Chronic low-back pain is a prevalent and costly problem for many adults in the United States. Currently, multidisciplinary treatment approaches are the treatment of choice for this problem. A meta-analysis was conducted on 43 published studies to describe the nature of these programs, the patients involved in them, treatment efficacy at discharge and follow-up, and possible relationships between these characteristics and outcome. Results show that these programs were often in university medical settings, with an emphasis on active patient participation. Common treatment approaches included physical therapy, skills training, medication management, supportive therapy, and behavior modification. Patients involved in these programs tended to be middle-aged, married, unemployed, and high-school educated, with an average pain duration of about five years. It was concluded that patients do show improvement at treatment completion (at least one-half standard deviation change) in physical fitness, reported distress levels, daily activity, and medication usage. At follow-up improvement over pre-treatment levels was still evidenced in reported distress levels, medication usage, mood, fitness levels, daily activities, and health perceptions. Results of correlational analyses suggest that the more impaired patients in these studies tended to show greater improvement. Data also suggest that patient dropouts rates were negatively correlated to medication usage and mood over time. Thus, improvements in these areas may be artifacts due to patient drop-out rates. Multidisciplinary treatment programs were found to be generally effective in promoting more adaptive functioning in their patients . However, it is recommended that closer attention be given to attrition rates and other potential sources of bias to maximize confidence in treatment effectiveness.

There are many craniofacial anomalies that exist in the oral mucosa, gingiva, lips, tongue, maxilla, mandible, floor of the mouth, palate, and teeth. These anomalies cause secondary issues such as airway obstruction, respiratory problems, feeding problems, ear disease, distal systemic issues, and speech and communication problems. Children that experience craniofacial anomalies and subsequent problems are often at a disadvantage with medical and dental related consequences, and especially speech, communication, and often present with psychosocial concerns. This paper explores such anomalies, consequential problems, and emphasizes the importance of having a multidisciplinary team when treating patients with craniofacial anomalies. Multidisciplinary teams consist of otolaryngologists, plastic surgeons, general dentists, prosthodontists, orthodontists, oral surgeons, pediatricians, neurologists, geneticists, social workers, psychologists, audiologists, and speech therapists. Based on past studies and data, multidisciplinary treatment has shown not only to provide the best options to correct an anomaly, but also to optimize the overall health and well-being of an individual as well. Multidisciplinary treatment of craniofacial anomalies outlines a coherent, inclusive, and revolutionized way on how to holistically treat a patient. This approach is present in the healthcare realm, but often underrated and not adopted by all healthcare professionals; this paper will demonstrate how such an approach will advance healthcare. Surgery removes, corrects, or improves a condition that exists in the oral cavity or oropharynx. Nevertheless, surgery often causes subsequent conditions and may even not be successful. Among the many disciplines exercised in treating patients with craniofacial anomalies and conditions, this paper highlights the importance of speech and language pathologists, psychologists, dentists, orthodontists, and geneticists to be included in the treatment plan. Studies demonstrated that each discipline’s responsibility, when implemented in a coordinated and timely fashion, can improve the outcomes, possibly prevent ensuing conditions, and therefore, optimize an individual’s health and quality of life.

Abstract PURPOSE: The aim of this study was to describe and compare possible differences regarding selected prognostic factors for disability between patients with non-specific chronic pain who were about to start a multidisciplinary treatment program (MMR), either within primary care (MMR1) or hospital care (MMR2). METHODS: The study had a descriptive and comparative cross sectional design. Eighty-nine patients were recruited consecutively when they were about to start their team treatment (50 in MMR1,39 in MMR2). The measurements were; Evaluation of self-reported self-efficacy for eight daily activities (STIVA-8), The Pain Belief Screening Instrument (PBSI) and Hospital Anxiety and Depression Scale (HADS). RESULTS: The study found some significant differences between the answers from patients in MMR1 and those from patients in MMR2. For instance, patients in MMR2 estimated lower self-efficacy according to STIVA-8 than patients in MMR1. Also, there were fewer low risk patients and more high risk patients in MMR2 than in MMR1 regarding pain intensity according to PBSI. In addition to this, there were fewer patients without depression and more with moderate depression in MMR2 than in MMR1 according to HADS. No significant differences could be shown for either anxiety according to HADS or for low- and high risk regarding activity disability according to PBSI. No significant differences could be found when pain intensity was measured with mean values on a scale from 0-10. CONCLUSIONS: Patients in MMR2 experienced more negative consequences from their pain disease than patients in MMR1. Systematic use of standardized self-reported instruments for selected prognostic factors could be helpful when screening for complexity and make it easier to decide whether the rehabilitation should be within MMR1 or MMR2 for patients in need of MMR. / Sammanfattning SYFTE: Syftet med denna studie var att beskriva och jämföra om patienter med långvarig smärtproblematik inom primärvård (MMR1) respektive specialiserad sjukhusvård (MMR2), som stod i begrepp att påbörja multimodal smärtrehabilitering (MMR), skattade olika avseende ett antal prognostiska faktorer för funktionsförmåga. METOD: Studien hade en deskriptiv och komparativ tvärsnittsdesign. Åttionio konsekutivt tillfrågade patienter deltog (50 i MMR1, 39 i MMR2). Datainsamlingen gjordes vid start av MMR med tre självskattningsformulär; Skattning av tilltro till sin förmåga att utföra åtta specificerade vardagsaktiviteter (STIVA-8), The Pain Belief Screening Instrument (PBSI) och Hospital Anxiety and Depression Scale (HADS). RESULTAT: Studien visade statistiskt signifikanta skillnader avseende att patienterna i MMR2 skattade lägre tilltro till sin förmåga enligt STIVA-8, det var färre andel lågriskpatienter och större andel högriskpatienter i MMR2 avseende smärtintensitet enligt PBSI samt färre andel patienter utan depression i MMR2 och fler med måttliga depressionsbesvär i MMR2 enligt HADS. Inga signifikanta skillnader kunde visas avseende låg- och högrisk för aktivitetsbegränsning enligt PBSI och inte heller för ångest enligt HADS. När smärtintensitet beräknades med medelvärde på skalan 0-10 fanns inga signifikanta skillnader. KONKLUSION: Patienterna i MMR2 skattade mer negativa konsekvenser av sin smärtsjukdom än i MMR1. Systematisk användning av skattningsformulär som ringar in olika prognostiska faktorer bör kunna underlätta selektion och sortering vid val av vårdnivå för patienter i behov av MMR.

Ce travail de thèse cherchait à étudier les compétences verbales chez les individus atteints de Troubles du Spectre Autistique, en se concentrant en particulier sur l'impact du traitement sur le développement de ces compétences, ainsi que sur l‘explication comportementale de la grammaire générative. Notre première étude comparait l'effet du traitement comportemental et du traitement pluridisciplinaire sur les aptitudes verbales des enfants avec TSA en milieu naturel. Les effets du traitement ont été évalués par l'analyse de résultats à des tests standardisés évaluant le vocabulaire commun, le vocabulaire spatial, la syntaxe et le raisonnement non – verbal, et en comparant le nombre d'enfants qui avaient intégré dans le milieu ordinaire (sans aménagement particulier). Les participants avec les meilleurs scores aux tests standardisés et dont les vitesses d'apprentissage atteignent ou dépassent la norme appartenaient au groupe ayant bénéficié d‘un traitement comportemental intensif précoce. C'est aussi dans ce groupe que se trouvait le plus fort pourcentage de participants ayant intégré le milieu ordinaire sans soutien particulier. Nous avons également exploré la façon dont les caractéristiques des enfants pourraient influencer l‘effet du traitement. Nos résultats indiquent que l'âge de début de traitement avait un effet que sur les vitesses d'apprentissage des compétences verbales et cela uniquement pour les participants ayant bénéficié d‘un traitement comportemental intensif. Nous avons aussi exploré la possibilité d'une relation entre la sévérité des symptômes à l'âge de 4-5 ans et les vitesses d'apprentissage et la sévérité des symptômes après environ 4ans de traitement comportemental intensif. L'analyse des données révèle que la gravité des symptômes à l'âge de 4 à 5 ans seraient prédictifs de la sévérité des symptômes qui seraient observés quelques années plus tard. Enfin, nous avons effectué un suivi et comparé les vitesses d'apprentissage après en moyenne 2 ans et après en moyenne 4 ans de traitement comportemental intensif. Une variabilité importante a été observée dans l'évolution des taux d'apprentissage d'un participant à un autre. Enfin, afin de mieux appréhender cette hétérogénéité, nous avons étudié la vitesse d'acquisition des compétences d'enfants avec TSA ayant bénéficié d‘un traitement comportemental intensif pendant en moyenne 4 ans. L'analyse des courbes d'apprentissage indique qu'il y aurait deux types d'apprenants ; des apprenants rapides et des apprenants lents, et cela in dépendamment de l'âge de début de traitement. Notre étude comparative a montré que si le traitement comportemental intensif résultait en des gains plus importants au niveau des aptitudes verbales des enfants atteints de TSA que le traitement multidisciplinaire, toutes les compétences verbales n‘étaient pas affectés de la même manière . En effet, les améliorations au niveau du vocabulaire sont plus importantes que celles observées pour la grammaire. Nous nous sommes attachés dans la deuxième partie de cette thèse à tenter d‘appréhender ces compétences grammaticales dans le cadre comportemental au sein d‘une population avec et sans troubles autistiques. Pour ce faire, nous avons utilisé des consignes réduites au strict minimum, des procédures d‘apprentissage des séquences et de Matching to Sample afin d‘apprendre aux participants à répondre à des stimuli. Ces réponses à ces stimuli étaient considérés comme analogues à certaines de compétences verbales complexes, notamment les relations syntaxiques, et les classes de mots (par exemple, les noms, les adjectifs, les verbes). / The current thesis aimed at investigating verbal skills in individuals with ASD, focusing in particular on the impact of treatment on the development of these skills, as well as attempting to contribute to a more complete behavior analytic explanation of complex generative language.Our first study aimed at comparing the effect of behavioral treatment and multi disciplinary treatment on the verbal skills of children on the autism spectrum in natural settings. Treatment outcome was assessed by analyzing the results to standardized tests evaluating common vocabulary, spatial vocabulary, syntax and non-verbal reasoning and by comparing the number of children who had been mainstreamed into regular classrooms without the help of an aide. Participants with the best test scores on the standardized tests and whose learning rates reached or exceeded normal learning rates of language skills belonged to the group that received early intensive behavioral treatment. It is also in this group that we find the highest percentage of participants who were mainstreamed without special support. We also set to explore how child variables could influence treatment outcome. Our results indicated that age of intake had an effect only on the learning rates of verbal skills and that only for participants who received intensive behavioral treatment. In addition, we explored the possibility of a relation between the severity of symptoms at the age of 4-5 years and the learning rates and the severity of symptoms after approximately 4 years of intensive behavioral treatment. Data analysis revealed that severity of symptoms impairing the development and interfering communication at the age of 4 to 5 years were predictive of the severity of the symptoms that would be observed a few years later. We also conducted a follow up and compared the learning rates after on average of 2 years of intensive behavioral treatment and after on average 4 years of treatment. Significant variability was observed in the evolution in learning rates from one participant to another. Finally, in an attempt to better understand this heterogeneity, we studied the rate of skill acquisition over a 4-year period of children on the autism spectrum who received intensive behavioral treatment. The analysis of the learning curves indicated that there were two types of learners, fast learners and slow learners and that, regardless of age of onset of treatment.Our comparative study showed that whilst intensive behavioral treatment resulted in more important gains in the verbal skills of children with ASD than multi disciplinary treatment, all verbal skills were not affected in the same way. Indeed the gains in vocabulary were more important than the ones in grammar. We thus set in the second part of this thesis to conduct a behavioral analysis of the development of complex verbal skills in the typically developing population but also in the population on the autism spectrum. We used minimal verbal instructions, and matching to sample and sequence training procedures to develop responding to stimulus classes. These were considered analogous to complex verbal skills, namely syntactic relations and classes of verbs, nouns or adjectives.

This research explores the experiences and practices of Medical Art Therapists; specifically, how working with clients in a medical setting, often as a part of a multidisciplinary team, impacts the work of an Art Therapist. Researchers reviewed the general literature regarding children and adults’ experiences of hospitalization and utilization of psychosocial services. Medical Art Therapy literature is reviewed next, emphasizing work with children, families, and adults. Informed by the literature, researchers invited Medical Art Therapists to participate in a focus group and/or follow-up survey. Researchers conducted a focus group in which participants discussed their experiences and created response art. A survey was then sent to focus group participants and other respondents who were unavailable for the focus group. Researchers identified four categories that emerged from the survey data: “art as self-expression,” “categorization of Art Therapy,” “considerations specific to the medical setting,” and “range of utility” of Medical Art Therapy. Researchers used these categories to analyze data from the focus group and response art. An additional category emerged from these two data sets: “personal experience.” The response art naturally offered another category for analysis: “features of the art.” Researchers compared findings across all data sets and discovered meanings by setting these findings in the context of the general and Medical Art Therapy literature. Further research is warranted to support expansion in the field of Medical Art Therapy.