Walkergate Park Hospital

Background Prior evidence suggests that behaviours closely related to the intervention delivered for autism are amenable to change, but it becomes more difficult when generalising treatment effects beyond that immediate context. Objectives The objectives were (1) to test an early autism social communication intervention designed to promote child social communication change in the naturalistic contexts of both home and education, with an additive effect on overall child symptom outcomes, and (2) to conduct a mechanistic study investigating the transmission of treatment effects within and across contexts to an overall treatment effect. Design The trial was a three-site, parallel-group, randomised controlled trial of the experimental treatment plus treatment as usual and treatment as usual alone. The primary intention-to-treat analysis used analysis of covariance. The mechanism analysis used regression models to test mediation of the primary outcome by parent–child and education staff (learning support assistant)–child social interactions. Setting The study took place in three urban/semiurban regions in Manchester, Newcastle upon Tyne and London. Participants Children aged 2–11 years who met the criteria for severe autism. Interventions The Preschool Autism Communication Trial was adapted to parallel components within home and educational settings using in-person and remote delivery. Treatment as usual was the control condition. Main outcome measures The primary outcome was autism symptoms on the Autism Diagnostic Observation schedule-2. The secondary outcomes were Brief Observation of Social Communication Change, dyadic social interaction between child and parent or learning support assistant, reported language, functional outcome and reduction in child disruptive behaviour. Outcomes were measured at baseline and at the 12-month end point in all settings; interim mechanism measurements were taken at 7 months. Results Participants (n = 249; 122 in the PACT-G group and 127 in the treatment-as-usual group; 51 were female and 197 were male) received a median of 10 (interquartile range 8–12) sessions at home and 8 (interquartile range 5–10) sessions in an educational setting. We found no significant treatment effects on the end-point Autism Diagnostic Observation Schedule-2 primary outcome (–0.04, 95% confidence interval –0.26 to 0.18; p = 0.734), on the end-point Brief Observation of Social Communication Change secondary outcome (–0.03, 95% confidence interval –0.31 to 0.25; p = 0.85) or on language, repetitive behaviour, adaptive behaviour and child well-being. We did find significant treatment effects on dyadic interactions (increased parent synchronous response 0.54, 95% confidence interval 0.39 to 0.69; p = 0.001); child initiations with a parent (0.27, 95% confidence interval 0.12 to 0.41; p = 0.001); learning support assistant synchronous response (0.32, 95% confidence interval 0.14 to 0.49; p = 0.001); child initiations with a learning support assistant (0.21, 95% confidence interval 0.06 to 0.36; p = 0.005); and unblinded measures of improved parental well-being and child disruptive behaviour across home and educational settings. Adult (parent/learning support assistant) synchronous responsiveness in a home/education setting improved child dyadic social initiation. The child dyadic social initiation was also associated with child symptoms on researcher Brief Observation of Social Communication Change. Limitations The delivered sessional dosage was 83% of that planned in the home setting and 67% in the educational setting, with 5.5% of home sessions and 5% of educational sessions deemed ‘unacceptable’, particularly for remote delivery. A change of therapy learning support assistant was experienced by over one-third of children by the mid-point of the trial, by another third by the end point, and by one-fifth at both points. Conclusions The multicomponent Paediatric Autism Communication Trial – Generalised (PACT-G) treatment for a child in a home or educational setting did not produce the hypothesised improvement in child autism symptomatology or adaptive behaviour, but did produce significant improvements in proximal adult–child reciprocal dyadic communication. Future work Future work will involve building on these results towards a further understanding of delivery options, dosage and multicomponent extension of social communication interventions for young children with autism in naturalistic settings. Trial registration Current Controlled Trials ISRCTN25378536. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health and Care Research (NIHR) partnership. This was also part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.

BackgroundThe aim of this study is to examine the feasibility of a future definitive randomised controlled trial of Family Focused Treatment for Adolescents UK (FFT-A UK) in the management of early-onset bipolar disorder (EOBD) (under 18 years). The FFT-A has been evaluated in the USA to augment the pharmacological treatment of adolescents with bipolar disorder (BD). The FFT-A UK has been condensed to 16 sessions over approximately 6 months to be utilised within the UK National Health Service.Research from the USA suggests that families experience high levels of distress, stress, burden and family disharmony when living with a young person who has BD. The FFT-A UK is a family-based approach designed to increase understanding of BD (psycho-education), improve communication and increase ability to problem-solve.Methods/DesignThe trial will examine the feasibility of a randomised, parallel group, non-blinded design and the procedures of a subsequent definitive trial. Thirty-three young people with BD and their families will be recruited. Participants will complete measures at baseline, on completion of the 6-month treatment and again after a further 6 months. The self-report measures include the Warwick Edinburgh Mental Well-being Scale, The McMaster Family Assessment Device (FAD), Conflict Behaviour Questionnaire aka ‘Interaction Behaviour Questionnaire’, EuroQuol EQ-5D-3L and EQ-5D-Y. Primary outcomes will be rates of eligibility, recruitment and retention, estimates of the variability in the self-report measures and assessment of the intervention delivery in the study population. Participants’ qualitative views on the measures and intervention will be sought to confirm the acceptability of intervention and study design. The health economics component will establish how cost-effectiveness will be assessed in a future definitive trial.DiscussionThe study will produce a full trial protocol and amendments to the FFT-A UK to inform a well-designed multi-centre randomised controlled trial (RCT) as an adjunct to pharmacotherapy in the management of EOBD.Trial registrationCurrent Controlled Trials ISRCTN59769322

ObjectiveThe contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.MethodThis retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.ResultsDrug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.ConclusionsThis is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.

Movement DisordersVolume 28, Issue 9 p. 1310-1313 Letters: New Observations Early neuropsychiatry features in neuroferritinopathy Michael J. Keogh, Michael J. Keogh Institute of Genetic Medicine, Newcastle University, International Centre for Life Newcastle upon Tyne, United Kingdom Department of Neurology, Royal Victoria Infirmary Newcastle Upon Tyne, United KingdomSearch for more papers by this authorBaldev Singh, Baldev Singh Neuropsychiatry Service, Walkergate Park Hospital, Newcastle upon Tyne, United KingdomSearch for more papers by this authorPatrick F. Chinnery, Corresponding Author Patrick F. Chinnery Institute of Genetic Medicine, Newcastle University, International Centre for Life Newcastle upon Tyne, United Kingdom Department of Neurology, Royal Victoria Infirmary Newcastle Upon Tyne, United KingdomCorrespondence to: Patrick F. Chinnery, E-mail: [email protected]Search for more papers by this author Michael J. Keogh, Michael J. Keogh Institute of Genetic Medicine, Newcastle University, International Centre for Life Newcastle upon Tyne, United Kingdom Department of Neurology, Royal Victoria Infirmary Newcastle Upon Tyne, United KingdomSearch for more papers by this authorBaldev Singh, Baldev Singh Neuropsychiatry Service, Walkergate Park Hospital, Newcastle upon Tyne, United KingdomSearch for more papers by this authorPatrick F. Chinnery, Corresponding Author Patrick F. Chinnery Institute of Genetic Medicine, Newcastle University, International Centre for Life Newcastle upon Tyne, United Kingdom Department of Neurology, Royal Victoria Infirmary Newcastle Upon Tyne, United KingdomCorrespondence to: Patrick F. Chinnery, E-mail: [email protected]Search for more papers by this author First published: 23 February 2013 https://doi.org/10.1002/mds.25371Citations: 9 Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume28, Issue9August 2013Pages 1310-1313 RelatedInformation

There are a number of neurological approaches used in the management of the patient following a neurological defi cit. The Bobath Concept is one of the most commonly used of these approaches (Davidson & Walters 2000; Lennon 2003), and it offers therapists working in the fi eld of neurological rehabilitation a framework for their clinical interventions (Raine 2006). This chapter will provide the reader with an overview of the Bobath Concept including the founders of the approach and its inception, the theoretical underpinning and its application into clinical practice.

Abstract This is a comprehensive reference suitable for the whole rehabilitation team, that summarises the management of common symptoms and disorders, and also outlines the increasing evidence base for the efficacy of these techniques.

Botulinum toxin (BoNT) is the most potent neurotoxin known, and its clinical effects have been recognized since the end of 19th century. There are seven immunologically distinct serotypes of botulinum toxin; there are two types in routine clinical use - BoNT type A (BoNT-A) and BoNT type B (BoNT-B). Most of the large-scale studies on botulinum toxin have been related to upper and lower limb spasticity. The usefulness of BoNT in the management of spasticity secondary to a variety of clinical conditions is increasing. It is now well accepted for the management of movement disorders, particularly dystonia. There is an increasing evidence base for the use as a management tool in spasticity. The products now have a licence for use in focal spasticity. Dysport is indicated for focal spasticity specifically including arm symptoms associated with focal spasticity in conjunction with physiotherapy.

The Bobath concept is a problem-solving approach to the assessment and treatment of individuals following a lesion of the central nervous system that offers therapists a framework for their clinical practice. The aim of this study was to facilitate a group of experts in determining the current theoretical assumptions underpinning the Bobath concept.A four-round Delphi study was used. The expert sample included all 15 members of the British Bobath Tutors Association. Initial statements were identified from the literature with respondents generating additional statements. Level of agreement was determined by using a five-point Likert scale. Level of consensus was set at 80%. Eighty-five statements were rated from the literature along with 115 generated by the group. Ninety-three statements were identified as representing the theoretical underpinning of the Bobath concept. The Bobath experts agreed that therapists need to be aware of the principles of motor learning such as active participation, opportunities for practice and meaningful goals. They emphasized that therapy is an interactive process between individual, therapist, and the environment and aims to promote efficiency of movement to the individual's maximum potential rather than normal movement. Treatment was identified by the experts as having “change of functional outcome” at its center.