A mixed methods research investigation was carried out to evaluate the development of verbal skills in young children with special needs receiving music therapy from a qualified therapist, and additional music sessions carried out by teaching assistants (TAs). Qualitative data was gathered to support the quantitative video analysis results. The music therapist set up music sessions for the TAs to carry out independently, to assess whether this collaboration enhanced the development of the children’s verbal skills. Eight children aged four to eight years attending a special school were selected to participate. Half of the children were randomly allocated weekly individual music therapy sessions for 24 weeks, and the remaining children received weekly individual music therapy sessions plus a weekly music session with a TA for 24 weeks. The music therapist met regularly with the TAs to exchange information, and to demonstrate musical and singing concepts for each individual child through sharing video material. The video data from both music therapy and music sessions with TAs in sessions 3 and 22 were analysed using a time-sampling method to assess progress in verbal and social interaction. The vocal scores were extracted from this data and a statistical analysis carried out on these figures. In addition, parents of the children and the TAs took part in interviews pre- and post-intervention to assess the children’s social and verbal development in other contexts. The analysis of the vocal scores indicated that there was a statistically significant difference pre- and post-intervention for the children who had had the additional TA music sessions. This indicated that the collaborative approach was effective in enhancing verbal skills. However, due to the small number of participants, these results cannot be generalised to other situations and a larger scale investigation would need to be carried out to demonstrate more conclusive results. This study suggests that music therapists and TAs in schools can work collaboratively and that this can potentially enhance the progress that children make in music therapy, with reinforcement of verbal development strategies in the class context.

Background: Osteoarthritis (OA) is the most common form of arthritis and is a major cause of disability and impaired quality of life (QoL). The prevalence of OA is rapidly increasing affecting approximately 15% of the world’s population. Currently, there are no disease modifying treatments available. Non-steroidal anti-inflammatory drugs, the most widely prescribed medications for patients with knee OA (KOA), are associated with serious side effects, including bleeding and gastric ulceration. As a result, both patients and professional societies are looking for alternative therapies, with good effects,and less toxicity, to control pain sufficiently. Low-level laser therapy (LLLT) is a non-invasive treatment modality in the field of physiotherapy for pain management. Nonetheless,the effectiveness of LLLT in the treatment of OA is debatable. Objectives and Design: A randomised, double-blind, controlled trial was conducted to evaluate the efficacy of LLLT when it is applied on specific acupuncture points (APs) at the knee joint in combination with exercises and advice in patients with KOA. Participants: Forty-nine patients with KOA were randomly assigned into two groups; active laser group (n= 26) and placebo laser group(n= 23). Intervention: Using a gallium-aluminium-arsenide laser device,patients received either active or placebo LLLT treatment at five APs (ST 35,Xiyan, ST 36, SP9, and SP10) on the affected knee. All participants received a series of 9 treatment sessions over a period of three weeks by using LLLT(active or placebo) in addition to strengthening exercise and advice. Outcome Measures: Visual analogue scale (VAS), Saudi knee function scale (SKFS), active range of motion (ROM), knee circumference (KC), and patient satisfaction were assessed at baseline, at the 5th treatment session,at the last (9th) treatment session, after six weeks and then six months after the last treatment session. Result: There was a statistically (but not clinically) significant improvement in the laser group compared to the placebo group in the primary outcome VAS after six weeks (P=0.014) and after six months of the last session of treatment (P= 0.003). There was a statistically (but not clinically) significant improvement in the laser group compared to the placebo group in the SKFS scores at the last treatment session (P= 0.035), and after six months (P= 0.006); in ROM only after six months (P= 0.019); inpatient satisfaction at the 5th session (P= 0.033) and after six months. No significant difference between both groups was noted in the KC at any time. Within both groups there was statistically significant improvement in most outcomes. Conclusions: The results demonstrate that the short-period application of LLLT on specific APs associated with exercises and advice is effective in reducing pain and improving the QoL in patients with KOA.

No description available.

No description available.

Introduction: Meghalaya is a state in northeast India that has a predominantly indigenous population and an age-old system of tribal medicine. There are practitioners of this system in most villages, who use medicinal plants sourced from the state’s vast forest bio-resources. This project studied the tribal medicine of Meghalaya from three perspectives, the healer, the community and the policy maker. It locates tribal medicine within the government’s policy on medical pluralism and seeks to understand how tribal medicine of a local context fits into the national policy of the Government of India. Methods: A mixed methods study design was employed. Estimates of awareness and use of traditional medicine in the community were obtained from the analysis of a household survey. For the qualitative component tribal healers, policy makers, and influential members of the community were interviewed. A combination of in-depth interviews, observations and focus group discussions was employed in the field with healers, while in-depth interviews were the main source of data from policy actors. Qualitative data was analysed using a thematic content analysis approach that incorporated elements of the grounded theory approach. Results: The community - tribal medicine has wide acceptance across the state, 87% believed it to be efficacious and 46 % reported using it in the 3 months prior to the survey. In comparison only 31% had heard of any of the AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) systems that are being promoted by the state and only 10.5% had ever used it in their lifetime. Healers - tribal healers are a heterogeneous group who treat a wide variety of ailments. Their expertise is well regarded in the community for certain ailments such as musculoskeletal disorders, but often their services were sought when patients were dissatisfied with biomedicine. For physical ailments that are culturally understood their services are often the preferred option. Their expertise niches have evolved through their interactions with, and the perceived needs of the community. 16 Policy actors – although there were some appreciative voices, several biomedical doctors and policy makers in the government department of health derided tribal medicine’s unscientific nature. In comparison other systems like Ayurveda and homeopathy were assumed to have scientific merit mainly because of institutionalisation and government recognition of these systems. The comparison with homeopathy is pertinent as its scientific credentials are being increasingly questioned in scientific literature. In contrast those outside the health department, academics, biomedical doctors and other influential members of the community favoured tribal medicine because of its widely regarded efficacy and its cultural value. Neglect of tribal medicine while promoting the imported AYUSH systems was seen as illogical and disrespectful to their culture by the latter group. Conclusions: the current policy in Meghalaya of mainstreaming AYUSH medicine is not supported by locally relevant evidence. It has led to a disproportionate increase in AYUSH doctors in the public sector. It represents a top down approach to policy formulation that ignores local realities. This study demonstrates the importance of contextualising policy to cultural milieus. It emphasises the importance of research in health system development and questions the generalising of policy in a country as diverse as India. The study illustrates the complexities, but points to the potential benefits of supporting tribal medicine in Meghalaya.

This thesis explores psychodynamic group music therapy with institutionalised, profoundly learning disabled residents, while introducing a novel way of including carers in the music therapy sessions. It is based on a detailed analysis of one case-study consisting of three residents, four carers and myself as the music therapist. Based upon theories from psychoanalysis, the dissertation firstly explores the inner world of learning disabled people and how this is affected by a traumatic early environment and institutionalised care. It then discusses the musical and psychological concepts that delimit this work. The particular way in which the carers participated in the music therapy treatment is then analysed, drawing from the theories of attachment and object relations. The case-study that follows is a detailed analysis of sessions or extracts from sessions spanning a period of three-and-a-half years. The thesis studies the methodologies and techniques that facilitated the following development in the group: a) Though at the beginning the patients functioned within an autistic type of isolation, they evolved into individuals who expressed their needs for human intimacy, creative exploration and autonomy; b) The carers shifted from being emotionally unresponsive to functioning as auxiliary music therapists; c) The music therapy setting became the ground for the evolution of life attachment bonds between the patients and the carers of the group. This music therapy setting included a particular way of perceiving, understanding and responding to the patients' sounds, based on the principle that any sound or non-verbal signal is meaningful and forms part of a patient's unconscious association to the phenomena in the group.

the combination of a photosensitiser, light and molecular oxygen results in the local formation of reactive oxygen species and a· phototoxic effect. This regime is known as photodynamic therapy (PDT) and is used clinically against a variety of diseases, including cancers. PDT has an inherent specificity due to the absolute requirement for light of a specific wavelength, which can be applied locally. However, photosensitisers generally have little intrinsic selectivity for tumours and much current research is devoted to the development of methods by which the specificity of PDT could be improved. Increasing the selectivity of PDT .by increasing tumour specific photosensitiser accumulation may improve treatment efficacy and reduce any risk of side effects caused by photosensitiser accumulation in non-target tissue. To target photosensitisers to tumours, a cyclic peptide, cRGDfK (L-arginine;L-glycine;L-aspartic acid;D-phenylalanine;L-lysine). was conjugated to the porphyrin photosensitiser, protoporphyrin IX was used. The arginine-glycine-aspartic acid (RGD) motif of the cyclic RGDfK peptide has been shown to specifically bind o.vP3 integrins, heterodimeric glycoproteins significantly upregulated on the surface of proliferating endothelial cells in tumour neovasculature. This study describes in vitro and in vivo characterisation of the novel conjugate and compares its properties to the free photosensitiser. The individual components in the system, protoporphyrin IX and cRGDfK, were shown to retain their respective photodynamic and integrin binding activity following the coupling step and produced a' conjugate of high purity. The PpIX:cRGDfK conjugate was shown to be a good photosensitiser in vitro, causing significant phototoxicity and the induction of apoptosis in several cell lines. The subcellular localisation of photosensitiser seems to be more important for treatment efficacy than the absolute amount of cell-associated photosensitiser as it has the potential to control the mechanism and speed of cell death. Pharmacokinetic analysis of PpIX:cRGDfK treated mice showed significant retention and accumulation of photosensitiser in tumour tissue with higher tumour:normal tissue ratios than the free photosensitiser. However, although the conjugate showed this higher accumulation and improved tumour:non-target tissue ratios, the overall in vivo PDT effect, between dose to light intervals of 0 and 6 hours, was . . not significantly better than for free protoporphyrin IX. These data agreed with the in vitro studies, where increased PpIX:cRGDfK uptake into cells expressing high levels of integrin C1vP3 did not give rise to an increased PDT response. Although PpIX:cRGDfK has been shown to be an effective in vivo and in vitro photosensitiser and to significantly accumulate in tumour cells, there are clearly other factors that determine the overall PDT outcome. Further analysis of treatment conditions, the spatial distribution of photosensitiser within tissue, compound metabolism and the effect of repeat treatments would be reqUired for the exploitation of this technology to its full potential. Supplied by The British Library - 'The world's knowledge'

This study explores how health beliefs and socio-cultural factors impact on the practice and delivery of Community Based Rehabilitation (CBR) and examines the implications for the theory and practice of physiotherapy. The World Health Organisation has promoted CBR for disabled people in developing countries (WHO, 1981) as an alternative to institutionalised rehabilitation. This study examines the practice of CBR in post-colonial Jamaica. The researcher, a trained physiotherapist who qualified in Jamaica and then worked in the UK conducted ethnographic fieldwork with eight rural families who took part in the 3D Projects programme in Jamaica. She spent a year participating in the life experiences of these participants, observing and conducting contextual interviews. Set against the legacy of imperialism, Jamaica presents the challenge of economic hardship, unemployment, crime and violence and class divide. However, it also offers community resistance and this thesis explores the experiences of families living within rural communities who are caring for children with disability. The study looks at CBR and analyses the role of women and their families caring for children with disability and the implications of community capacity building and the notion of community. Some of the tensions that exist between western ideologies of disability and traditional Jamaican explanations for the causation of disability and then the implications for care are explored. The key role of the Community Rehabilitation Workers (CRW) was recognised. It is suggested that CBR should take into account the cultural and social context of the client, the family and the community. The implications call for the physiotherapist is the need to develop skills of networking, management and negotiation, in order to facilitate the optimal function of the disabled child, the child's family and community. In conclusion, the researcher suggests that there is no one single model of CBR. Physiotherapists are increasingly working in countries other than their own (Noorderhaven, 200 I) and as such, there is a need to develop models of practice which reflect cultural sensitivity in the assessment, planning, implementation and evaluation necessary for the practice of physiotherapy in a CBR programme within a post-colonial society.

The relationship between human beings and nature has played an important role throughout history, as part of traditional medicine and curative rituals. The Shaman, the healing man, incorporated nature into rituals aiming to help both the individual and the community heal from misfortunes and make the transition from one life phase to another. However, the development of industry and urbanization put a distance between human beings and nature. The new healing methods that were constructed in the 20th century largely overlooked the relationship with nature, working mainly through cognition and verbal communication, relating to the relationship between people as the core element. In the last decade, along with the development of post-modernism, new therapeutic approaches emerged. Some of them, like the expressive-at1 therapies, seek to expand cognitive and verbal techniques to non-verbal and creative modes of working, emphasizing people's creativity and imagination abilities. Other approaches seek to expand the process by relating to 'the larger then self', inviting transpersonal and spiritual work to widen the person-to-person discourse. Ecopsychology invites people to expand their relationships beyond the 'person-to-person' relationship into one which will include nature. Despite its nature-oriented philosophy, however, Ecopsychology has not yet atticulated into a therapeutic form, that specifies practical methods for therapeutic work. The present study aims to develop a therapeutic approach taking place in nature, using non-verbal and creative methods to extend common therapeutic practices in ways that can include a dialogue with nature. Using a reflexive Action Research strategy, the study examines the experience of both practitioners who used Nature Therapy in practice and who took pat1 in training courses, and uses these data as a basis for the conceptualization and development of an innovative therapy theory. The implications of the study, for theory, research and practice in psychotherapy, are discussed.

Ulceration of the lower limb is a chronic, debilitating condition affecting an increasing percentage of the adult and elderly populations. Conservative treatment options are limited, and generally result in surgery or amputation. The purpose of this research was to investigate the feasibility of using intermittent pneumatic compression for the treatment and management of chronic non-healing leg ulcers. The aim was to develop a system capable of improving the healing of leg ulcers of varying causes through improving distal blood flow whilst also being comfortable and easy to use, to encourage patient compliance. Using Doppler ultrasound, it was demonstrated that intermittent pneumatic compression was capable of producing a distal blood flow response in the limb of a healthy volunteer. Further investigations examined the effect on this distal response of altering the cuff design, pressure and cycle duration in order to determine the optimal compression regime for enhancing the distal circulation the ultimate objective being to use intermittent pneumatic compression to improve the healing of chronic leg ulcers by improving distal blood flow. The optimal sequence involved a 3-chamber thigh cuff, using a pressure of 60mmHg and a short sequential cycle which was operated within a 2 minute on and off sequence. The optimal system was investigated for distal blood flow effects in a group of 20 healthy volunteers, and 14 patients with leg ulcers of differing aetiologies. A distal hyperaemic response was achieved during the 2 minutes without compression, consequent upon changes included in the venous circulation during the 2 minutes of compression. A greater response was detected in the patient group as compared with the healthy volunteer group. A 3 month case study of the clinical effects of the new system resulted in the complete healing of the patients long standing non-healing leg ulcer. Further case studies are required to determine the significance of this finding.