A radical argument is presented that it is plausible to look at the condition of mental handicap as entailing dynamic cognitive processes which may be available to some degree of therapeutic intervention at a fundamental level. An overview of some broad aspects of mental handicap is presented and it is argued that much of the subject of mental handicap is based on assumptions which may not be justified. On the assumption that in normal infancy play is a powerful medium for promoting developmental change, aspects of the mentally handicapped child's inability to play is examined and discussed. This is done by adopting the Piagetian notion of decentration and showing how the concept has explanatory value for looking at change in the severely, or profoundly mentally handicapped child. A model of aspects of the process is developed and implemented as a computer simulation. This model entails he processes of "Integration and Differentiation" of hierarchical chunks. The prospects and usefulness of a developmental curriculum as a framework within which to work with the profoundly and severely mentally retarded is discussed. The notions of Integration and Differentiation are applied to systems of sensori-motor competence and presented as a candidate for a curriculum. A presentation of the Uzgiris & Hunt scales serves to provide the user with the means to understand where the child is "at" in the curriculum. The computer simulation is further developed to show how it could be extended to provide explanations for the effects of success and failure upon developmental process. The model provides an insight into the nature of stereotypy and the implications of the model are explored in a therapy undertaked with a mentally handicapped and withdrawn child. The relationship between the understanding gained here and the processes of normal mothering is introduced. The theme of the mothering process is develcped apd explored as a means of providing the mentally Nandi Gaped child with the experience of success that section 3 suggests is the means for promoting change. This is demonstrated via several case accounts. The transactional interface between the intractable organic and the potentially more plastic cognitive/social process is tentatively explored by a discussion of "eye contact". Finally an evaluative framework for the possible implications of the work are discussed.

A touch is an inseparable part of the mutual contact between a nurse and a patient.The more a patient depends on the assistance of the others in common daily activities, the more a nurse uses physical contact in the care, not only in relation to the professional ortherapeutic acts, but also to the expression of compassion, sympathy, encouragement or calming a patient.Despite the fact that a touch is so important in patient care, it only receives a marginal attention.The goal of the thesis was to examine the reasons for and the obstacles to the application of a touch in nursing care, and if a touch belongs to the present nursing care.Research questions were set to achieve the goals:How do nurses perceive a touch in the present nursing care?How do patients perceive a nurse's touch in the treatment?Three hypotheses were formulated in dependence on the above set goals:H1:Nurses perceive a touch more as a part of the direct (physical)care than a therapeutic intervention.H2:Nurses rather use a touch as an unintentional method than as an intentional therapeutic intervention.H3:Nurses use a touch rather intuitively, not realizing the risk that a touch can be perceived negatively.The theoretical part of the thesis was elaborated on the base of literature sources.The empiric part was implemented on the base of a qualitative and quantitative research.The data for the qualitative research was gained by means of semi-structured interviews with ten patients.A questionnaire research for general nurses was used for the data collection in the quantitative research.On the base of the results the hypotheses were evaluated as follows:H1 Nurses perceive a touch more as a part of the direct (physical) care than a therapeutic intervention unconfirmed.H2:Nurses rather use a touch as an unintentional method than as an intentional therapeutic intervention unconfirmed.H3:Nurses use a touch rather intuitively, not realizing the risk that a touch can be perceived negatively unconfirmed. It is obvious from the results we achieved in the research that a touch has been and will always be an inseparable part of the mutual relation between a nurse and a patient.The research has shown that nurses perceive a touch as a part of the direct care as well as a therapeutic intervention.And if nurses use a touch as a therapeutic intervention, they do it intentionally, mostly to build confidence, to calm a patient, to create the feeling of safety, certainty and understanding.More than a half of the nurses replied that they used a touch instinctively, not realizing that they are touching the patient, on the other hand, more than a half of the nurses replied that they cared about at what points a patient perceived a touch negatively.Although the nurses replied that a therapeutic touch was not time consuming, it is not applied frequently in the therapeutic care.The research has also shown that patients accept a touch within the care and they accept it resignedly.When nurses touch patients, the patients are glad if such a touch is accompanied by words.The interviews revealed that a nurse should not underestimate a handshake at the first contact, as patients perceive this act as a feeling of interest and creation of confidence.The research shows indisputably that a touch is a very important holistic nursing interventionin patient care. It has confirmed that although a touch and its perception is something so intimate, individual and indispensable in nursing care, it only receives a marginal attention.This thesis might serve as study material for numerous nurses, so that a touch is used as an effective intervention by a nurse that perceives a patient as a holistic being and has a sympathy for him/her in his/her uneasy life situation.This thesis might initialize a more extended research combining more research methods.An application of hidden observation for deeper understanding of the use of a touch in nursing care might be particularly interesting.

Text in Afrikaans / Every person yearns to function as an independent and integrated human being who experiences inner peace and wholeness. The search for a way of life that leads to wisdom and life knowledge has continued through the centuries and according to Hancock (2005:8) it began as early as 40 000 years ago. This research study takes up this search, describing human wholeness from a spiritual, philosophical and psychological perspective, in the context of specific essential characteristics. Together with this, applicable therapeutic approaches were researched to structure an intervention model to achieve wholeness. Wholeness therapy is an eclectic approach based on medical hypnoanalysis with added aspects of the rational-emotive behavioural therapy of Albert Ellis, choice theory of William Glasser and Victor Frankl’s logotherapy. By means of qualitative research a case study from a psychological practice was described, in which a person was enabled to experience wholeness through wholeness therapy which is described in full. / Educational Studies / D.Ed. (Sielkundige Opvoedkunde))

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Area of focus/rationale for the study: This study is an evaluation of an intervention, named Thrive, which is designed to promote the emotional development of children with Emotional and Behavioural Difficulties (EBD). The focus is to investigate the extent to which Thrive is effective in improving certain emotional and behavioural outcomes for children as well as exploring the experiences of those who are involved with the programme. The study is set out in two papers. Paper one assesses changes in pupil emotional well being over time using two subscales designed to measure specific aspects of resiliency, namely, ‘emotional reactivity’ and ‘sense of relatedness’. It also uses an assessment to measure changes in emotional and social skills which are considered important in order for pupils to engage in learning in a mainstream classroom environment (readiness to learn). Paper one also looks at the possible association between the Thrive training and staff attitudes towards pupils with EBD. Paper two explores, in depth, the experiences of the Thrive approach from the perspective of a small sample of school staff, pupils and parents. This process of exploration serves to better understand the outcomes from paper one by identifying a number of factors which may contribute to the successful or unsuccessful implementation of Thrive in a particular educational context. Context, Background and Research Objectives: Broad labels of ‘Emotional and Behavioural Difficulties’ (EBD) and’ Behavioural Emotional and Social Difficulties’ (BESD) tend to encompass behaviour which interferes with a child’s own or other’s learning; signs of emotional turbulence; and difficulties in forming and maintaining relationships. SEBD is used interchangeably with BESD (Behavioural, Emotional and Social Difficulties) in policy documents and theoretical writing (Evans, 2010). Schools tend to use the term EBD and this will generally refer to children whose behaviour and emotions prevent them and others from learning to their potential (DCSF, 2008). For ease and consistency I will use the term EBD throughout this study. The Special Needs and Disability Act (2001) sets out the right for children with EBD to be educated in mainstream schools. Due to the disruptive impact on learning for self and others, this group of children have been cited as one of the most difficult groups to include (Evans & Lunt, 2002). Behaviour management continues to be high on the education policy and practice agenda in England and the rest of the UK. Schools are faced with the challenge of finding ways of ensuring children with EBD are included in the ordinary classroom with their peers and to ensure that the needs of this vulnerable group of children are adequately met. Alongside this, Government Policy (e.g. NICE Guidelines, 2007) now requires schools to promote the emotional well-being of children who exhibit signs of emotional and behavioural disturbance. There is a demand for evidence based approaches to support children with EBD in mainstream schools from which professionals, such as Educational Psychologists, can draw on in order to make positive changes (see literature review in Appendix B.9 for more details). Thrive is a trademarked programme developed by a multidisciplinary team named ‘Fronting the Challenge’ (ftc). The programme is described as a ‘dynamic developmental approach to working with vulnerable and challenging children whose behaviour interrupts their own and others learning’. The Thrive programme borrows from a range of research and theory around neuroscience, child development, attachment theory and the role of creativity and play (for example Sunderland, 2006; Hughs, 2004; Illsey- Clarke & Dawson, 1989; Stern, 2003). It can be described as a school based intervention which is informed by a psychotherapeutic model as it aims to support children by addressing core relational and developmental features (Evans et al., 2003). Similar to nurture groups, Thrive is based on the understanding that for a child to develop a healthy ability to adapt to his or her social environment they must have experienced a sensitive, responsive and caring relationship with a significant carer/parent (Stern, 2003; Sunderland, 2006). But additional to a nurture group approach, the intervention draws on a concept from Transactional Analysis (Berne, 1964; Levin, 1982; Illsley Clarke & Dawson, 1998) which assumes that a child moves through a number of clearly defined stages of emotional development. The Thrive approach uses a computer based assessment, which relies on pupil observations, to identify specific ‘interruptions’ in this development; and targeted relational experiences, i.e., experiences of being in relationship with another human being, are recommended to promote further development. This will be discussed in more detail within the introduction of this thesis. As part of a wave two pathfinder for the Targeted Mental Health in Schools (TaMHS) Project under DCSF, in 2009, Thrive training was delivered to staff working with children and young people in three learning communities within a local authority in the South West of England. This included staff from approximately forty schools (including primary schools, secondary schools, a PRU and a special school) as well as multi-disciplinary staff such as CAMHS, Educational Psychologists and Behaviour support staff. At the time of beginning this study, thirty eight primary schools within the local authority had already been trained in Thrive and were implementing the intervention with some of their pupils. There was much testimony from staff working with children and young people that the training was highly valued and influential on their professional practice. Furthermore, there were a number of claims suggesting that pupils involved in Thrive were experiencing a whole range of positive outcomes attributable to the programme. For example, that the most disruptive pupils were calmer and making fewer visits to the Head Teacher’s office; that emotionally vulnerable children had become more confident and more trusting; that attendance had improved; and that the number of fixed term exclusions had diminished. Although there were a small number of detailed case studies prepared by schools themselves, the claims were, in the main, based on anecdote. Where schools had made some attempt to measure the impact of Thrive the methodology lacked basic rigour and findings were susceptible to bias; pre and post measurements were very limited and control measures were absent in all cases. The project lead for TaMHS reported ‘emerging’ data in relation to reduced numbers of fixed term exclusions, reductions in referrals to other services and referrals for statutory assessment. However, the source of this data was also said to be unreliable. Despite all of this, a general positive ‘vibe’ about the intervention based on a melange of potentially unreliable evidence was persuasive enough for the local authority to consider further investment into the intervention. Further details of current evidence related to the impact of Thrive can be found in Appendix A.1. Objectives of this study: • To provide a more reliable understanding of the effectiveness of the Thrive programme in supporting children with EBD within mainstream primary schools. More specifically: - To find the extent to which Thrive reduces pupil ‘emotional reactivity’, improves pupil ‘sense of relatedness’ and improves ‘readiness to learn in a mainstream classroom’. - To find whether there is an association between the Thrive training and staff attitudes towards the inclusion of children with EBD in mainstream primary schools. • To explore how a small sample of pupils, parents and staff experience Thrive.

The full text will be available at the end of the embargo: 17th July 2024

Current interventions used to reduce skeletal fragility are insufficient at enhancing bone across multiple hierarchical levels. Bisphosphonates, such as Zoledronate (ZOL), treat a variety of bone disorders by increasing bone mass and bone mineral density to decrease fracture risk. Despite the mass-based improvements, bisphosphonate use has been shown to compromise bone quality. Alternatively, Raloxifene (RAL) has recently been demonstrated to improve tissue quality and overall mechanical properties by binding to collagen and increasing tissue hydration in a cell-independent manner. We hypothesized that a combination of RAL and ZOL would improve mechanical and material properties of bone more than either monotherapy alone by enhancing both quantity and quality of bone. In this study, wildtype (WT) and heterozygous (OIM+/-) male mice from the Osteogenesis Imperfecta (OI) murine model were treated with either RAL, ZOL, or RAL and ZOL from 8 weeks to 16 weeks of age. Combination treatment resulted in higher trabecular architecture, cortical mechanical properties, and cortical fracture toughness in diseased mouse bone. Two fracture toughness properties, direct measures of the tissue’s ability to resist the initiation and propagation of a crack, were significantly improved with combination treatment in OIM+/- compared to control. There was no significant effect on fracture toughness with either monotherapy alone in either genotype. Following the mass-based effects of ZOL, bone volume fraction was significantly higher with combination treatment in both genotypes. Similar results were seen in trabecular number. Combination treatment resulted in higher ultimate stress in both genotypes, with RAL additionally increasing ultimate stress in OIM+/-. RAL and combination treatment in OIM+/- also produced a higher resilience compared to the control. Given no significant changes in cortical geometry, these mechanical alterations were likely driven by the quality-based effects of RAL. In conclusion, this study demonstrates the beneficial effects of using combination therapy to increase bone mass while simultaneously improving tissue quality, especially to enhance the mechanical integrity of diseased bone. Combination therapies could be a future mechanism to improve bone health and combat skeletal fragility on multiple hierarchical levels.

Made available in DSpace on 2016-04-28T20:39:37Z (GMT). No. of bitstreams: 1 ana rocha.pdf: 755675 bytes, checksum: e6ce5efbda31c55ef64a019e01b1e446 (MD5) Previous issue date: 2007-12-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this paper is to propose and analyze a therapeutic intervention of a psycho-analytical character by playing with a recently hospitalized child in the light of the Winnicottian theory. The specific objective is to analyze the contributions from the Environmental Psychology to the proposal of therapeutic intervention, specifically the privacy and personal space phenomena. A study with two subjects was conducted in a public hospital, with a 5-year-and-6- month boy and a 4-year-and-11-month girl. The methodology consisted in: semi-guided interview with the respective mothers and therapeutic intervention by playing with each child in the first two days of hospitalization. With the collected data it was possible to make a psychological diagnostic hypothesis for each case, utilizing the Winnicottian theory. The hypothesis determined in which developmental stage the child supposedly was and how he or she has seemed to relate to reality since they were babies, developing individual manners of playing. The manner in which each child has developed seemed consistent with the reactions and the rapport established in playing in intervention with the researcher. The privacy and personal space phenomena were observed during the intervention process and were also coherent with the ways each child developed since babies to the reality, expression of their feelings, emotions and perceptions at the moment of intervention. It seemed to have been fundamental to the establishment of interaction and its continuity, as well as the continuity of the established playing, the knowledge of and respect for each child s need and desire for privacy and their own ways to mark the personal space. It was also realized that offering the possibility of playing, that was made in a noninvading way and coherent with each child s desires and needs, contributed for the building of an environment where there was acceptance and, therefore, they were able to express themselves according to their real self. It was concluded that there is need for more studies to be developed about how to offer hospitalized children a caring environment in which playing is incentivated, in the beginning of hospitalization. The identification and the expressions of privacy and personal space by the subjects could contribute to the / O objetivo da presente pesquisa foi propor e analisar uma intervenção terapêutica de caráter psicanalítico a partir do brincar com a criança recém hospitalizada à luz da teoria winnicottiana. O objetivo específico foi analisar as contribuições da Psicologia Ambiental à proposta de intervenção terapêutica, especificamente os fenômenos de privacidade e espaço pessoal. Foi realizado o estudo de caso em hospital público com dois sujeitos, sendo eles um menino de 5a6m e uma menina de 4a11m. O método consistiu em: entrevista semidirigida com as respectivas mães e intervenção terapêutica a partir do brincar com cada criança, nos dois primeiros dias de internação. Com os dados colhidos foi possível realizar a hipótese de diagnóstico psicológico de cada caso, tendo como base a teoria winnicottiana. A hipótese remeteu a qual fase do amadurecimento a criança supostamente se encontrava e como desde bebê ela pareceu se relacionar com a realidade, desenvolvendo formas particulares de brincar. A forma como cada criança se desenvolveu pareceu consoante às suas reações e ao estabelecimento da interação e do brincar em intervenção junto à pesquisadora. Os fenômenos da privacidade e espaço pessoal foram observados no processo de intervenção também em consonância às formas como cada criança apreendeu desde bebê a realidade, e às expressões de seus sentimentos, emoções e percepções no momento da intervenção. Pareceu ter sido fundamental ao estabelecimento da interação e à sua continuidade, assim como à continuidade do brincar estabelecido, o conhecimento e o respeito às necessidades e desejos de cada criança por privacidade e às suas formas de demarcação do espaço pessoal. Percebeu-se, também, que o oferecimento da possibilidade de brincar, que se deu de forma não invasiva e coerente aos desejos e necessidades de cada criança, contribuiu à construção de um ambiente de acolhimento, e assim elas puderam se expressar em consonância a seu verdadeiro self. Concluiu-se que existe a necessidade de desenvolvimento de mais estudos sobre como oferecer à criança hospitalizada um ambiente de acolhimento propício ao brincar, no início da internação. A identificação e as expressões de privacidade e espaço pessoal pelos sujeitos puderam contribuir às propostas de intervenção, inclusive às que se baseiam na teoria winnicottiana

This study focuses on the use of a bridging technique to overcome contact–making barriers in adolescents. Contact is regarded as an integral part of all human experiences, but barriers (also called contact boundary disturbances) often hinder effective contact–making with the environment. To overcome contact boundary disturbances, several model bridges were constructed prior to the study and these were used as a metaphor during the intervention phase with adolescents. The goal of the research was to determine whether a technique called “bridging” could overcome contact boundary disturbances in adolescents in therapy. The research was conducted from an existential–phenomenological Gestalt approach. Combined quantitative and qualitative approaches were followed and a single system experimental design, A–B–A–A, was applied. A total of 14 adolescent participants between the ages of 11 and 14 were purposefully selected from three different schools in the Gauteng Province, South Africa, as well as their parents and teachers. Quantitative data were collected from the pre–intervention assessment, the post–intervention assessment and a follow–up assessment where questionnaires were completed by the researcher for each of the adolescent participants. The follow–up assessment was done four weeks after the postassessment in order to determine the consistency of the intervention. These questionnaires were analysed according to the semantic differential scale, and raw scores were plotted on line and bar graphs in order to assess the contact skills and contact boundary disturbances in the participating adolescents. Qualitative data were collected through semi–structured interviews with parents and teachers and through therapeutic interventions with adolescents. The data were analysed using the Creswell spiral and the a priori and inductive coding approaches. Three main themes were identified which were contact boundary disturbances, personal emotional factors and behavioural factors. Quantitative and qualitative data results and findings were discussed in context, to the relevant literature. The findings of the data indicated that the bridging technique can be useful in working with adolescents in therapy to overcome contact–making barriers. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2012.

This study focuses on the use of a bridging technique to overcome contact–making barriers in adolescents. Contact is regarded as an integral part of all human experiences, but barriers (also called contact boundary disturbances) often hinder effective contact–making with the environment. To overcome contact boundary disturbances, several model bridges were constructed prior to the study and these were used as a metaphor during the intervention phase with adolescents. The goal of the research was to determine whether a technique called “bridging” could overcome contact boundary disturbances in adolescents in therapy. The research was conducted from an existential–phenomenological Gestalt approach. Combined quantitative and qualitative approaches were followed and a single system experimental design, A–B–A–A, was applied. A total of 14 adolescent participants between the ages of 11 and 14 were purposefully selected from three different schools in the Gauteng Province, South Africa, as well as their parents and teachers. Quantitative data were collected from the pre–intervention assessment, the post–intervention assessment and a follow–up assessment where questionnaires were completed by the researcher for each of the adolescent participants. The follow–up assessment was done four weeks after the postassessment in order to determine the consistency of the intervention. These questionnaires were analysed according to the semantic differential scale, and raw scores were plotted on line and bar graphs in order to assess the contact skills and contact boundary disturbances in the participating adolescents. Qualitative data were collected through semi–structured interviews with parents and teachers and through therapeutic interventions with adolescents. The data were analysed using the Creswell spiral and the a priori and inductive coding approaches. Three main themes were identified which were contact boundary disturbances, personal emotional factors and behavioural factors. Quantitative and qualitative data results and findings were discussed in context, to the relevant literature. The findings of the data indicated that the bridging technique can be useful in working with adolescents in therapy to overcome contact–making barriers. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2012.