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  • Psychosocial interventions for community dwelling people following diagnosis of mild to moderate dementia. Findings of a systematic scoping review

    Keogh, F.; Mountain, Gail; Joddrell, P.; Lord, Kathryn (2018)
    National policies and evidence reviews recommend psychosocial interventions (PIs) as an essential support, particularly in the period following dementia diagnosis. However, the availability and uptake of these interventions is comparatively low. One of the reasons for this is that clinicians lack information about what might be provided and the potential benefits of different interventions. This paper identifies and describes psychosocial interventions for community dwelling people following diagnosis of mild to moderate dementia and presents the available evidence to inform practice decisions. A systematic scoping review was employed to map the evidence relating to PIs for this group. This identified 63 relevant studies, testing 69 interventions, which could be grouped into six categories; 20 cognition-oriented interventions; 11 behaviour-oriented; 11 stimulation-oriented; 13 emotion-oriented, 5 social-oriented and 9 multi-modal. There were three targets for outcome measurement of these PIs; the person with dementia, the family carer and the person-carer dyad. Over 154 outcome measures were identified in the studies with outcomes measured across 11 main domains. The lack of a classification framework for PIs means it is difficult to create a meaningful synthesis of the breadth of relevant evidence to guide clinical practice. Possible dimensions of a classification framework are proposed to begin to address this gap.
  • Preference of non-pharmaceutical preoperative anxiety reduction intervention in patients undergoing elective surgery

    Dagona, S.; Archibong, Uduak E.; McClelland, Gabrielle T. (2018-12)
    For patients to be treated, decisions about their care must be made before treatment begins. In case of pre-operative anxiety, it is currently unknown how clinicians and patients discuss information about the issue, and it is also not known whether clinicians consider (or are ready to consider) their patients’ preferences of non-pharmaceutical pre-operative anxiety reduction interventions. At present no study has been conducted to find information on surgical patients’ preferences of, and their involvement in decisions about non-pharmaceutical interventions for reducing their pre-operative anxiety. This paper investigates elective surgical patients’ involvement in treatment decisions with the aim of finding out their preferred non-pharmaceutical pre-operative anxiety reduction interventions before they undergo elective surgery. Method: A survey method was used to collect data on patients’ preference of non-pharmaceutical preoperative anxiety reduction interventions at a tertiary health facility in Nigeria. Participants: A sample of 30 participants-17 male and 13 female, schedule to undergo surgical operations was selected using a convenient sampling method. Their ages range between 17 to 70 years (mean age = 41.03 and standard deviation = 16.09). Study design/procedure: To elicit preference of interventions, the study participants were presented with cards that contain picture of surgical patient receiving one of the non-pharmaceutical interventions used in reducing pre-operative anxiety. The pictures were presented one at a time for 30-40 seconds. The researcher then gives the participants a sheet of paper with the different interventions boldly written for the participants to rank order them according to the degree of their preferences. Through this process, data was collected from all the 30 participants. Results: The results obtained were entered into SPSS for analysis. Descriptive statistics, at 95 % confidence was calculated to estimate the percentage, mean, standard deviation and confidence intervals based on the participants’ preference of the interventions. Discussions: The findings were discussed alongside the existing literature and recommendations were offered for clinical practice and further research.
  • How do consultant radiographers contribute to imaging service delivery and leadership?

    Snaith, Beverly; Clarke, R.; Coates, A.; Field, L.; McGuinness, A.; Yunis, S. (2019-01-02)
    Background: Consultant radiographer numbers remain low despite the ongoing capacity challenges in diagnostic imaging. This is compounded by the limited evidence of how such roles can positively impact on service delivery, particularly in relation to their leadership expectations. Aims: To examine the activities undertaken by consultant radiographers; evidence the impact of the roles, and consider whether the roles encompass the four domains of consultant practice. Method: Six consultant radiographers employed in a single NHS Trust completed an activity diary over a period of 7 days. Interval sampling every 15 minutes enabled the collection of a large volume of complex data. Findings: All consultants worked beyond their contacted hours. The documented activities demonstrate the breadth of the roles and confirmed that the participants were undertaking all four core functions of consultant practice. Conclusion: The impact of the roles stretched beyond the local department and organisation to the health system and wider profession.
  • Point of care creatinine testing in diagnostic imaging: a feasibility study within the outpatient computed tomography setting

    Snaith, Beverly; Harris, M.A.; Shinkins, B.; Messenger, M.; Lewington, A.; Jordaan, M.; Spencer, N. (2019-03)
    Introduction: Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway. Method: Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48–72 h. Results: 14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25% from baseline) post contrast administration, but no instances of PC-AKI (≥50% from baseline) were identified. Conclusion: PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment.
  • Standardising the Capture and Processing of Custody Images

    Jilani, Shelina K.; Ugail, Hassan; Cole, S.; Logan, Andrew J. (2018)
    Custody images are a standard feature of everyday Policing and are commonly used during investigative work to establish whether the perpetrator and the suspect are the same. The process of identification relies heavily on the quality of a custody image because a low-quality image may mask identifying features. With an increased demand for high quality facial images and the requirement to integrate biometrics and machine vision technology to the field of face identification, this research presents an innovative image capture and biometric recording system called the Halo. Halo is a pioneering system which (1) uses machine vision cameras to capture high quality facial images from 8 planes of view (including CCTV simulated), (2) uses high quality video technology to record identification parades and, (3) records biometric data from the face by using a Convolutional Neural Networks (CNN) based algorithm, which is a supervised machine learning technique. Results based on our preliminary experiments have concluded a 100% facial recognition rate for layer 34 within the VGG-Face model. These results are significant for the sector of forensic science, especially digital image capture and facial identification as they highlight the importance of image quality and demonstrates the complementing nature a robust machine learning algorithm has on an everyday Policing process.
  • A Comprehensive Model of Factors Associated with Capability to "live Well" for Family Caregivers of People Living with Mild-to-Moderate Dementia: Findings from the IDEAL Study

    Clare, L.; Wu, Y.-T.; Quinn, Catherine; Jones, I.R.; Victor, C.R.; Nelis, S.M.; Martyr, A.; Litherland, R.; Pickett, J.A.; Hindle, J.V.; Jones, R.W.; Knapp, M.; Kopelman, M.D.; Morris, R.G.; Rusted, J.M.; Thom, J.M.; Lamont, R.A.; Henderson, C.; Rippon, I.; Hillman, A.; Matthews, F.E. (2019)
    Understanding key influences on outcomes for caregivers of people with dementia is hampered by inconsistent conceptualization and measurement of outcomes and limited evidence about the relative impact of different variables. We aimed to address these issues. We analyzed data from 1283 caregivers of community-dwelling individuals with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life cohort study. We generated a “living well” latent factor from measures of quality of life, satisfaction with life, and well-being. We used structural equation modelling to derive latent variables for 7 domains reflecting caregivers’ perceptions of their personal resources and experiences, and to examine the associations with caregivers’ perceptions of their capability to “live well.” The domain of psychological characteristics and psychological health was most strongly related to living well [2.53; 95% confidence interval (CI), 2.08-2.97], followed by physical fitness and physical health (1.48; 95% CI, 1.04-1.91) and experiencing caregiving (1.34; 95% CI, 0.99-1.70). Social capitals, assets and resources (0.68; 95% CI, 0.35-1.00) and relationship with the person with dementia (−0.22; 95% CI, −0.41 to −0.03) had smaller, significant associations. Social location (0.28; 95% CI, −0.33 to 0.89) and managing everyday life with dementia (0.06; 95% CI, −0.15 to 0.28) were not significantly associated with living well. These findings demonstrate the importance of supporting caregivers’ psychological and physical health and their ability to develop and maintain positive coping strategies, as well as enabling them to maintain vital social capitals, assets and resources.
  • "I Don't Think of It As An Illness": Illness Representations in Mild to Moderate Dementia

    Clare, L.; Quinn, Catherine; Jones, I.R.; Woods, R.T. (2016-02-27)
    The self-regulatory model proposes that illness representations influence adjustment and coping in chronic conditions. Better understanding of the illness representations held by people with dementia could help with targeting information and support so as to optimize adjustment and coping. In this mixed-methods study of illness representations among people with mild to moderate Alzheimer’s, vascular, or mixed dementia we aimed to clarify the nature of the representations held, to determine whether specific profiles can be identified based on perceptions of the identity and cause of the condition, and to examine associations between these profiles and other participant characteristics. Data were collected in the second wave of the Memory Impairment and Dementia Awareness Study (MIDAS). Sixty-four people with dementia, who had been told their diagnosis at a memory clinic, completed interviews and responded to questionnaires. In each case a carer was also interviewed. Cluster analysis based on responses about identity and cause identified three profiles. ‘Illness’ cluster participants saw themselves as living with an illness and used diagnostic labels, ‘ageing’ cluster participants did not use diagnostic labels and viewed their difficulties as related to ageing, and ‘no problem’ cluster participants considered that they did not have any difficulties. ‘Illness’ cluster participants had better cognition and better awareness, but lower mood, and perceived more practical consequences, than ‘ageing’ cluster participants. Holding an ‘illness’ model may not be advantageous. Rather than encouraging adoption of such a model, it may be preferable to target information and select interventions in line with the person’s representation profile.
  • Illness representations in caregivers of people with dementia

    Quinn, Catherine; Jones, I.R.; Clare, L. (2017-05)
    Illness representations shape responses to illness experienced by the self or by others. The illness representations held by family members of those with long-term conditions such as dementia influence their understanding of what is happening to the person and how they respond and provide support. The aim of this study is to explore components of illness representations (label, cause, control and timeline) in caregivers of people with dementia. This was an exploratory study; the data reported came from the Memory Impairment and Dementia Awareness Study (MIDAS). Data from semi-structured interviews with 50 caregivers of people with dementia were analysed using content analysis. The majority of caregivers gave accounts that appeared to endorse a medical/diagnostic label, although many used different terms interchangeably. Caregivers differentiated between direct causes and contributory factors, but the predominant explanation was that dementia had a biological cause. Other perceived causes were hereditary factors, ageing, lifestyle, life events and environmental factors. A limited number of caregivers were able to identify things that people with dementia could do to help manage the condition, while others thought nothing could be done. There were varying views about the efficacy of medication. In terms of timeline, there was considerable uncertainty about how dementia would progress over time. The extent of uncertainty about the cause, timeline and controllability of dementia indicated that caregivers need information on these areas. Tailored information and support taking account of caregivers' existing representations may be most beneficial.
  • Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia

    Martyr, A.; Nelis, S.M.; Quinn, Catherine; Wu, Y.-T.; Lamont, R.A.; Henderson, C.; Clarke, R.; Hindle, J.V.; Thom, J.M.; Jones, I.R.; Morris, R.G.; Rusted, J.M.; Victor, C.R.; Clare, L. (2018-10)
    Current policy emphasises the importance of 'living well' with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1-0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
  • Beliefs About Dementia: Development and Validation of the Representations and Adjustment to Dementia Index (RADIX)

    Quinn, Catherine; Morris, R.G.; Clare, L. (2018-06)
    The Self-Regulation Model (SRM) identifies that the beliefs people hold about an illness can influence their responses to that illness. Although there are generic measures of illness representations, there is a need for a brief tailored measure to use with people with dementia. The aim of this study was to develop and validate a brief measure called the Representations and Adjustment to Dementia Index (RADIX). The RADIX contains questions on the SRM elements: Identity, Cause, Timeline, Control, and Consequences. The RADIX validation was conducted with a sample of 385 community-dwelling people with mild to moderate dementia who were taking part in the IDEAL cohort study. Test-retest reliability was conducted over a 4-week period with a separate sample of 20 people with dementia. The validation process resulted in a reduction in the number of items in the Timeline, Control, and Consequences items. The resulting RADIX demonstrated good acceptability, internal reliability, and test-retest reliability. All the RADIX items had low missing data, indicating good acceptability. The factor analysis confirmed that the Consequences items formed two subscales (practical and emotional consequences) that had Cronbach's α of 8 and 0.91 respectively. Test-retest reliability indicated that the Identity, Timeline, and Control items had moderate reliability and the practical and emotional consequences scales had good reliability. The RADIX demonstrates acceptable psychometric properties, proves to be a useful measure for exploring people's beliefs about dementia, and could aid the provision of tailored information and support to people with dementia.
  • Dualities of dementia illness narratives and their role in a narrative economy

    Hillman, A.; Jones, I.R.; Quinn, Catherine; Nelis, S.M.; Clare, L. (2018-06)
    The concept of 'narrative economies' has recently been proposed as a set of exchange relationships that, through biography and story-telling, facilitate access to resources and act as a source of value. We utilise this concept to inform our analysis of 18 qualitative interviews with five people with dementia and four informal carers. Our participants are members of a pre-existing group of dementia advocates, representing the voices of those living with the condition. There are a growing number of people in the early stages of dementia - like our participants - being called upon to account for their experience, as a means of developing a politicised 'collective illness identity'. These interviews present an opportunity to study a group of people who are actively involved in speaking as, and for, people with dementia. Four themes emerged from the data: becoming a voice of or for people with dementia; biographical reinforcement; responsibilisation; and resistance. These themes illustrate the ways in which people with dementia participate in their own identity construction and, as representatives of those living with dementia, they also illustrate the ways in which illness narratives produce material and symbolic value.
  • Inequalities in living well with dementia-The impact of deprivation on well-being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study

    Wu, Y.-T.; Clare, L.; Jones, I.R.; Martyr, A.; Nelis, S.M.; Quinn, Catherine; Victor, C.R.; Lamont, R.A.; Rippon, I.; Matthews, F.E.; Improving the experience of Dementia and Enhancing Active Life (IDEAL) study (2018-12)
    Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations. The analysis was based on a large cohort study of 1547 community-dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well-being were measured as indices of "living well." Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer. Negative dose-response relationships between deprivation and measures of quality of life (-2.12; 95% CI: -3.52, -0.73), life satisfaction (-1.27; 95% CI: -2.70, 0.16), and well-being (-5.24; 95% CI: -10.11, -0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference. The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer.
  • Archaeology and modern reflections on death

    Dayes, Jennifer E.; Faull, C.; Büster, Lindsey S.; Green, Laura I.; Croucher, Karina T. (2018-09-22)
  • From Plastered Skulls to Palliative Care: What the Past Can Teach Us About Dealing with Death

    Büster, Lindsey S.; Croucher, Karina T.; Dayes, Jennifer E.; Green, Laura I.; Faull, C. (2018)
    Modern, advanced healthcare detects and monitors long-term and life-limiting illness more comprehensively than ever before. However, death is now often considered medical failure, and is a virtually taboo topic of conversation in daily life. At a time when the societal relevance of archaeology is under scrutiny more than ever before, the AHRC-funded Continuing Bonds Project – a collaboration between archaeology and palliative care – explores the potential of the past to promote discussion. Not only does archaeology illuminate the diversity of practice surrounding death, the past provides a safe, distanced platform for considering death, dying and bereavement today. Through archaeological and ethnographic case studies, health and social care professionals and students consider topics such as place, choice and identity, in both personal and professional life. This article examines participant responses to a variety of archaeological material and presents post-workshop reflections which demonstrate the success of archaeology in opening up conversations and increasing confidence in discussing this most enduring and problematic of life events.
  • The impact of comorbidity on the quality of life of people with dementia: findings from the IDEAL study

    Nelis, S.M.; Wu, Y.-T.; Matthews, F.E.; Martyr, A.; Quinn, Catherine; Rippon, I.; Rusted, J.; Thom, J.M.; Kopelman, M.D.; Hindle, J.V.; Jones, R.W.; Clare, L. (2018)
    The aim was to investigate the comorbidity profile of people with dementia and examine the associations between severity of comorbidity, health-related quality of life (HRQoL) and quality of life (QoL). The improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of comorbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL. The majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of comorbid conditions was associated with low QoL scores, and those with severe comorbidity (≥5 conditions) showed the greatest impact on their well-being. Comorbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of comorbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.
  • Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life

    Silarova, B.; Nelis, S.M.; Ashworth, R.M.; Ballard, C.; Bienkiewicz, M.; Henderson, C.; Hillman, A.; Hindle, J.V.; Hughes, J.C.; Lamont, R.A.; Litherland, R.; Jones, I.R.; Jones, R.W.; Knapp, M.; Kotting, P.; Martyr, A.; Matthews, F.E.; Morris, R.G.; Quinn, Catherine; Regan, J.; Rusted, J.M.; van den Heuval, E.A.; Victor, C.R.; Wu, Y.-T.; Clare, L. (2018-10)
    There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to ‘live well’ vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from underresearched groups of people with dementia, who are likely to have their own distinct perceptions of living well.
  • Reflections on PPI from the ‘Action on Living Well: Asking You’ advisory network of people with dementia and carers as part of the IDEAL study

    Litherland, R.; Burton, J.; Cheeseman, M.; Campbell, D.; Hawkins, M.; Hawkins, T.; Oliver, K.; Scott, D.; Ward, J.; Nelis, S.M.; Quinn, Catherine; Victor, C.; Clare, L. (2018-11-01)
    This article describes the work of the ‘Action on Living Well: Asking You’ group – an involvement group of people with dementia and carers attached to the IDEAL research study. The article describes the work of the group, the methods that have helped them to stay involved and people’s perspectives on their experiences of being involved and the impact it has had, for themselves and others. The article has been written following a reflective piece of work with the ‘Action on Living Well: Asking You’ group to review and remember the work of the past four years. An accompanying film brings to life the work and activities of the group, available at www.idealproject.org.uk/mclass/
  • Impact of body part thickness on AP pelvis radiographic image quality and effective dose

    Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018-10-03)
    Introduction: Within medical imaging variations in patient size can generate challenges, especially when selecting appropriate acquisition parameters. This experiment sought to evaluate the impact of increasing body part thickness on image quality (IQ) and effective dose (E) and identify optimum exposure parameters. Methods: An anthropomorphic pelvis phantom was imaged with additional layers (1e15 cm) of animal fat as a proxy for increasing body thickness. Acquisitions used the automatic exposure control (AEC), 100 cm source to image distance (SID) and a range of tube potentials (70e110 kVp). IQ was evaluated physically and perceptually. E was estimated using PCXMC software. Results: For all tube potentials, signal to noise ratio (SNR) and contrast to noise ratio (CNR) deceased as body part thickness increased. 70 kVp produced the highest SNR (46.6e22.6); CNR (42.8e17.6). Visual grading showed that the highest IQ scores were achieved using 70 and 75 kVp. As thickness increases, E increased exponentially (r ¼ 0.96; p < 0.001). Correlations were found between visual and physical IQ (SNR r ¼ 0.97, p < 0.001; CNR r ¼ 0.98, p < 0.001). Conclusion: To achieve an optimal IQ across the range of thicknesses, lower kVp settings were most effective. This is at variance with professional practice as there is a tendency for radiographers to increase kVp as thickness increases. Dose reductions were experienced at higher kVp settings and are a valid method for optimisation when imaging larger patients.
  • Does a more dynamic method of partial weight bearing instruction translate to improved protocols?

    Graham, Claire; Jeffrey, Sarah; Hellawell, Michael (2018-11-02)
    Background: Partial weight bearing protocols are commonly incorporated into rehabilitation to enhance recovery. Patients are often prescribed protocols that refer to a percentage of their body weight, such as 20% weight bearing, that should be placed through the healing limb during activities such as walking (gait). In order to achieve these partial weight baring protocols patients are usually provided with walking aids such as crutches. Accurate reproducibility of and compliance with these protocols could be considered essential to the rehabilitation process, however poor reproducibility of partial weight bearing protocols during crutch assisted gait using a current method of instruction has been shown. Aims: The aim of this study was to determine whether a more dynamic method of partial weight bearing protocol instruction, was more accurately reproduced. Methods: In total, 16 participants were randomly allocated to one of two groups and were taught 20% partial weight bearing using two different methods of instruction. A participant’s ability to reproduce their target load using crutch assisted gait was assessed using a force plate. Findings: The mean error for the static method of instruction was significantly greater than the more dynamic method. Conclusion: As seen previously, the static method of instruction of partial weight bearing protocols, using bathroom scales, does not seem to translate accurately to dynamic motion; however, the more dynamic method assessed in this study appears to result in more accurate reproducibility.
  • Qualitatively exploring the suitability of tablet computers to encourage participation with activities by people with moderate stage dementia

    Smith, S.K.; Mountain, Gail; Hawkins, R.J. (2018)
    Introduction: Opportunities to participate with enjoyable activities is one of the most frequently reported unmet needs by the person living with dementia. Enabling and intuitive technologies may offer accessible ways to engage with such activities. Objectives: To explore how tablet computers might encourage participation in enjoyable activities by people with moderate levels of dementia and to consider how such technologies might be incorporated into the repertoire of activities currently provided through day care settings. Methods: A focused visual ethnographic approach was developed specifically to meet the research objectives. Twelve participants attending a community day care centre and nine supporters (both volunteers and paid staff) consented to take part in the research. Technology facilitated group activity sessions took place twice a week for a period of four weeks and all were video recorded. Findings: Video analysis demonstrated that the majority of people with dementia found the technology an effective means of participating in enjoyable activities. Analysis also revealed the extent to which participation relies on the existence of effective support. It showed how maintaining focus on retained strengths and abilities enabled the group overall to meet and often exceed their own and others perceived capacity to participate. Finally, analysis confirmed the importance of enjoyment of activities ‘in the moment’ and the need for those supporting people in the moderate stages of dementia to acknowledge and work with this. Conclusion: The use of tablet computers to enhance participation in sociable and enjoyable activities in day care settings is realistic and achievable if supported appropriately.

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