published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Purpose/Statement of Problem: Disorders of Consciousness (DoC) are a group of disorders encompassing Coma, Unresponsive Wakefulness Syndrome (UWS), and Minimally Conscious State. These disorders are characterized by altered or absent alertness and consciousness and inability to follow commands or participate in daily activities or function. DoC can be caused by a multitude of etiologies including trauma, stroke, tumors, metabolic disarray, and many others. Individuals with severe DoC are profoundly functionally and cognitively impaired, and frequently require extensive rehabilitation in order to return to their prior level of function. Additionally, a category has recently been discovered within the umbrella of DoC called Cognitive Motor Dissociation (CMD), in which individuals may show no outward signs of the ability to follow commands but can be seen to respond appropriately to commands when monitored by Electroencephalography (EEG). The current standard of rehabilitative care for individuals with severe DoC is minimal. There are no clear guidelines for rehabilitation of these individuals, particularly in the acute stage. Rehabilitation is often initiated once individuals are awake and able to follow commands, despite evidence that earlier intervention (particularly in the form of stimulation) may accelerate recovery. In this retrospective study, we had three primary aims and one case study. The first aim was to characterize the time frame in which a cohort of individuals with severe DoC received therapy and whether the timeframe in which they received therapy was appropriate. The second aim was to retrospectively determine which therapy and demographics factors could predict better short- and long-term outcomes. The third aim was to determine whether the presence of CMD had a mediating effect on therapy. Finally, the case study was intended to determine safety of a prospective study recruiting individuals extremely early after admission for a standardized stimulation intervention. Procedures and Methods: This study was a retrospective analysis of data from a cohort of individuals who were recruited to participate in multiple studies of consciousness in the neurological intensive care unit (NICU) in an academic medical center in New York City between 2014 and 2021, heretofore referred to as the parent study. All individuals had a severe DoC, were connected to EEG, had no previous history of brain injury, and were tested for presence of CMD. Charts were examined to determine whether individuals could have received therapy earlier. Regression modeling was used to determine the effect of various therapy factors (such as timing, volume, frequency, and therapy content) as well as demographics data on a variety of short term and long-term outcome measures. These outcome measures included scores on the Coma Recovery Scale-Revised, scores on the AM-PAC “6 Clicks” Basic Mobility and Daily Activity short forms, recovery of active participation in therapy, discharge destination, and Glasgow Outcomes Scale-Extended scores. Analyses were also performed on the individual effect of each therapy variable on the effect of CMD status, and on the overall effect of CMD status on outcomes. Results: Thirty-eight of the fifty eight (65.52%) individuals in this cohort who received therapy after the median day received for the cohort could have safely received therapy earlier in the form of a standardized stimulation protocol. Multiple therapy variables were implicated in both short- and long-term outcomes. More specifically, therapy frequency, therapy volume, CMD status, sitting at edge of bed, and age were all implicated in both short- and long-term outcomes. Therapy timing was not an independent predictor for any outcomes but was significantly associated with therapy frequency. Therapy frequency was an independent predictor of multiple outcomes including discharge destination, Basic Mobility scores, and GOS-E scores. Sitting at the edge of the bed was an independent predictor of Daily Activity Score, and all therapy variables except timing were independent predictors of change in Basic Mobility Score. CMD status had a modulatory effect on multiple therapy variables (variable based on outcome) and was an independent predictor of long-term outcomes. Conclusions: Individuals with severe DoC were an underserved population from a therapy perspective. With the current standard of care, individuals with severe DoC frequently overlooked in favor of those who are more able to participate in active therapy. Analyses performed in this study indicated that individuals with severe DoC could a.) safely receive therapy sooner, b.) benefit from increased therapy frequency and specific modes of therapy, c.) could make excellent functional progress and d.) might have performed better with therapy if they had CMD. These results indicate that individuals with severe DoC might benefit earlier and more consistent therapy to maximize their chances of functional recovery.

Sex offenders are often required by the court to enter therapy and receive help so they can stop deviant sexual behaviors. Mental health professionals must have some means of evaluating a mandated client's progress in therapy, however, there are currently no valid criteria available. A survey form was developed containing 73 items which professionals identified as having possible utility in evaluating progress.

The cell survival curve is the only means by which to both qualitatively and quantitatively assess morphologic alterations directly resulting from in vitro irradiation of the cell. A ������Co cell survival curve experiment has successfully demonstrated the response of the AtT-20 clone mammalian cell line to the effects of gamma rays. With the results of this experiment, a low LET radiation cell survival curve now exists to be used as a comparative upon the completion of BNCT cell survival curves. / Graduation date: 1995

M.A. (Psychology) / The overall aim of this study is to evaluate the effect that Human Modelling in a group therapeutic setting, has on the mental health or personal integration of prisoners. The General Systems Theory, principles of Cybernetics and Botes' (1987) integrated model of mental health are used as a meta theoretic point of departure. From the literature study it transpires that it is important to explain and treat the prisoner in totality in order to make treatment more effective. An attempt is thus made to formulate an integrated model for the explanation of the crime phenomenon by virtue of already existing models. Furthermore the personal functioning (intra- and interpersonal) - as index of mental health of the criminal is surveyed. A short comparison is done between the traits of a mentally healthy person (Botes, 1987) and the personal functioning of the criminal or prisoner. From this it appears that the criminal has certain deficiencies in this regard and hence cannot be described as an integrated person once the traits are unbalanced. He thus requires guidance towards a higher degree of personal integration, which should lead to a change in traits and accordingly balance is restored. From the literature study it is evident that treatment of prisoners is to a large extent unsuccessful. The reasons for this are pointed out. Human Modelling in a group therapeutic setting however, has the potential to lead the prisoner towards a higher degree of personal integration, due to it's metaphoric and synthetic nature, and to make treatment more successful. The potential that Human Modelling as a metaphor holds for the therapist and mental health of the prisoner, is pointed out and described...

Filial therapy, originally developed by Bernard Guerney (1964), is a form of parent child therapy utilizing child-centered skills and limit setting strategies to improve the parent child relationship and to increase positive child behaviors. Parent Child Interaction Therapy (PCIT), developed by Sheila Eyberg (1988), is an empirically supported treatment for improving parenting skills and decreasing negative externalizing behavior with children. Child Parent Relationship Therapy (CPRT), developed by Garry Landreth (2002), is an up and coming form of Filial therapy, supported in the literature for improving the parent child relationship and improving the child’s general functioning. Children diagnosed with Autism Spectrum Disorders (ASD) often present with deficits in their socialization and communication abilities. These deficiencies can cause strain on the parent child relationship because of the challenges inherent to the maladaptive interactions common among families with a child diagnosed with ASD. Therefore, there is a need for effective interventions to improve the functioning between the parent and child. However, a review of the literature discovered a lack of research using Filial therapy with children diagnosed with ASD and no research comparing different forms of Filial therapy. In order to better inform practitioners, the current study utilized qualitative analysis through a deconstructing evidence approach to examine the experience of four participants in either the PCIT or CPRT group. Participants completed pre and post assessments measuring changes in the parent child relationship and their child’s adaptive functioning. The counselors of the group also recorded the parents’ reactions to the group through their weekly progress notes. The results yielded little support for one approach over the other. One participant in the CPRT had a very successful experience overall, reporting improvement in the parent child relationship and her child’s adaptive functioning. Furthermore, the counselors recorded a more positive reaction from the parents in the CPRT group as compared to the largely neutral or negative reactions from the parents in the PCIT group. However, overall, the study concluded that more research is needed on identifying a clearly superior Filial therapy approach for children diagnosed with ASD. / Department of Counseling Psychology and Guidance Services

Most counselors agree that the therapeutic relationship is essential in counseling. However, the current evidence-based treatment movement has resulted in a focus on treatment protocols and techniques in outcome research. Researchers have called for the inclusion of relationship variables in future outcome research. Child-centered play therapy (CCPT) is an empirically-supported, developmentally responsive intervention for children that emphasizes building a therapeutic relationship based on the philosophy of person-centered theory. Exploring the impact of the relationship on CCPT outcomes would be beneficial, but no current quantitative measure exists for obtaining the child’s view of the therapeutic relationship. The purpose of this study was to create a developmentally appropriate instrument to measure children’s perceptions of the therapeutic relationship. Established instrument development procedures were followed to create the Relationship Inventory for Children (RIC), a 15-item instrument for use in outcome research that measures the child’s perspective of the therapeutic relationship. Participants were 33 child experts who participated in interviews and preliminary testing of the instrument as well as 100 children whose scores on the 31-item pilot instrument were submitted to exploratory factor analysis (EFA). Children (62% male) ranged in age from 6 to 9 years (M = 6.92) and 53% identified as Caucasian, 14% as Hispanic, 14% as African American, 2% as Asian American, 0.8% as Native American, 8% as Multiracial, and 9% unreported. The EFA resulted in three factors: Positive Regard, Unconditional Acceptance, and Empathy. Implications for further development of the RIC, for use of the RIC in research, and for application of the RIC to person-centered theory are discussed.

There is a dearth of research available on child services in the community mental health setting in the fields of psychology and counseling. The purpose of this study was to conduct an experimental evaluation of university-based play therapy clinical services with children aged 3 to 10 years old and to explore dimensions of the effectiveness of child-centered play therapy (CCPT) with children. This study examined real-life clinical services to the largest number of child participants in decades of mental health research, especially in the field of play therapy. Archival data from cases of 364 children served through a university-based play therapy clinic in the southwestern United States was examined. The effectiveness of child-centered play therapy (CCPT) was measures by a decrease in a child's behavioral problems perceived by a parent/guardian measured by scores of the Internalizing Problems, Externalizing Problems and Total Problems on the Child Behavioral Checklist (CBCL) and a reduction of parent-child relationship stress manifested in the Child Domain, Parent Domain and Total Stress Score on the Parenting Stress Index (PSI). Data from pretest and posttest was gathered for use in the analysis. Independent samples t-test, repeated measures analysis of variance, and ordinary least squares regression, including effect sizes, were utilized to detect the differences between groups and the treatment effects. After receiving individual CCPT, results of this study demonstrated statistically significant differences on overall CBCL and PSI measures, with the exception on Parent Domain. Additionally, findings highlighted the effectiveness of individual CCPT through demonstrated moderate to large effects over time (partial η2 = .097 to .201). Individual CCPT also revealed very large effects (η2 = .26 to .37) when specifically examined with participants who completed play therapy treatment. Further, statistically significant predictions were found on CBCL and PSI measures, with the exception on Total Problems. Termination and family relationship concern variables were found as strong contributors on predicting greater improvement. Based on the statistical, practical, and clinical significances, the primary contribution of this study is the fully exploration of child characteristics and effectiveness of play therapy for children who seek mental health services.

Background: Art therapeutic intervention has already been part of complex therapeutic programs in institutional treatment of addictive disorders in the Czech Republic for several decades already. However, the form of art therapy is neither codified, nor is there a universally accepted education system. In 2017, the profession of an art therapist was removed from the list of non-medical professions in the field of health care. Aims: To describe how an art therapeutic program is implemented in selected institutional addiction treatment facilities in terms of formal status, documentation, processes, personnel and team collaboration. Methods: Qualitative analysis focused on the treatment program was applied. Five addiction treatment facilities were selected, and cooperation with nine respondents - employees of these facilities - was established. These respondents were selected both intentionally and by self-selection. Semi-structured interviews with art therapists (five respondents) and their collaborators (four respondents) and available written documents anchoring clinical practice were used to obtain data. Results: Art therapy is clearly defined and distinguished from activity and work therapies in the selected facilities. The art therapeutic program is usually carried out once a week mandatory for...