorder, our group sought to delineate an explicit and replicable, evidence-based model that intentionally builds upon both the neurobiological actions of the medication and the phenomenology of the drug experience. Having identified considerable concordance in proposed mechanisms of change between Acceptance and Commitment Therapy (ACT) and psilocybin therapy, we employed ACT as an overarching psychotherapeutic framework. We hypothesize that the psilocybin experience can provide direct experiential contact with ACT processes that increase psychological flexibility, and that these deeply felt experiences may in turn be reinforced during ACT-informed follow-up therapy sessions. In this paper, we describe the rationale for selecting ACT, areas of potential synergism between ACT and psilocybin-therapy, the basic structure of our treatment model, and limitations to this approach.

Background Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to “older adults,” “dementia,” and “institutional care” and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets.

This chapter discussed the potential usefulness of robot-assisted therapy for motor recovery after a stroke. An overview of the available literature was performed providing up-to-date information about the use of robot-assistive technology in rehabilitation practice. The chapter discussed the rationale for the use and the different machines in terms of basic engineering principles and the related rehabilitation possibilities. Finally, clinical and rehabilitative implications of the findings were critically discussed.

OBJECTIVE: Opioid use disorder (OUD) is a notable concern in the United States (US) and strongly associated with mortality. There is a high prevalence of OUD in patients with posttraumatic stress disorder (PTSD) and the mortality associated with OUD may be exacerbated in patients with PTSD. Medication-assisted treatment (MAT) for OUD has become standard of care for OUD and has been shown to reduce mortality. However, there has been little study of MAT and mortality in patients with PTSD and OUD. METHODS: We conducted a retrospective cohort study in U.S. veterans who had newly engaged in PTSD treatment, were diagnosed with OUD and were provided MAT for at least one day between 2004 and 2013. We assessed mortality for one year following the index diagnosis date. We calculated all-cause mortality as well as death by external cause, overdose plus suicide, overdose, and suicide rates per 100,000. We used hazard ratios (HR) and 95% confidence intervals (CI) to compare death rates between patients with high versus low adherence to MAT. We evaluated the impact of high versus low exposure to general substance abuse care. We considered a confidence interval that did not cross one to be significant. RESULTS: A total of 5,901 patients met inclusion criteria. Most patients were men and the average age was 43.3 years (SD=13.8). The all-cause mortality rate was 1,370 per 100,000 patients. High adherence to MAT resulted in a non-significant, decreased risk for death due to all-cause (HR=0.73, 95% CI [0.47, 1.13]), external cause (HR=0.71, 95% CI [0.38, 1.35]), and overdose or suicide (HR=0.66, 95% CI [0.33, 1.35]). Patients with high exposure ( 60 days) to general substance abuse care were significantly less likely to die due to external cause (HR=0.39, 95% CI [0.18, 0.85]) and overdose or suicide (HR=0.31, 95% CI [0.12, 0.77]). CONCLUSIONS: In patients with PTSD and OUD, improved adherence to MAT and greater exposure to general substance abuse care may result in lower mortality. Studies with longer follow-up and larger sample sizes to assess the impact of MAT on suicide are needed to confirm our findings.

Animal-assisted therapy (AAT) has been suggested to increase prosocial behavior in children diagnosed with Autism Spectrum Disorder (ASD). Out of all the animals used in AAT, dogs have been found to be the most utilized and accessible. This systematic review examines the current state of literature on canine-assisted therapy (CAT) for children with ASD based on peer-reviewed articles. Five studies met inclusion and exclusion criteria. All articles found that presence of a therapy dog was correlated with increased frequency and duration of social behavior both throughout treatment and, in the case of one study, at follow-up. However, methodological limitations such as small sample sizes and sub-optimal analytic procedures suggest that existing studies might not accurately reflect the true nature of the relationship between CAT and social behavior. Therefore, further exploration of this area of research using methodologically strong studies is warranted and necessary. Recommendations for future research are included.

Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.

Namen magistrske naloge je bil ugotovili, ali terapevtskim konjem sodelovanje v hipoterapiji predstavlja stres. Poskus smo izvajali na lokaciji CIRIUS Kamnik, kjer smo opazovali 4 terapevtske konje med hipoterapijo. Spremljali smo pogostost oblik obnašanja, ki nakazujejo na stres (položaj ušes in glave ter gibanje) in v določenih časovnih razmakih (pred terapijo, po terapiji, 45 minut po terapiji) merili očesno temperaturo ter odvzeli vzorce sline za določanje koncentracije kortizola. Konje smo štirikrat spremljali v poletni in štirikrat v jesenski sezoni. Pripravili smo tudi anketo za ocenjevanje osebnosti konj. Na podlagi zbranih podatkov smo v poletni sezoni zabeležili značilno več sprememb v gibanju konja kot v jesenski sezoni in večjo pogostost sprememb položaja glave, ko je konja jahal pokreten uporabnik. Višjo koncentracijo kortizola v slini smo izmerili v jesenski sezoni, značilna interakcija med sezono in meritvijo pa je pokazala razliko med prvo in četrto meritvijo v jesenski sezoni. Glede na čas odvzema vzorca sline smo zabeležili značilno višjo koncentracijo kortizola tik po terapiji v primerjavi z meritvijo 45 minut po terapiji. Med meritvama pred terapijo in po terapiji nismo ugotovili značilnih razlik. Pri meritvah očesne temperature je bila izmerjena značilno višja očesna temperatura v poletni sezoni v primerjavi z jesensko sezono, značilne so bile tudi razlike med posameznimi meritvami. Interakcija med sezonama in meritvami je pokazala nihanja očesne temperature le v jesenski sezoni, značilna interakcija med sezono in časom meritve pa značilno razliko v očesni temperaturi pred terapijo in 45 minut po terapiji, vendar le v jesenski sezoni. Podatki očesnih temperatur morda niso optimalni, saj ni bilo možno zagotoviti optimalnih pogojev za merjenje. Na podlagi ankete o osebnosti konj nismo ugotovili stopnje strinjanja med tremi ocenjevalci za posameznega konja, so se pa ocenjevalci med seboj strinjali na podlagi vseh 69 osebnostnih lastnosti za vse 4 konje. Na podlagi vseh zbranih rezultatov lahko sklepamo, da so konji med sodelovanjem pri hipoterapiji doživeli nekaj stresa. The purpose of the master's thesis was to find out whether participation in hippotherapy stresses out therapeutic horses. The research was performed in CIRIUS Kamnik, where 4 therapeutic horses were observed during hippotherapy. We monitored the frequency of behaviours indicating stress (ear and head position and movement). Before therapy, right after the therapy and 45 minutes after the therapy we measured the eye temperature and took saliva samples to determine cortisol concentration. The horses were monitored four times in the summer and four times in the autumn season. We also prepared a survey to assess the personality of the horses. We recorded significantly more changes in the horse movement in the summer season than in the autumn season and a higher frequency of changes in head position when the horse was ridden by a mobile user. Higher cortisol concentrations in saliva were measured in the autumn season. The interaction between the season and the measurement showed a significant difference between the first and the fourth measurement in the autumn season. Significantly higher cortisol concentration was recorded right after therapy compared to the measurement 45 minutes after the therapy. No significant differences were recorded between pre-therapy and post-therapy measurements. A significantly higher eye temperature was measured in the summer season compared to the autumn season differences between individual measurements were also significant. The interaction between the seasons and the measurements showed significant fluctuations in eye temperature only in the autumn season. The interaction between the season and the time of the measurement showed a significant difference in the eye temperature before the therapy and 45 minutes after the therapy, but only in the autumn season. It was not possible to provide optimal measuring conditions for measuring eye temperature and therefore the eye temperature data may not be accurate. Based on the horse personality survey, we did not find a degree of agreement between the three evaluators for each horse, but the evaluators agreed on all 69 personality characteristics for all 4 horses. Based on the all collected data, we can conclude that the horses experienced some stress while participating in the hippotherapy.

Objectives This study is a follow-up to previous research regarding buprenorphine medication-assisted therapy (MAT) in Johnson City, Tennessee. For-profit MAT clinics were surveyed to determine changes in tapering practice patterns and insurance coverage during the last 3 years. Methods Johnson City for-profit MAT clinics; also called office based opioid treatment centers, were surveyed by telephone. Clinic representatives were asked questions regarding patient costs for therapy, insurance coverage, counseling offered onsite, and opportunities for tapering while pregnant. Results All of the MAT clinics representatives indicated that tapering in pregnancy could be considered even though tapering in pregnancy is contrary to current national guidelines. Forty-three percent of the clinics now accept insurance as compared with 0% in the 2016 study. The average weekly cost per visit remained consistent. Conclusions The concept of tapering buprenorphine during pregnancy appears to have become a standard of care for this community, as representatives state it is offered at all of the clinics that were contacted. Representatives from three clinics stated the clinics require tapering, even though national organizations such as the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine do not recommend this approach. Although patients who have government or other insurance are now able to obtain buprenorphine with no expense at numerous clinics, the high cost for uninsured patients continues to create an environment conducive to buprenorphine diversion.

Background Medicine is currently experiencing a “psychedelic renaissance”, said by many to have commenced in 2006. Since then, clinical trials have consistently demonstrated promising findings for psychedelic-assisted therapies in the treatment of various mental health conditions and addictions. While most of this work has been privately funded, governmental biomedical research funding bodies in countries such as Australia, Canada, Israel, New Zealand, and the United Kingdom have begun supporting it. Given that the United States National Institutes of Health (NIH) is the largest public funder of biomedical research in the world, it is important to understand the degree to which the organization is supporting clinical trials of psychedelic-assisted therapies. We are unaware of existing literature quantifying direct NIH grant support for psychedelic-assisted therapy clinical trials, so we sought to answer this important question by searching all NIH grants awarded since the beginning of the psychedelic renaissance. Methods We queried NIH RePORTER, NIH’s grant database, for grants awarded from 2006-2020 mentioning the psychedelics 3,4-Methylenedioxymethamphetamine (MDMA), 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), ayahuasca, dimethyltryptamine (DMT), ibogaine, lysergic acid (LSD), mescaline, peyote, and psilocybin. We manually reviewed resulting grants to determine whether they directly funded psychedelic-assisted therapy clinical trials. Results We identified zero NIH grants directly funding psychedelic-assisted therapy clinical trials during the study period. Conclusion While governmental biomedical research funding bodies in other countries have begun funding clinical trials of psychedelic-assisted therapies during the psychedelic renaissance, NIH has yet to directly fund a single psychedelic-assisted therapy clinical trial. Concerns about risks related to psychedelics, a federal law preventing promotion of legalization of Schedule 1 drugs, and prioritization of grants for other types of studies on psychedelics may explain the dearth of NIH funding for psychedelic-assisted therapy clinical trials.

Mindfulness-based interventions and psychedelic-assisted therapy have been experimentally utilised in recent years as alternative treatments for various psychopathologies with moderate to great success. Both have also demonstrated significant post-acute and long-term decreases in clinical symptoms and enhancements in well-being in healthy participants. These two therapeutic interventions share various postulated salutogenic mechanisms, such as the ability to alter present-moment awareness and anti-depressive action, via corresponding neuromodulatory effects. Recent preliminary evidence has also demonstrated that psychedelic administration can enhance mindfulness capacities which has already been demonstrated robustly as a result of mindfulness-based interventions. These shared mechanisms between mindfulness-based interventions and psychedelic therapy have led to scientists theorising, and recently demonstrating, synergistic effects when both are used in combination, in the form of potentiated therapeutic benefit. These synergistic results hold great promise but require replication in bigger sample groups and better controlled methodologies, to fully delineate the effect of set and setting, before they can be extended onto clinical populations.

Objectives Several studies have evaluated the impact of oral medication on the gut microbiome (GM) in Parkinson’s disease (PD). However, the impact of PD device-assisted therapies (DAT) on the GM remains to be investigated. We profiled acute temporal GM stability around the initiation of PD DAT. Methods The GM of 21 PD patients initiating either Deep Brain Stimulation (DBS) or levodopa-carbidopa intestinal gel (LCIG) were compared to 10 spousal healthy control (HC) subjects. 16S amplicon sequencing of the V3-V4 region of stool bacterial DNA was used to compare temporal GM stability between groups and with clinical outcome measures, including disease alternations relative to therapy initiation. GM response to therapy in the PD group was assessed by comparing pre-therapy (-2 and 0 weeks) with post-therapy initiation timepoints (+2 and +4 weeks) and HCs at baseline (0 weeks). Results Altered GM compositions were noted between the PD and HC groups at various taxonomic levels, including specific differences for DBS and LCIG therapies. Beta diversity changes were also identified across the 4 week post-treatment initiation period, implying a therapy-effect on the GM. Conclusions We present the first acute longitudinal assessment of GM response to PD DAT. The pre-treatment PD-specific GM (consistent with previous studies) was altered following DAT initiation, indicating DATs have a modulatory impact on the GM in PD.

Dog-assisted therapy (DAT) consists of an intervention, applied and supervised by duly qualified health professionals, in which the dog is an integral part of the treatment, causing behavioral changes and the health of people with different types of needs. This article aims to identify, through a literature review, the health areas capable of receiving intervention with dogs and their benefits in treatment. The results showed the possibility of implementing DAT in different configurations such as hospitals, nursing homes, clinics or schools and demonstrated the beneficial potential of this intervention for physical, mental and emotional rehabilitation. Keywords: Assisted therapy; Dog; Animal.

Psychedelic substances such as psilocybin and ketamine may represent the future of antidepressant treatment, due to their rapid and prolonged effects on mood and cognition. The current body of psychedelic research has focused on administration and treatment within a psychiatric context. Here, instead, we put to the test the contention that it is necessary to evaluate the current state of this literature from a broader biopsychosocial perspective. Examining these arguably neglected social and psychological aspects of psychedelic treatment can provide a more holistic understanding of the interplay between the interconnected domains. This review of six major clinical trials applies a biopsychosocial model to evaluate the antidepressant effects of psilocybin and ketamine assisted therapy. We conclude that combination psychedelic treatment and psychotherapy facilitate more enduring and profound antidepressant effects than produced by ketamine or psilocybin alone. Emphasising the advantages of therapeutic intervention will encourage those who may attempt to self-medicate with psychedelics to instead seek a framework of psychological support, minimising associated risks of unregulated use.

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Scientific research on the therapeutic use of psychedelics has rapidly expanded over the past decade and, over the next decade, they may be approved for clinical use. Psychedelics have been used for centuries in ritual, community, and spiritual contexts and yet the potential for a scientific approach to these drugs has possibly never been greater than it is now. Modern well controlled trials show preliminary efficacy in relation to a range of different psychological problems. In this introduction we outline the aims of this special issue, present the case for integrating psychedelics and contextual behavioral science, and provide an overview of the papers in the issue.

In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.

This work proposed the development of a game with a robot, built with Lego pieces, to make the rehabilitation treatment of children with Cerebral Palsy more effective. The aim of the game is to stimulate the motor coordination, cognition, memory and attention level of children, and to complement the activities carried out by the Neuropsychomotor Rehabilitation Program of the Nucleus of Occupational Therapy of NAMI (Nucleus of Integrated Medical Attention) of UNIFOR (The University of Fortaleza, Ceara, Brazil). The interaction between the child and the robot takes place through an Android remote control app installed on a smartphone. To validate the proposed method, five children were submitted to various sessions of activities with the robot, over a two-month period. A brain wave sensor, responsible for measuring the level of attention during the activities was employed. In addition, a questionnaire was applied to the professionals and parents of the children, in order to validate the tool proposed here. After analyzing the results, it was concluded that the robot is an effective and very promising complementary tool to assist in the rehabilitation treatment of children with Cerebral Palsy.

A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment. To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars. This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library. Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32–15.52; p

Introduction Dog-assisted therapy is a method that facilitates rehabilitation and therapy of persons with disabilities. Therapy sessions are attended by a patient, a therapist, and a trainer with a dog specially selected and trained for this purpose. Aim The aim of the study is to evaluate the impact of a dog’s presence on the therapy, and consequently on the motor development of children with physical and intellectual disabilities. Material and methods This study was conducted during a period from January 2014 to May 2014. We enrolled 25 children with various disorders. The subjects were students of “Always Together” Private Elementary and Middle School in Poznań. The majority of the children have been diagnosed with cerebral palsy or meningomyelocele. Three tests were used for the assessment of the results of the therapy: The EUROFIT Special Test, an original Manual Skills Test, and a Satisfaction Survey. Results The results show significant improvement both in the EUROFIT and the manual skills tests accompanied by a high level of satisfaction. The results were not affected by the severity of intellectual disability, sex, or the type of the disorder. Conclusions The presence of a specially trained and selected dog had a positive impact on the results of physical fitness tests achieved by children with disabilities

The article is dedicated to one of the methods of animal-assisted therapy, which is dolphin therapy based on observation of individual sessions with patients during a stay at the “Oskar” dolphinarium in Truskawiec in Ukraine. The author characterizes the method of therapy with dolphins. In addition, describes the role and features of a dolphin, draws attention to the indications and contraindications to therapy with a dolphin. Presents the results of the dolphin therapy studies conducted so far. Discusses the stages of dolphin therapy, its role and effects in selected specific patient diseases.

Tetraplegia resulting from cervical injury is the most frequent neurologic category after spinal cord injury and causes substantial disability. The residual strength of partially paralyzed muscles is an important determinant of independence and function in tetraplegia. Small improvements in upper extremity function can make a clinically significant difference in daily activities. Major advances in rehabilitation technologies over the past 2 decades have allowed testing of robotic devices in rehabilitation of motor impairments. This literature assessment provides an overview of robotic-assisted training research for improving arm and hand functions after cervical spinal cord injury.