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"Cross, Susan"
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Liz Glynn : objects and actions
From her first participatory performance building Rome in 24 hours--in cardboard--to Open House, her open-air Gilded Age ballroom--cast in concrete--in Central Park, Liz Glynn examines the past to shed light on present day social and economic conditions through a diverse array of sculptures, structures, and actions. This monograph, designed to emphasize Glynn's interest in process, temporality, labor, and shifting notions of value, features a series of essays on the artist's practice as a whole, texts on each of her discrete projects as well as images from the artist's studio, and documentation of her performances. Together they give readers a comprehensive overview of an artist whose career has garnered enormous attention from audiences and critics alike.
Book
P12 Treating sleep paralysis: setting up a service to provide group cognitive behavioural therapy for sleep paralysis at the royal london hospital for integrated medicine
IntroductionThe insomnia team at the Royal London Hospital for Integrated Medicine (RLHIM), part of UCLH, is the largest NHS provider of Cognitive Behavioural Therapy for insomnia (CBTi). As part of our service development plans we are expanding the courses of treatment we offer.It is estimated that 8% of people experience Isolated Sleep Paralysis at least once in their life. Episodes can occur just after falling asleep or upon waking, and are characterised by a temporary inability to move, often accompanied by terrifying hallucinations, and the feeling of suffocation.The aims of our therapy are to reduce patient’s fear and anxiety, reduce the frequency and duration of episodes, and make each episode less distressing.MethodDuring the COVID pandemic, our CBTi service moved from face-to-face to group sessions over zoom. The Sleep Paralysis groups were introduced in 2022, running on similar lines, incorporating treatment plans suggested by Sharpless and Doghramji.1 Our Sleep Paralysis therapy course consists of 4 hour-long sessions covering education about the condition and the underlying physiology, sleep hygiene, diaphragmatic breathing, disruption techniques and strategies to manage hallucinations. Each session ends with ‘homework’ – techniques for patients to practice daily.ResultsTo date we have run 4 small groups of up to 4 patients, with a growing waiting list with 37 referrals in 2022, and 20 in the first 6 months of 2023DiscussionTherapy is well received by patients, who welcome the opportunity to talk about their condition with people who understand their experiences. Patients would like the addition of a face-to-face session to facilitate more peer support. Therapists would like face-to-face sessions to improve practical training for diaphragmatic breathing.ConclusionFurther work is needed to identify appropriate outcome measures, or to develop a new measure.Reference‘Sleep Paralysis: Historical, Psychological, and Medical Perspectives’ Brian A Sharpless and Karl Doghramji; 2015, Oxford University Press ISBN 978-0-19-931380-8
Journal Article
Home-based rehabilitation using a soft robotic hand glove device leads to improvement in hand function in people with chronic spinal cord injury:a pilot study
Background
Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual’s capability to perform essential activities of daily living (ADL).
Objective
This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB.
Methods
Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale.
Results
The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm,
p
<0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up.
Conclusions
Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI.
Trial registration number
Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered,
http://www.isrctn.com/ISRCTN98677526
Journal Article
Jane Savoie's dressage 101 : the ultimate source of dressage basics in a language you can understand
Provides techniques for dressage training that range from paces and flatwork to self-carriage and extended gait, along with solutions to common training problems.
Book
Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia
BackgroundObstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia.MethodsAn existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units.ResultsInjury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87–0.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66–93) and 88% (75–94) in the development group, and 77% (65–87) and 81% (68–90) in the validation group. Similar results were demonstrated with the original model.ConclusionImplementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments.Trial registration numberResults, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).
Journal Article
Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial
RationaleHighly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation.ObjectiveTo determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia.Methods and measurementsMultinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome.Main results1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully ‘adherent’ (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI −7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect −1.15, 95% CI −10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference −1.26, 95% CI −2.2 to –0.32; p=0.01).ConclusionCPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia.Trial registration numberACTRN12605000799651.
Journal Article
17 A systematic review of the treatment of restless leg syndrome and periodic limb movements in people with spinal cord injury
IntroductionPeople with spinal cord injury (SCI) have a high prevalence of sleep disorders, which often remain undiagnosed and untreated, resulting in reduced quality of life. Their sleep may be disturbed by pain and spasms, but these could also be symptoms of Restless Leg Syndrome (RLS) or Periodic Limb Movements (PLMs). Studies estimate that RLS affects 17-19% of people with SCI. Little is known about the management of RLS or PLMs after SCI.MethodA systematic review was conducted following PRISMA guidelines, searching 5 databases, for studies of any intervention to manage RLS and/or PLMs in people with SCI. Outcomes of interest were changes in severity of RLS or PLMs, or effects on sleep quality (see table 1).Abstract 17 Table 1Terms used in healthcare databases advanced search’ (HDAS) function in OpenAthensResults465 Manuscripts were identified. 12 studies fulfilled inclusion/exclusion criteria, totalling 108 participants. Risk of bias assessment revealed low evidence quality due to small sample sizes and lack of randomised controlled trials.Interventions investigated included• L-dopa and pramipexole were shown to reduce PLMs objectively measured by polysomnography, and subjectively reported RLS symptoms.• Exercise reduced the PLM index measured by polysomnography.• Intrathecal baclofen injection reduced PLMs.DiscussionIt is thought that in people with SCI dopaminergic medications exert their effect in the spinal cord rather than in the brain.Reviewed papers report potential confusion between PLMs and spasticity, and between neuropathic pain and RLS.The RLS diagnostic criteria are challenging to apply after SCI. It is unclear how a patient with altered sensation following SCI will experience the ‘urge’ to move.ConclusionsThere is evidence that some sleep measures improved with dopaminergic medication or exercise. Clinicians should consider investigation for RLS and PLMs in patients with neuropathic pain or spasticity unresponsive to usual treatment, with symptoms predominating in the evening or at night. These patients may respond to treatment for these sleep disorders.
Journal Article