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This chapter explores the impact of strokes and the role of music therapy in post-stroke rehabilitation. It highlights the urgency of seeking immediate medical attention for stroke symptoms, emphasizing that prompt treatment can minimize brain damage. The chapter also discusses the potential for music to aid in cognitive recovery, as evidenced by studies showing improvements in verbal memory and concentration in stroke patients who listened to music regularly. Furthermore, the chapter looks at the application of music therapy for addressing specific post-stroke conditions such as aphasia and hemiparesis. It describes melodic intonation therapy (MIT) as a promising intervention for speech recovery in aphasia patients, showcasing its ability to stimulate new neural connections in the brain. Additionally, it explores the effectiveness of rhythmic auditory stimulation (RAS) in improving gait and coordination in patients with hemiparesis. The chapter underscores the importance of tailoring music therapy to individual needs and preferences, emphasizing the potential for music to enhance emotional well-being and motivate patients during their rehabilitation journey. It concludes by advocating for the integration of music therapy into standard stroke rehabilitation practices, recognizing its potential to improve patient outcomes and quality of life.
This title explores the principles and mechanisms for the reparation of human rights violations under international human rights law. It discusses the obligation of states to provide full reparation for harm suffered as a result of human rights violations, including restitution, compensation, rehabilitation, satisfaction, and guarantees of nonrepetition. The section examines the legal standards for determining and quantifying reparation, the procedural aspects of reparation processes, and the role of international and national bodies in monitoring and enforcing reparation awards. It also highlights the challenges in ensuring effective and timely reparation, the importance of victim participation in reparation processes, and the impact of reparation on the rehabilitation and empowerment of victims. By analyzing the principles and practices of reparation, this title aims to provide a comprehensive understanding of the mechanisms for addressing the consequences of human rights violations and the importance of reparation in achieving justice and reconciliation.
This part explores the principles and mechanisms for the reparation of human rights violations and the enforcement of decisions rendered by international human rights bodies. It discusses the obligation of states to provide full reparation for harm suffered as a result of human rights violations, including restitution, compensation, rehabilitation, satisfaction, and guarantees of nonrepetition. The sections examine the legal standards for determining and quantifying reparation, the procedural aspects of reparation processes, and the role of international and national bodies in monitoring and enforcing reparation awards. Additionally, this part focuses on the enforcement mechanisms and challenges in implementing international human rights decisions. It discusses various models of enforcement, including judicial review, hybrid monitoring, and political and diplomatic control. The part highlights the importance of effective enforcement in ensuring the realization of human rights and the accountability of states for human rights violations. By providing insights into the reparation and enforcement processes, this part emphasizes the critical role of comprehensive and effective mechanisms in achieving justice and reconciliation for victims of human rights violations.
This chapter explores the principle of full reparation for human rights violations under international human rights law. It discusses the obligation of states to provide reparation, the forms of reparation, and the challenges in implementing this principle. The chapter examines the legal standards for full reparation, including restitution, compensation, rehabilitation, satisfaction, and guarantees of nonrepetition. It also highlights the role of international bodies in monitoring and enforcing reparation obligations, the importance of victim participation in reparation processes, and the challenges in providing adequate and effective reparation for human rights violations.
The perpetration of torture in peacetime almost inevitably involves the responsibility of a State. Indeed, State responsibility is at the heart of the international human rights law prohibition of torture, which also applies in a situation of armed conflict. In the case of torture as a war crime, a crime against humanity, or genocide, however, an entity other than a State may be directly responsible for acts of torture. Nevertheless, as a matter of general international law, given the seriousness of the violation of a jus cogens norm, in all situations the victims and survivors of torture are entitled to a remedy to help compensate for the harm they have suffered. The same principle should pertain to other forms of ill-treatment even though their prohibition is not also a peremptory rule of international law. The consequences of being tortured for the individual and his or her family can be both devastating and lifelong. Rehabilitation may help to turn a victim into a survivor, but it will never fully dispel the harm that has been inflicted. Some of the techniques developed by dedicated experts and non-governmental organizations to promote physical and psycho-social rehabilitation are referred to in this chapter.
Because plea bargaining is usually about disposition rather than guilt or innocence, the discussion in Chapter 8 transitions nicely into Part III, which is mostly about sentencing. People on both the left and the right acknowledge that our current punishment system is overly dependent on prolonged incarceration and that our astounding imprisonment rates need to be reduced. Chapter 9 argues that the antidote to our hyper-punitiveness is preventive justice, which relies heavily on empirical assessments of recidivism risk and intervention needs. While this type of regime would still depend on retributive criteria to set (broad) sentencing ranges, it replaces the current emphasis on calibrating sanctions according to the culpability of offenders with a focus on whether imprisonment is needed to protect the public. After describing preventive justice in skeletal form, the chapter explains why this approach to sentencing could become a critical tool for reducing incarceration and the harms it causes, without increasing the threat to public safety. The chapter also addresses constitutional and philosophical concerns about a regime focused on prevention. Most importantly, it explains why preventive justice is not Minority Report in disguise.
The author reflects on some significant legal and policy developments – on the newly expanded scope of anti-trafficking, on the rehabilitation of sex workers, and on the escalated targeting of Bangladeshi migrants – that have emerged since her ethnographic research. Through these updates, she revisits some of the key themes outlined in the Introduction and tracked through the book: the excess of legality around the governance of prostitution and trafficking in India, the central role played by NGOs in these forms of governance, and the impact of these forms of governance on the women they target. It is argued that even as the legal framework of anti-trafficking now exceeds that of anti-prostitution, they continue to remain deeply connected, through the work of anti-trafficking NGOs, and through existing models of intervention established under India’s anti-prostitution law (the ITPA). The author also discusses how the anti-immigrant sentiments against Bangladeshi women that shaped the implementation of anti-prostitution and anti-trafficking imperatives during her research have been greatly magnified and exacerbated by India’s Hindu right wing-led government in the decade since.
In-patient mental health rehabilitation services provide specialist treatment to people with complex psychosis. On average, rehabilitation admissions last around a year and usually follow several years of recurrent and often lengthy psychiatric hospital admissions.
Aims
To compare in-patient service use before and after an in-patient rehabilitation admission, using electronic patient healthcare records in one National Health Service Trust in London.
Method
We carried out a retrospective cohort study comprised of individuals with an in-patient rehabilitation admission lasting ≥84 days between 1 January 2010 and 30 April 2019, with at least ≥365 days of records available before and after their rehabilitation admission. We used negative binomial regression models to compare the number of in-patient days before and after the rehabilitation admission.
Results
A total of 172 individuals met our eligibility criteria. The median percentage of days spent as an in-patient before the rehabilitation admission was 29% (interquartile range 18–52%), and 8% (interquartile range 0–31%) after the admission. The regression model adjusted for potential confounder variables produced an incidence rate ratio of 0.520 (95% CI 0.367–0.737).
Conclusions
The rate of in-patient service use was halved in the period after an in-patient rehabilitation admission compared with the period before. This suggests that in-patient rehabilitation is a clinical and cost-effective intervention in the treatment and support of people with complex psychosis.
Ostracism, or exclusion by peers, has been practiced since ancient times as a severe form of punishment against transgressors of laws or social norms. The purpose of this paper is to offer a comprehensive analysis on how ostracism affects behavior and the functioning of a social group. We present data from a laboratory experiment, in which participants face a social dilemma on how to allocate limited resources between a productive activity and theft, and are given the opportunity to exclude members of their group by means of majority voting. Our main treatment features an environment with heterogeneity in productivity within groups, thus creating inequalities in economic opportunities and income. We find that exclusion is an effective form of punishment and decreases theft by excluded members once they are re-admitted into the group. However, it also leads to some retaliation by low-productivity members. A particularly worrisome aspect of exclusion is that punished group members are stigmatized and have a higher probability of facing exclusion again. We discuss implications of our findings for penal systems and their capacity to rehabilitate prisoners.
People with advanced cancer express the need for support to balance everyday activities to experience quality of life. The Balance, Activity and Quality of Life Intervention was developed to address this need using a resource- and activity-oriented approach that integrates rehabilitation into palliative care. To inform a future full-scale evaluation, the objective of this feasibility study was to test if the selected outcome measures of health-related quality of life, including physical function and fatigue, and occupational balance could capture any possible changes of the Balance, Activity and Quality of Life Intervention in people with advanced cancer.
Methods
Repeated-measurement feasibility study without a control group (ClinicalTrials.gov NCT04772690). Twenty-two home-living adults with advanced cancer participated in the study. The intervention was delivered at the research clinic of REPHA, The Danish Knowledge Centre for Rehabilitation and Palliative Care. Data regarding health-related quality of life, including physical function and fatigue, and occupational balance were collected with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and the Occupational Balance Questionnaire at baseline, after a 5-day intervention stay and at 6- and 12-week follow-up.
Results
The outcome measure of health-related quality of life captured a statistically significant improvement (p = 0.0046) after the 5-day intervention stay, with 64% of the participants experiencing clinically relevant improvements. No other statistically significant changes were found. Missing data were minor.
Significance of results
Health-related quality of life is a promising outcome measure to capture the possible changes of the Balance, Activity and Quality of Life Intervention. The results indicate that a resource- and activity-oriented approach may be helpful when integrating rehabilitation into palliative care.
Physical rehabilitation in people with Parkinson’s disease (PD) aims to restore everyday functioning and mobility through a multidisciplinary approach. We present and discuss the current evidence on efficacy of key rehabilitation specialties and therapies that contribute to improving everyday (motor and non-motor) functioning in PD. Rehabilitative therapies aiming to improve posture and balance, transfers, gait, and physical condition have been shown effective. Evidence that physical therapy interventions using for example external or internal cues is effective for improving gait and gait-related mobility is strong, although the evidence for improving upper limb function, speech, and swallowing deficits is still limited. Optimal intensity of rehabilitation services offered by physical therapists, occupational therapists, and speech therapists, as well as their active ingredients and long-term impact, need further underpinning to help continuing development and updating of clinical guidelines.
Migraine management involves a wide range of clinical rehabilitation practices. This variability hampers the clinical applicability of these protocols. Before proposing any recommendations for migraine interventions, one needs to identify how interventions are generally structured. This study aimed to systematically map the activities in multidisciplinary rehabilitation programs for people with migraine.
Methods:
We conducted a scoping review from January 2002 to April 2024 in MEDLINE®, CINAHL, Academic Search Complete, AMED, APA PsycInfo and Academic Search Complete databases. Search terms were related to (i) migraine or headache, (ii) intervention and (iii) multidisciplinary or interdisciplinary care. Language and population inclusion criteria were applied. Two researchers independently screened titles, abstracts and full-text articles and extracted data according to three topics: (i) activities and their modalities, (ii) professionals involved and (iii) tools used.
Results:
The activities identified ranged from medication management and a variety of exercise types and lifestyle changes using education strategies to stress management techniques. Psychological interventions were rarely defined and appeared to overlap with education and stress management techniques. Information on treatment delivery was scarce. Professionals from many disciplines were mentioned. The outcomes assessed included migraine or headache characteristics, psychological symptoms, disability and quality of life. No explicit theoretical models were found.
Conclusions:
The results highlight the heterogeneity of activities in multidisciplinary interventions for people with migraine. Operationalizing an intervention based on a theoretical model is essential for allowing replications, evaluation and implementation in rehabilitation settings.
The Antarctic Treaty System has put in place international agreements to provide comprehensive protection of the Antarctic environment. Despite this high degree of protection, human presence on the continent has resulted in environmental contamination, particularly at locations established prior to the development of the more stringent codes of conduct in recent decades. Rehabilitation of legacy contaminated sites is a priority for environmental management, and a framework for such efforts has been established. In this contribution, we re-evaluate the rehabilitation of the site of the former Vanda Station, a New Zealand outpost occupied from 1969 to 1991. We describe the design and implementation of the restoration, which included the removal of many tonnes of contaminated soils and groundwater, along with the post-action monitoring of the site. Our goal is to determine where challenges to the use of recent guidelines would have arisen. We found that while guidelines on clean-up of contaminated sites in Antarctica are valuable, challenges to implementation remain. These largely reflect a lack of understanding of the consequences of contamination on Antarctic ecosystems and the trajectory of natural rehabilitation. We present recommendations on how to address some of these challenges.
Major advances over the past decades have transformed the management landscape of neuromuscular disorders. Increased availability of genetic testing, innovative therapies that target specific disease pathways and mechanisms, and a multidisciplinary approach to care including both transitional and palliative care contribute to timely and more appropriate management of conditions that are associated with a severe disease burden and often also a reduction of life expectancy.
There is an increasing number of consensus recommendations/guidelines that are a useful adjunct for establishing a timely and accurate diagnosis, and enable prognostication of disease-related complications, are a guide for multidisciplinary care and treatment, and expedite initiation of disease-modifying interventions. A number of these guidelines have been referred to in various cases, such as myasthenia gravis (MG), myotonic dystrophy type 1 and 2, chronic inflammatory demyelinating neuropathies (CIDP), and Duchenne muscular dystrophy (DMD), to name a few.
The endemic tree Neltuma caldenia Burk. and the shrub Neltuma flexuosa var depressa F.A. Roig (Fabaceae; subfam: Mimosoideae) are two promising species from the central region of Argentina, with high potential for use in the restoration of disturbed environments, for extensive livestock grazing and apiculture. Both species have seeds with physical dormancy. Ecological study of native species is important from the point of view of rehabilitation of degraded areas by natural regeneration or via seed-based programmes. The objective of this study was to evaluate soil seed bank persistence and seedling traits to understand variation among different populations of each of the study species growing along an ecological gradient and to identify potential components driving this variation. Home environments influenced seed bank persistence, which was higher in populations originating from more arid and unpredictable environments where it could act as a bet-hedging strategy between years and seasons. We also observed differences associated with seedling growth traits between the species and populations. Populations with higher seed persistence were associated with greater seedling growth in N. caldenia. The rapid elongation rate of N. caldenia seedlings growing in large populations and unstable environments could help their ability to escape drought by accessing deeper soil moisture and would confer a high relative competitive ability. In contrast, N. f. var depressa displayed higher seed persistence, which was associated with more arid and unstable conditions and correlated with lower seedling growth, possibly due to an inbreeding depression effect, resulting from the presence of mother plants in low-densities or being isolated from other individuals. There was no effect of population size on seed persistence. To better understand seed persistence and associated seedling trait variation, future studies need to consider the genotype, environment and landscape conditions.
Drowning persists as a preventable pediatric cause of severe morbidity and mortality. This study aims to investigate the risk factors, circumstances, and medical consequences associated with pediatric drowning incidents in order to identify patterns that can inform targeted interventions.
Methods:
This was a retrospective analysis of a cohort of pediatric drowning cases. The study encompassed children aged 0-18 years who presented to the pediatric emergency departments (PEDs) of Hadassah Medical Centers in Jerusalem from January 1, 2004 through April 30, 2023. Inclusion criteria were individuals with main registration diagnosis containing the terms “drowning” or “submersion.”
Results:
Analysis revealed 129 cases of pediatric drowning, males comprising 66% of the cohort. The average age was 4.9 years (SD = 4.5). Predominantly, drownings occurred in private (38%) or public pools (27.1%). Forty-eight percent of children required hospitalization in intensive care. Notably, children from the Arab minority were significantly younger at the time of drowning (3.8 years; P = .04) and were at elevated risk of severe neurologic outcomes necessitating rehabilitation (P = .03). Incidents occurring on weekends were associated with younger victim ages (3.5 years; P = .04) and with increased likelihood of outcomes necessitating rehabilitation (P = .04). Conversely, children from families with four or more siblings were notably older at the time of drowning (5.3 years; P = .01). No other statistically significant differences were observed among demographic groups.
Conclusions:
Strategies aimed at promoting child health and preventing drowning must surmount feasibility barriers. Intervention efforts should be tailored to populations at heightened risk, including younger children, minority groups, and incidents occurring during weekends.
Increased rehabilitation intensity, the number of minutes of therapy per day, is associated with improved outcomes. However, it is unclear whether males and females receive the same inpatient stroke rehabilitation intensity. A sub-analysis of a retrospective population-based cohort study of adults (5877 females, 6893 males) with stroke discharged to inpatient rehabilitation between 2017 and 2021 was conducted. The mean rehabilitation intensity was 75.86 min/day for males and 73.33 min/day for females (p < .0001). Males <80 years of age were more likely to receive higher rehabilitation intensity than females. Future research should explore what factors account for this sex difference.
Acquired prosopagnosia is a rare disorder, but it serves as a model for impairments in expert-level visual processing. This review discusses five key observations made over the past 30 years. First, there are variants, an apperceptive type linked to damage to the inferior occipitotemporal cortex and an amnestic type associated with anterior temporal lesions, both either right or bilateral. Second, these variants are clustered in syndromes with other perceptual deficits, the apperceptive type with field defects, dyschromatopsia and topographagnosia, and the amnestic type with topographagnosia and the auditory disorders of phonagnosia and acquired amusia. Third, extensive testing often shows additional problems with recognizing exemplars of other objects, especially when degrees of expertise are taken into account. Fourth, the prosopagnosic impairment does not affect all facial information. For example, the perception of expression and lip-reading likely depends on other neural substrates than those for processing facial identity. Last, face perception in prosopagnosia is not immutable but can improve with extensive training, though as yet this does not represent a cure for the condition. Continuing work with neural networks and animal models will enhance our understanding of this intriguing condition and what it tells us about how our brains process vision.
Cognitive impairment (CI) is one of the most prevalent and burdensome consequences of COVID-19 infection, which can persist up to months or even years after remission of the infection. Current guidelines on post-COVID CI are based on available knowledge on treatments used for improving CI in other conditions. The current review aims to provide an updated overview of the existing evidence on the efficacy of treatments for post-COVID CI.
Methods
A systematic literature search was conducted for studies published up to December 2023 using three databases (PubMed–Scopus–ProQuest). Controlled and noncontrolled trials, cohort studies, case series, and reports testing interventions on subjects with CI following COVID-19 infection were included.
Results
After screening 7790 articles, 29 studies were included. Multidisciplinary approaches, particularly those combining cognitive remediation interventions, physical exercise, and dietary and sleep support, may improve CI and address the different needs of individuals with post-COVID-19 condition. Cognitive remediation interventions can provide a safe, cost-effective option and may be tailored to deficits in specific cognitive domains. Noninvasive brain stimulation techniques and hyperbaric oxygen therapy showed mixed and preliminary results. Evidence for other interventions, including pharmacological ones, remains sparse. Challenges in interpreting existing evidence include heterogeneity in study designs, assessment tools, and recruitment criteria; lack of long-term follow-up; and under-characterization of samples in relation to confounding factors.
Conclusions
Further research, grounded on shared definitions of the post-COVID condition and on the accurate assessment of COVID-related CI, in well-defined study samples and with longer follow-ups, is crucial to address this significant unmet need.
The physical health comorbidities and premature mortality experienced by people with mental illness has led to an increase in exercise services embedded as part of standard care in hospital-based mental health services. Despite the increase in access to exercise services for people experiencing mental illness, there is currently a lack of guidelines on the assessment and triage of patients into exercise therapy.
Aims
To develop guidelines for the pre-exercise screening and health assessment of patients engaged with exercise services in hospital-based mental healthcare and to establish an exercise therapy triage framework for use in hospital-based mental healthcare.
Method
A Delphi technique consisting of two online surveys and two rounds of focus group discussions was used to gain consensus from a multidisciplinary panel of experts.
Results
Consensus was reached on aspects of pre-exercise health screening, health domain assessment, assessment tools representing high-value clinical assessment, and the creation and proposed utilisation of an exercise therapy triage framework within exercise therapy.
Conclusions
This study is the first of its kind to provide guidance on the implementation of exercise therapy within Australian hospital-based mental healthcare. The results provide recommendations for appropriate health assessment and screening of patients in exercise therapy, and provide guidance on the implementation and triage of patients into exercise therapy via a stepped framework to determine (a) the timeliness of exercise therapy required and (b) the level of support required in the delivery of their exercise therapy.