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The Weighting of Cues to Upright Following Stroke With and Without a History of Pushing
- Lindsey E. Fraser, Avril Mansfield, Laurence R. Harris, Daniel M. Merino, Svetlana Knorr, Jennifer L. Campos
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 45 / Issue 4 / July 2018
- Published online by Cambridge University Press:
- 21 June 2018, pp. 405-414
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- Article
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Objective: Perceived upright depends on three main factors: vision, graviception, and the internal representation of the long axis of the body. We assessed the relative contributions of these factors in individuals with sub-acute and chronic stroke and controls using a novel tool; the Oriented Character Recognition Test (OCHART). We also considered whether individuals who displayed active pushing or had a history of pushing behaviours had different weightings than those with no signs of pushing. Method: Three participants experienced a stroke <3 months before the experiment: one with active pushing. In total, 14 participants experienced a stroke >6 months prior: eight with a history of pushing. In total, 12 participants served as healthy aged-matched controls. Visual and graviceptive cues were dissociated by orienting the visual background left, right, or upright relative to the body, or by orienting the body left, right, or upright relative to gravity. A three-vector model was used to quantify the weightings of vision, graviception, and the body to the perceptual upright. Results: The control group showed weightings of 13% vision, 25% graviception, and 62% body. Some individuals with stroke showed a similar pattern; others, particularly those with recent stroke, showed different patterns, for example, being unaffected by one of the three factors. The participant with active pushing behaviour displayed an ipsilesional perceptual bias (>30°) and was not affected by visual cues to upright. Conclusion: The results of OCHART may be used to quantify the weightings of multisensory inputs in individuals post-stroke and may help characterize perceptual sources of pushing behaviours.
20 - Self-harm: assessment in children
- from I - Disorders
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- By Daniel M. Bennett, Royal Cornhill Hospital, Aberdeen, Mercedes Acevedo Merino, Royal Aberdeen Children's Hospital
- Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons
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- Book:
- 101 Recipes for Audit in Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2011, pp 59-60
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Summary
Setting
This audit is of particular relevance to those services providing assessments to children who self-harm. The original audit was conducted in a child and family psychiatry service covering children up to the age of 13.
Background
The National Institute for Health and Clinical Excellence (NICE) produced a guideline on the topic of self-harm in 2004, with a section relating to the special provision for children and young people. It recommends that all those involved in triage, assessment and treatment should be ‘trained to work with children and young people who self-harm’ and should be ‘adequately trained to assess mental capacity in children of different ages and must understand how issues of capacity and consent apply to this group and have access at all times to specialist advice about these issues’. NICE further recommends that ‘All children and young people should normally be admitted into a paediatric ward under the overall care of a paediatrician and assessed fully the following day’ and the responsible paediatric team should ‘obtain consent for mental health assessment’.
Standards
ᐅ All patients should have a psychosocial assessment.
ᐅ Consent for a mental health assessment should be recorded in the case notes.
ᐅ The assessment should be performed by a clinician trained to work with children and young people.
ᐅ The parents or other responsible adult should be consulted in the process of the assessment.
ᐅ An assessment of risk should be recorded.
Method
Data collection
All patients presenting to accident and emergency (A&E) with self-harm were identified using the department's computer system. The search terms ‘self-harm’ and ‘overdose’ were used. The psychiatric case file was then accessed. Where there were no child or adult psychiatry notes, the A&E cards were examined. If they were also unavailable, the children's hospital medical notes were examined. The notes were inspected to determine the following:
ᐅ the nature of the self-harm and age of the patient
ᐅ whether a mental health assessment was requested
ᐅ whether consent for a mental health assessment was recorded by the requesting clinician
ᐅ whether the assessment was conducted by a clinician trained to work with children and young people
ᐅ whether a risk assessment was recorded
ᐅ whether the parents or other responsible adults were consulted.