Introduction to Applied Psychology Rehabilitation, PDF

Introduc)on to Applied Psychology Rehabilita)on Psychology patient similar to health ↳ payc but patient condition limit their participation in social...

Introduc)on to Applied Psychology Rehabilita)on Psychology patient similar to health ↳ payc but patient condition limit their participation in social world * adaptation to disability ↳ often no Michael Sullivan, PhD. solution Department of Psychology, McGill University Montreal, Canada Rehabilitatio n Psychology Rehabilita@on psychology is the study and applica@on of psychological principles on behalf of persons who have disability due to injury or illness. Rehabilita@on psychologists are involved in prac@ce, research, and advocacy, with the broad goal of fostering independence and opportunity for people with disabili@es.  Rehabilitation Psychology The specialty of rehabilita@on psychology addresses behavioral and mental health issues faced by individuals across the lifespan who are aDected by any injury or chronic condi@on that leads to disability. Clinical focus might include: term with -coming to Fostering eDec@ve coping, letting go of somethingyou can't do Evalua@on of psychological status. anymorephobiabyfrom difficulty en: dev a accident ; harder not : the patient plebia often ↳ errational like most ~ Promo@ng behavior that contributes to posi@ve doesn' get full often work accident - explication from limited adapta@on to disability. opportunity find to doctor a new job need to Minor adjustment issues as well as severe 4 pryc send him back often no health condition list of with most opportunity psychopathology. the S preparatory with question of doesn't ↳ come stres life for thiis stressor but is the * prepare patient for port operation rehab  Disabling Conditions Musculoskeletal (arthri@s) progressive > - + recovery no Neurological (Mul@ple Sclerosis, Parkinson’s, ALS) death in less than five years ↳ Sensory (Vision, Auditory) fatigue -impact or Metabolic (Diabetes, Kidney disease)possibilities but major issue often t many diff Cardiovascular problems (Conges@ve bram heart failure) to toathou have bowel urge go a a incd Pain-related (Chron’s, IBS, Migraine) Cogni@ve (Demen@a, Alzheimer’s) o function ↓ Non-SpeciUc (Fibromyalgia, chronic fa@gue) Injury (Spinal cord injury, TBI, Whiplash)  become less De4ning attractive to society stigma Disability ↳ there is some bind of accomodations (WHO) always but there is limitation and limited way to help A disability is any condi@on of the body or mind (impairment) that makes it more diWcult for the person with the condi@on to do certain ac@vi@es (ac@vity limita@on) and interact with the world around them (par@cipa@on restric@ons). Spinal Cord Injury Prevalence. It is es@mated that there are approximately 300,000 spinal cord injury survivors in North America. Incidence. There are approximately 25,000 new spinal cord injuries every year. Gender/Sex Di>erences. The majority of spinal cord injuries are sustained by men (3:1). Impairment. Associated with signiUcant restric@ons and compromise par@cipa@on in a range of life ac@vi@es. Life Expectancy. Mortality is highest in the Urst year following injury. Respiratory problems (pneumonia) and infec@ons (pressure sores, urinary tract). ↳ often from reduce mobility Causes of Spinal Cord Injury Accidents. Auto and motorcycle accidents account for almost half of spinal cord injuries each year. Falls. A spinal cord injury a^er age 65 is most o^en caused by a fall. Acts of violence. About 12% of spinal cord injuries result from violent encounters (gunshot, knife wounds). Sports and recrea)on injuries. Athle@c ac@vi@es (impact sports, diving) cause about 10% of spinal cord injuries. Diseases. Cancer, arthri@s, osteoporosis and inaamma@on of the spinal cord also can cause spinal cord injuries. card tissue ↳ lack of blood flaw to spinal Spinal Cord Injury -depend if full "it' damage in a arca on consequence everything under Loca@on and Innerva@on  ↓ sensation involuntary , movement and voluntary could be insample injury central ord 1) syndrome 2) anterior / " 3) brown sequard" u) overs medalleris" paraplegia (under audel  Living with a Spinal Cord Injury The Challenges The Accident imobilization is ritical to avaid making any lesion worse especially when incomplete lesion could become amplate The Hospital full evaluation of your condition Early Rehabilitat ion to get you move around on your own strengthening of your other muscle Independen t Living Most survivor are around their 20 ↳ your expectations for the rest of your life are change Vocational Involvement there might be stigma ↓ employment chance but fortunately many jobs sedentary are The Role of the Psychologist Coping with the a^ermath of the accident (PTSD). Coping with the reality of life with a spinal cord injury. The stress and strain of a disability (Depression). Coping with chronic pain. Dealing with stage/age-related challenges.  A systema@c review of the literature concerning A Craig, Y Tran and J Middleton (2009) the nature of the psychological morbidity in people with spinal cord injury (SCI). Psychological morbidity and spinal Findings suggest that approximately 30% of cord injury: a people with SCI are at risk of having a depressive systematic review. disorder while in rehabilita@on. Results from controlled longitudinal research suggest that up to 30% of persons with SCI have Spinal Cord (2009) 47, 108–114 raised levels of anxiety. Fewer studies have examined prevalence rates of PTSD; Undings show that women are more suscep@ble.  The study evaluated the eDects of trea@ng major Kemp et al. (2016) depression in individuals with spinal cord injury (SCI). Treatment of Major Depression in Twenty-eight par@cipants who accepted treatment were Individuals With assigned to a treatment group; 15 individuals who declined treatment were assigned to a nontreatment Spinal Cord Injury SCI group. ↳ 5-15 years living with CBT + pharmaco e At the end of 6 months, in the treatment group, 30% of par@cipants had no depression, 42% had minor Journal of Spinal Cord depression, and 29% s@ll had major depression. Medicine, 27: 1, 22-28. to participation - physical barrier DiWcul@es in transporta@on, likely restrict the ability to implement needed services to many individuals with SCI.  To evaluate a mul@disciplinary cogni@ve behavioral Heutink et al. (2012) treatment program for persons with chronic neuropathic pain a^er SCI. The eDectiveness of art therapy A total of 61 people were randomized to either the interventions in interven@on group or the wai@ng list control group. reducing post- traumatic stress disorder (PTSD) SigniUcant interven@on eDects (Time X Group symptoms in pediatric interac@ons) were found for anxiety and par@cipa@on trauma patients. in ac@vi@es, but not for the primary outcomes. PAIN, 153; 120–128 better outcomes for treatment group & pain o anxiety and activity participation This study implies that a mul@disciplinary cogni@ve behavioral program might have beneUcial eDects on people with chronic neuropathic SCI pain. Multiple Sclerosis  Multiple Sclerosis (MS) Prevalence. It is es@mated that there are approximately 1,000,000 people diagnosed with MS in North America. Incidence. There are approximately 250 new cases of MS diagnosed each week. Gender/Sex Di>erences. Women are more suscep@ble to MS than men by a ra@o of ↳ condition approximately 3:1. more severe Life Expectancy. People with MS have a life expectancy that is 5 to 10 years shorter than the general popula@on.  cause (unknow) sheat new medication affect myelin factors : vilamin DL chair optical nerve viral Ms X depression ↳ ↓ life in infection spine ↳ depression 2x population brain smoking autammene disorder ↳ some neuro aspect much later in discar might influence ~ depression rehab goal Living with ↳ if you had MDD the ↳ avoid relapse before MS depres sian will be worse ↳ participate in ↳ condition (MS) social life will get worse with MDD Multiple Sclerosis between 30-45 (mort ave ↳ 2 forms sometimes 20s 1) attacks influence your reaction relapse X remitting Ms 1960 form ; attacks (relapse the disorder to diagnosis and you get better you point ↳ 1/3 conversion and how and/or hysteria your future 2 progressive degeneration ↳ no bioligical origin (found) for pain The Challenges The Diagnosis  wheelchair walker ame Symptom Progression ↳ diff walking (myelination of nerf sciatique i) warmer climate ↳ some symptoms might beexarcalated snowflake disease ↳ not one time bits all  Review of psychological factors/consequences of Maria José Sa (2008) Mul@ple Sclerosis. Depression was found to be prevalent, with one-year es@mates of approximately 20%, and life@me prevalence Psychological aspects of approximately 50%. ↳twice (2-3x) than gu pop of multiple sclerosis. Anxiety was also prevalent, and when co-morbid with depression appears to be associated with suicidal idea@on. Clinical Neurology and Neurosurgery 110 (2008) 868–877 The author suggests that important resources for individuals with MS include psychotherapy, cogni@ve behavioural therapy, strengthen of coping, and speciUc medica@ons.  To examine the eDec@veness and acceptability of an 8-week Kiropoulos et al (2016) individual tailored cogni@ve behavioural therapy (CBT) interven@on for the treatment of depressive symptoms in those newly diagnosed with mul@ple sclerosis. A pilot randomized controlled trial of a A total of 30 individuals who were newly diagnosed with tailored cognitive mul@ple sclerosis were randomized to the CBT interven@on (n = 15) or treatment as usual (TAU) (n = 15). behavioural therapy- based intervention for depressive symptoms in Large between group treatment eDects were found for level of those newly diagnosed depressive symptoms at post and at 20 weeks follow-up. with multiple sclerosis. Treatment-related reduc@ons in anxiety were not maintained BMC Psychiatry at follow-up. (2016) 16:435 These data suggest that the tailored early interven@on is appropriate and clinically eDec@ve for the treatment of depressive symptoms in those newly diagnosed with MS.  To evaluate the safety and eWcacy of a mul@ple sclerosis- Gold et al. (2023) speciUc, internet-based cogni@ve behavioural therapy (iCBT) program for the treatment of depressive symptoms associated with MS. Internet-delivered cognitive behavioural therapy A total of 279 par@cipants were enrolled; 101 were programme to reduce allocated to receive stand-alone iCBT, 85 to receive guided depressive symptoms in iCBT, and 93 to the control condi@on. patients with multiple sclerosis: a multicentre, Both versions of the iCBT program signiUcantly reduced randomised, controlled, depressive symptoms compared with the control group. phase 3 trial patient Lancet Digit Health MS : diff with 2023; ↳ 5: e668–78 The authors suggest that this remote-access, scalable mobility so more access interven@on increases the therapeu@c op@ons for MS pa@ents and could help to overcome treatment barriers. ↳ displacement  ↳ aggravate MS To examine the eWcacy of a stress management Mohr et al. (2012) program in reducing neuroimaging markers of mul@ple sclerosis (MS) disease ac@vity. A randomized trial of A total of 121 pa@ents with relapsing forms of MS were stress management randomized to receive stress management therapy for for the prevention of MS (SMT-MS) or a wait-list control condi@on. new brain lesions in MS. SMT-MS resulted in a reduc@on in cumula@ve lesions and greater numbers of par@cipants remained free of lesions during the treatment, compared to par@cipants Neurology 79 July receiving the control treatment. 31, 2012 This trial indicates that SMT-MS may be useful in reducing the development of new MRI brain lesions while pa@ents are in treatment. Subjec@ve Assessment of Cogni@ve DeUcits in Mul@ple Sclerosis aused white matter deay by in the brain  is improvemen ↳ low evidencefor restorative approach I practice cog still compensatory approach ↳ more of a drategy to help with deficit Cognitive Rehabilitation of a Patient with MS Joan; a 40-year-old woman, diagnosed with MS x 7 years. Minimal symptoms of MS other than problems with cogni@on. MRI revealed plaque forma@on in various areas of the brain. Worried about the impact of her cogni@ve diWcul@es on her work. Developed a program of interven@on to help her compensate for the diWcul@es she was experiencing. demand minimize on Goal semng; planning ac@vi@es; memory aids; environment log process structuring. strategy to help her do her job and working with her deficit ; Con@nued to work for another 4 years. Other symptoms began to worsen (balance, strength, endurance).