Physical Restraint Research Papers - Academia.edu (original) (raw)

Positional asphyxia refers to a situation where there is compromise of respiration because of splinting of the chest and/or diaphragm preventing normal respiratory excursion, or occlusion of the upper airway due to abnormal positioning of the body. Examination of autopsy files at Forensic Science SA revealed instances where positional asphyxia resulted from inadvertent positioning that compromised respiration due to intoxication, multiple sclerosis, epilepsy, Parkinson disease, Steele-Richardson-Olszewski syndrome, Lafora disease and quadriplegia. While the manner of death was accidental in most cases, in one instance suicide could not be ruled out. We would not exclude the possibility of individuals with significant cardiac disease succumbing to positional asphyxia, as cardiac disease may be either unrelated to the terminal episode or, alternatively, may result in collapse predisposing to positional asphyxia. Victims of positional asphyxia do not extricate themselves from dangerous situations due to impairment of cognitive responses and coordination resulting from intoxication, sedation, neurological diseases, loss of consciousness, physical impairment or physical restraints.

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- Multiple sclerosis, Epilepsy, Forensic Medicine, Accidents

Rapid activation of central serotonergic systems occurs in response to the social stress of aggression in dominant lizards. The most rapid expression of serotonergic activity occurs in nucleus accumbens, hippocampus and brainstem. To compare previously measured responses induced by social stressors with those provoked by physical stress, serotonergic activity was examined following restraint stress (handling) and forced physical exertion. After handling, some male Anolis carolinensis were placed on a race track and either run until there was no movement following 1 min of prodding, or half that time. Controls were killed without treatment. Lizards stressed by handling showed rapid (25 s) increases in serotonergic activity (5-HIAA/5-HT) in striatum, dorsal cortex, locus ceruleus, and nucleus accumbens. Other changes in serotonergic systems caused by stress occurred in raphe and hippocampus. Serotonergic changes induced by handling stress were reversed by exercise (to 50% maximal exertion time) in subiculum, striatum and nucleus accumbens. The serotonergic profile of lizards run until they would no longer respond to prodding (maximal exertion time) was significantly different from that for more acute exertion in hippocampus, subiculum, striatum, medial amygdala, locus ceruleus, area postrema, and raphe. Physical stress (handling) mimicked social stress by producing rapid serotonergic changes in hippocampus, subiculum, nucleus accumbens and locus ceruleus. In contrast, the medial amygdala, which has previously been demonstrated to respond serotonergically to social stress only after a temporal delay, did not show a rapid response to restraint stress.

- by Cliff Summers
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- Nucleus Accumbens, Serotonin, Brain Mapping, Brain

Exposure of pregnant rats to stress results in offspring that exhibit abnormally fearful behavior and have elevated neuroendocrine responses to novelty and aversive stimuli. This study examined the effects of prenatal stress on plasma corticosterone, adrenal weight, defensive withdrawal behavior, and the density of receptors for corticotropin releasing factor (CRF) in the amygdala. Pregnant Sprague-Dawley rats were stressed by daily handling and saline injection (s.c., 0.9%, 0.1 mL) during the last week of gestation. Male offspring were studied at adulthood (60-120 days of age). Adrenal hypertrophy and increased plasma corticosterone were observed in the prenatally stressed offspring. Defensive withdrawal, an ethological measure of the conflict between exploratory behavior and retreat, was quantified in naive offspring, and in offspring exposed to restraint stress (2 h). Restraint stress increased defensive withdrawal in both control and prenatally stressed offspring. Both naive and restraint-stressed prenatally stressed offspring exhibited increased defensive withdrawal compared to control offspring. There was a significant interaction between prenatal stress and restraint stress, suggesting increased vulnerability of prenatally stressed offspring. The effects of restraint in the defensive withdrawal test were reduced by intracerebroventricular administration of the CRF antagonists, ␣-helical CRF9-41 (20 g every hour) or D-phe 12 , Nle 21,38 , C ␣-MeLeu 37 ]-CRF (12-41) (5 g every hour) during the restraint period. The difference between control and prenatally stressed offspring was abolished by the CRF antagonists, suggesting that increased activation of CRF receptors may be a factor in the behavioral abnormalities of prenatally stressed rats. Measurement of CRF receptors in amygdala revealed a 2.5-fold increase in binding in prenatally stressed offspring. In light of previous work from this laboratory demonstrating increased content and release of CRF in amygdala from prenatally stressed offspring, the present study suggests that the increased fearfulness of prenatally stressed rats may be a consequence of increased activity of CRFergic systems in the amygdala.

- by A. Salm
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- Behavior, Corticotropin Releasing Hormone, Biological Sciences, Pregnancy
- by Anne Matthews
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- Nursing, Violence, Focus Groups, Qualitative Research
- by Mary Happ
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- Philosophy, Ethics, Medical Law, Philosophy of Medicine

Background/purpose: Persistent inflammatory response secondary to congenital or acquired biliary choleastasis plays an important role in the pathophysiology of hepatic tissue damage. The polyunsaturated fatty acids (PUFA) have been shown to suppress the inflammatory reactions in vivo and in vitro. PUFA has been shown also to protect againts various types of experimental liver damage in animal models and isolated hepatocytes.

- by Nurzen Sezgin
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- Pediatrics, Stress, Medicine, Prevention

OBJECTIVES: To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints. DESIGN: Cluster-randomized controlled trial with nursing units as the basis for randomization. SETTING: Forty group dwelling units for people with dementia. PARTICIPANTS: At baseline, there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group. At the 6-month follow-up, there were 156 staff and 185 residents (36 newly admitted) in the intervention group and 133 staff and 165 residents (26 newly admitted) in the control group. INTERVENTION: A 6-month education program for all nursing staff. MEASUREMENTS: Staff knowledge and attitudes and physical restraint use were measured before and after the education program. RESULTS: In the intervention group, staff knowledge about and attitudes toward restraint use changed, and the overall use of physical restraints decreased. A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline, whereas it was significantly lower in the intervention group at follow-up. Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group. There was no significant change in the number of falls or use of psychoactive medication.

- by Yngve Gustafson
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- Physical Restraint, Health Personnel

acute and residential care settings Objectives. The objective of this review was to investigate physical restraint minimization in acute and residential care settings. The first aim was to determine the effectiveness of attempts to minimize the use of physical restraint, and the second was to generate a description of the characteristics of restraint minimization programmes. Method. A comprehensive search was undertaken involving all major databases and the reference lists of all relevant papers. To be included in the review studies had to be an evaluation of restraint minimization in an acute or residential care setting. As only a single randomized controlled trial (RCT) was identified, it was not possible statistically to pool the findings of different studies on the effectiveness of restraint minimization. To generate a description of the characteristics of restraint minimization programmes, the reported components of these programmes were identified and categorized. Results. A total of 16 studies evaluating restraint minimization were identified: three in acute care and 13 in residential care. Of these, only one was an RCT, with the most common approach being the before and after study design. Based on the findings of the single RCT, education supported by expert consultation effectively reduced the use of restraint in residential care. There has been little evaluation of restraint minimization in acute care settings. The common approach to restraint minimization has involved a programme of multiple activities, with restraint education being the characteristic common to most programmes. Discussion. Evidence suggests that physical restraint can be safely reduced in residential care settings through a combination of education and expert clinical consultation. There is little information on restraint minimization in acute care settings. The major finding of this review is the need for further investigation into all aspects of restraint minimization.

- by Leonnie Lambert
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- Program Evaluation, Nursing, Health Services Research, Critical Care

Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction/prevention strategies have been identified, implemented, and reported. Both states and residential providers have implemented prevention approaches, made significant changes, reduced restraint/seclusion use, and offered their experience and positive outcomes.

- by kevin Huckshorn
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- Law, Child Welfare, Public Health, Adolescent

In monkey neuroimaging, head restraint is currently achieved via surgical implants. Eradicating such invasive head restraint from otherwise non-invasive monkey studies could represent a substantial progress in terms of Reduction and Refinement. Two non-invasive helmet-based methods are available but they are used exclusively by the pioneering research groups who designed them. In the absence of independent replication, they have had little impact in replacing the surgical implants. Here, we built a modified version of the helmet system proposed by Srihasam et al. (2010 NeuroImage, 51(1), 267-73) and tested it for resting state fMRI in awake monkeys. Extremely vulnerable to motion artifacts, resting state fMRI represents a decisive test for non-invasive head restraint systems. We compared two monkeys restrained with the helmet to one monkey with a surgically implanted head post using both a seed-based approach and an independent component analysis. Technically, the helmet system proved relatively easy to develop. Scientifically, although it allowed more extensive movements than the head post system, the helmet proved viable for resting state fMRI, in particular when combined with the independent component analysis that deals more effectively with movement-related noise than the seed-based approach. We also discuss the pros and cons of such device in light of the European Union new 2013 regulation on non-human primate research and its firm Reduction and Refinement requests.

- by Gislène Gardechaux and +2
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- Magnetic Resonance Imaging, Brain, Neuroimage, Wakefulness

After repeated stressful experiences, DBA/2 (DBA) mice showed an increase in apomorphine-induced climbing while C57BL/6 (C57) mice showed a clear-cut decrease of this behavior. Genetic analysis involving F1 and F2 hybrids and the backcross populations (F1 X C57; F1 X DBA) indicated complete dominance of the C57 genotype and a significant genotype X environment interaction. These findings are discussed in terms of dopaminergic plasticity and of the heuristic value of this animal model in relation to disturbed behaviors triggered by stressful experiences.

- by Alberto Oliverio
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- Animal Behavior, Dopamine, Mice, Neuronal Plasticity

Systemic administration of cannabidiol (CBD), a non-psychotomimetic compound from Cannabis sativa, attenuates the cardiovascular and behavioral responses to restraint stress. Although the brain structures related to CBD effects are not entirely known, they could involve brainstem structures responsible for cardiovascular control. Therefore, to investigate this possibility the present study verified the effects of CBD (15, 30 and 60 nmol) injected into the cisterna magna on the autonomic and behavioral changes induced by acute restraint stress. During exposure to restraint stress (1 h) there was a significant increase in mean arterial pressure (MAP) and heart rate (HR). Also, 24 h later the animals showed a decreased percentage of entries onto the open arms of the elevated plus-maze. These effects were attenuated by CBD (30 nmol). The drug had no effect on MAP and HR baseline values. These results indicate that intracisternal administration of CBD can attenuate autonomic responses to stress. However, since CBD decreased the anxiogenic consequences of restraint stress, it is possible that the drug is also acting on forebrain structures.

- by Francisco S Guimarães
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- Pharmacology, Animal Behavior, HR, Anxiety

Motor vehicle crashes are the leading cause of death in the United States for people ages 3-33, and rollover crashes have a higher fatality rate than any other crash mode. At the request and under the sponsorship of Ford Motor Company, Autoliv conducted a series of dynamic rollover tests on Ford Explorer sport utility vehicles (SUV) during 1998 and 1999. Data from those tests were made available to the public and were analyzed in this study to investigate the magnitude of and the temporal relationship between roof deformation, lap-shoulder seat belt loads, and restrained anthropometric test dummy (ATD) neck loads. During each of the three FMVSS 208 dolly rollover tests of Ford Explorer SUVs, the far-side, passenger ATDs exhibited peak neck compression and flexion loads, which indicated a probable spinal column injury in all three tests. In those same tests, the nearside , driver ATD neck loads never predicted a potential injury. In all three tests, objective roof/ pillar deformation occurred prior to the occurrence of peak neck loads (F z , M y) for far-side, passenger ATDs, and peak neck loads were predictive of probable spinal column injury. The production lap and shoulder seat belts in the SUVs, which restrained both driver and passenger ATDs, consistently allowed ATD head contact with the roof while the roof was contacting the ground during this 1000 ms test series. Local peak neck forces and moments were noted each time the far-side, passenger ATD head contacted (''dived into'') the roof while the roof was in contact with the ground; however, the magnitude of these local peaks was only 2-13% of peak neck loads in all three tests. ''Diving-type'' neck loads were not predictive of injury for either driver or passenger ATD in any of the three tests.

- by JOHN COCHRAN
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- Engineering, Automobiles, United States, Rotation

Aims and objectives. The aim of the study was to map nursing staff's individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland.

- by Arja Isola
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- Psychology, Nursing, Finland, Older people

BACKGROUND AND SIGNIFICANCE Falls are among the most common and serious problems facing elderly persons. Falling is associated with considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. 1–5 Falls generally result from an interaction of multiple and diverse risk factors and situations, many of which can be corrected. This interaction is modified by age, disease, and the presence of hazards in the environment. 6 Frequently, older people are not aware of their risks of falling, and neither recognize risk factors nor report these issues to their physicians. Consequently opportunities for prevention of falling are often overlooked with risks becoming evident only after injury and disability have already occurred. 7–9 Both the incidence of falls and the severity of fallrelated complications rise steadily after age 60. In the age 65-and-over population as a whole, approximately 35% to 40% of community-dwelling, generally healthy older persons fall a...

- by Teresita Hogan
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- Algorithms, Geriatrics, Evidence Based Medicine, Risk assessment

Dental schools are increasingly incorporating behavioral management strategies into the curriculum; however, little is known about the efficacy of this instruction. The purposes of this study were to evaluate student exposure to several categories of behavioral management techniques, assess student opportunity to observe faculty use of these techniques, and determine the extent of students' personal use of various behavioral management techniques. Third-year dental students (n=98, X age=26.52; s=4.05) were administered a survey assessing their exposure to and willingness to use behavioral management strategies. Results indicated differences between the techniques students recalled being taught and what they indicated they plan to use in their own future clinical practices. Student technique endorsement also varied as a function of student age, gender, ethnicity, and patient age. Despite increasing concerns regarding the use of these techniques, a significant minority of students...

- by Torrey Creed
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- Dentistry, Behavioral Sciences, Adolescent, Dental Education

Background-Small lesions to rostral versus caudal portions of the hand representation in the primary motor cortex (M1) produce different behavioral deficits. The goal of the present study was to determine if rehabilitative training has similar effects on functional topography of the spared M1 after rostral versus previously reported caudal M1 lesions.

- by Numa Dancause and +1
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- Cognitive Science, Brain Mapping, Neural Repair, Motor Cortex

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk-arm kinematics in stroke patients with neglect... more

- by Keh-Chung Lin
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- Treatment Outcome, Activities of Daily Living, Stroke, Movement

In this study we tested the hypothesis that St John's wort (Hypericum perforatum) may counteract stress-induced memory impairment. Object recognition test and Morris water maze were used to determine whether administration of H. perforatum (350 mg kg −1 for 21 days), standardized to 0.3% hypericin content, protects against non-spatial and/or spatial memory impairments due to chronic restraint stress (2 h daily for 21 days). A group of rats administered the exogenous corticosterone at the dose of 5 mg kg −1 daily for 21 days, yielding its similar plasma levels as these observed in stress was run in parallel. In the first experiment all rats were tested for recognition memory in the object recognition test. On the following day, the animals were tested in open field and elevated "plus" maze to control for the contribution of respectively, motor and emotional effects of our treatments to the memory tests. In the second experiment, new group of stressed animals was tested for spatial memory in the water maze. We observed that H. perforatum prevented the deleterious effects of both chronic restraint stress and long-term corticosterone on learning and memory as measured in both, the object recognition and the water maze tests. The herb not only prevented stress-and corticosterone-induced memory impairments, but it significantly improved recognition memory (p < 0.01) in comparison to control. These results suggest that H. perforatum has a potential to prevent stress memory disorders.

- by Emil Trofimiuk
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- Spatial Memory, Stress, Recognition memory, Object Recognition

b a ( h o n s ) d i p s w c q s w c e r t s w e d c e r t m t d , B . P A T E R S O N 3 b a m e d p h d r m n r n l d , G . Y O R S T O N 4 m b b s m s c m r c p s y c h , Physical intervention: a review of the literature on its use,... more

b a ( h o n s ) d i p s w c q s w c e r t s w e d c e r t m t d , B . P A T E R S O N 3 b a m e d p h d r m n r n l d , G . Y O R S T O N 4 m b b s m s c m r c p s y c h , Physical intervention: a review of the literature on its use, staff and patient views, and the impact of training

- by Brendon Stubbs
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- Violence, Organizational Culture, Occupational Health, Evidence Based Practice

Treatment interference, also known as therapy disruption, device disruption, or self extubation, is a common and especially difficult clinical problem in critical care. This paper presents creative and practical clinical innovations and relevant research findings as a “best practice approach” to prevent treatment interference in critical care settings. Key principles are presented to guide patient assessment and selection of nursing strategies. Nursing assessment parameters are described and a wide range of nonrestraint strategies are discussed.

- by Mary Happ
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- Nursing, Critical Care, Best practice, Patient Compliance
- by Torunn Askim
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- Cognitive Science, Pediatrics, Occupational Therapy, Traumatic Brain Injury

The aims of this study are to quantify the movement limitation of upper limbs in hemiplegic children with traumatic brain injury (TBI) by using a clinical-functional scale and upper limb kinematics and to evaluate the effectiveness of constraint-induced movement therapy (CIMT) on upper limbs. Design: Pre-post study. Setting: Clinical rehabilitation research laboratory. Participants: Ten children with TBI. Main Outcome Measures: The participants were evaluated by clinical examinations (Gross Motor Function Measure, Besta scale, Quality of Upper Extremities Skills Test, and Manual Ability Classification System) and 3D kinematic movement analysis of the upper limb before the CIMT program (pretest: 0.7 years after the injury) and at the end of the program (posttest: 10 weeks later). Results: After the CIMT, most of the clinical measures improved significantly. Some significant improvements were present in terms of kinematics, in particular, in the movement duration and the velocity of movement execution of both tasks; the index of curvature and the average jerk improved, respectively, during reaching and hand-to-mouth task, while the adjusting sway parameter decreased during the 2 movements. Significant improvements were found in upper limb joint excursion after the rehabilitative programme too. Conclusions: Our results suggest that the CIMT program can improve movement efficiency and upper limb function in children after TBI. The integration of the clinical outcomes and upper limb kinematics revealed to be crucial in detecting the effects of the CIMT programme.

- by Jyrki Korkeila
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- Law, Violence, Motivation, Finland

Procedures in the commercial production of animals involve stressful situations which lessen the animal's welfare. This study on Japanese quail evaluated whether an environmental enrichment manipulation can affect avian immune responses and if combined with a chronic stressor exposure can help to counteract the negative effects of stress on the immune system. Potential gender effects were also considered. After hatch, half of the birds were housed in non-enriched boxes and half were housed in environmentally enriched boxes. From day 33 to 42 of age, all birds within half of the non-enriched and enriched boxes remained undisturbed while the other half were daily exposed to a 15 min restraint stressor (chronic stressor). The inflammatory response (lymphoproliferation after phytohemagglutinin-p), percentage of lymphocytes, heterophil/lymphocyte (H/L) ratio and primary antibody response against sheep red blood cells were assessed. The chronic stressor application and the enrichment ...

- by Raul Marin
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- Biology, Stress, Medicine, Animal Husbandry

2 0 0 6 ) Journal of Clinical Nursing 15, 581-587 Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting? Background. The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls, decreased mobility and disorientation. By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk, nurses may be less inclined to resort to physical restraints, thereby improving clinical outcomes. Aims and objectives. To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards. Design. Randomized controlled trial. Methods. Consecutively, patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong, and who were perceived by nurses to be at risk of falls were randomly assigned to intervention and control groups. For the intervention group subjects, nurses were given access to bedchair pressure sensors. These sensors were not available to control group subjects, as in usual practice. The trial continued until discharge. The primary outcomes were the proportion of subjects restrained by trunk restraint, bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied. The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell. Results. One hundred and eighty subjects were randomized. Fifty (55AE6%) out of the 90 intervention group subjects received the intervention. There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints. There was also no group difference in the chance of improving in mobility and transfer ability, and of having a fall. Ó 2006 Blackwell Publishing Ltd 581

- by Eric Tam and +1
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- Psychology, Nursing, Risk assessment, Hong Kong

Aspects of the treatment and management of challenging behaviour were investigated among 500 adults with intellectual disabilities receiving various forms of residential supports. The present results indicated that: (1) 53% of participants were reported to have shown at least onè moderately serious' or`severe' form of challenging behaviour in the previous month; (2) the most commonly employed management strategies were physical restraint (used with 44% of people showing challenging behaviour), sedation (35%), seclusion (20%) and mechanical restraint (3%); (3) the most commonly employed`treatment strategies' were goal setting within individual programme plans (used with 62% of people showing challenging behaviour), antipsychotic medication (49%), written intervention programmes (23%) and written behaviourally orientated intervention programmes (15%); and (4) factors identi®ed through logistic regression analyses to be associated with the use of speci®c treatment and management strategies included personal characteristics of the person with intellectual disabilities (e.g. age and diagnosis of autism), resources (e.g. type of accommodation, cost of provision and staf®ng levels), the organization of resources (e.g, planning of support to residents) and the nature of the challenging behaviour (e.g. more sustained episodes of challenging behaviour).

- by Sophia Kessissoglou
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- Psychology, Cognitive Science, Education, Social Work

A 36-year-old man with comorbid panic disorder with agoraphobia, major depression, and histrionic personality disorder since age 21 was resistant to combined drug and psychotherapy treatment. His conditions had progressively worsened with time, causing him to withdraw socially and to simultaneously require continuous physical restraint, which further worsened his functioning. He spent almost 3 consecutive years in restraint, until he consented to receive bilateral ECT treatment. He improved after 13 sessions in all areas (social and role functioning, and panic, depressive, and histrionic symptoms) and is well 3 months later with a lithium-atypical antipsychotic combination.

- by Gloria Angeletti and +2
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- Agoraphobia, Social behavior, Electroconvulsive therapy, Major Depressive Disorder

The purpose of this investigation was to identify the critical tasks encountered by correctional officers (COs) on the job and to conduct a comprehensive assessment and characterization of the physical demands of these tasks. These are the first steps in developing a fitness screening test for COs in compliance with recent legislation. The most important, physically demanding, and frequently occurring tasks were identified using Delphi methodology, focus groups, and questionnaire responses from 190 experienced front-line COs. These tasks were structured into emergency response scenarios for which a physical and physiological characterization was conducted to verify their relative physical demands analysis. Oxygen consumption and the forces exerted by COs were quantified while they were responding and then controlling and restraining inmates. The female COs used less force than the male COs did to control and restrain the same inmates (body control = 46 vs. 60 kg, wrist hold = 32 vs. 49 kg, and arm retraction = 37 vs. 47 kg) and did not exert their maximal strength during their control and restraint activities. The mean oxygen consumption of the female and male COs while performing the on-the-job tasks was similar (39.5 vs. 38.5 mLÁkg -1 Ámin -1 ). We concluded that the essential components of a fitness screening protocol for CO applicants are cell search, expeditious response, body control, arm restraint, inmate relocation, and an assessment of aerobic fitness. The criterion performance standards for completing these tasks in a circuit were set at the job performance level of safe and efficient female COs.

- by Norman Gledhill and +1
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- Focus Groups, Biological Sciences, Prisons, Canada

Physical restraint use among hospitalized older adults remains an important issue. Despite evidence indicating that restraints can be harmful and strict regulatory rules restricting the use of restraints, healthcare practitioners continue to utilize physical restraints, often in the name of safety. The purpose of this study was to examine the perceptions regarding physical restraint use among registered nurses (RNs) and nursing assistants (NAs). The Perceptions of Restraint Use Questionnaire (PRUQ) was used to evaluate nursing staff perceptions. The overall mean score for the PRUQ was 2.8 out of a possible 5, indicating a neutral perception. Both RNs and NAs identified treatment interference as the most important reason for restraining a patient and substituting of restraints for staff as the least important reason. This study revealed an overall less favorable perception of restraints than previous studies. NAs favored physical restraint for fall prevention more than RNs. It was also noted that protection from physical abuse and patient combativeness was the most salient reason cited by the emergency department staff. (Geriatr Nurs 2011;32:39-45)

- by Joyce Fitzpatrick
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- Nursing, Perception, Geriatric Nursing, Registered Nurse

The purpose of this article was to describe a child-friendly modified constraint-induced movement therapy protocol that is combined with goal-directed task-specific bimanual training (mCIMT-BiT). This detailed description elucidates the approach and supports various research reports. This protocol is used in a Pirate play group setting and aims to extend bimanual skills in play and self-care activities for children with cerebral palsy and unilateral spastic paresis of the upper limb. To illustrate the content and course of treatment and its effect, a case report of a two-year-old boy is presented. After the eight-week mCIMT-BiT intervention, the child improved the capacity of his affected arm and hand in both quantitative and qualitative terms and his bimanual performance in daily life as assessed by the Assisting Hand Assessment, ABILHAND-Kids, Video Observations Aarts and Aarts Module Determine Developmental Disregard, Canadian Occupational Performance Measure and Goal Attainment Scaling. It is argued that improvement of affected upper-limb capacity in a test situation may be achieved and retained relatively easily, but it may take a lot more training to stabilize the results and automate motor control of the upper limb. Future studies with groups of children should elaborate on these intensity and generalization issues.

- by Jan van der Burg and +1
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- Occupational Therapy, Cerebral Palsy, Clinical Sciences, Occupational

The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. (Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.)

- by Kevin Huckshorn
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- Psychology, Mental Health, Mental Health Policy, Health Policy

OBJECTIVES: To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes. DESIGN: A quasi-experimental longitudinal design. Study duration was 8 months. SETTING: Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups. PARTICIPANTS: Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents. INTERVENTION: The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions. MEASUREMENTS: The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period.

- by Elizabeth Capezuti
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- Nursing Homes, Confidence intervals, Follow-up studies, Time Factors
- by Gerald Maccioli
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- Nursing, Patient Safety, Evidence Based Medicine, Treatment

Chronic or repeated stress during human fetal brain development has been associated with various learning, behavioral, and/or mood disorders, including depression in later life. The mechanisms accounting for these effects of prenatal stress are not fully understood. The aim of this study was to investigate the effects of prenatal stress on early postnatal brain development, a disturbance of which may contribute to this increased vulnerability to psychopathology. We studied the effects of prenatal stress on fetal growth, stress-induced corticosterone secretion, brain cell proliferation, caspase-3-like activity and brain-derived neurotrophic factor protein content in newborn Fischer 344 rats. In addition to a slight reduction in birth weight, prenatal stress was associated with elevated corticosterone levels (33.8%) after 1 h of maternal deprivation on postnatal day 1, whereas by postnatal day 8 this pattern was reversed (؊46.5%). Further, prenatal stress resulted in an approximately 50% decrease in brain cell proliferation just after birth in both genders with a concomitant increase in caspase-3-like activity within the hippocampus at postnatal day 1 (36.1%) and at postnatal day 5 (females only; 20.1%). Finally, brainderived neurotrophic factor protein content was reduced in both the olfactory bulbs (؊24.6%) and hippocampus (؊28.2%) of prenatally stressed male offspring at postnatal days 1 and 5, respectively. These detrimental central changes observed may partly explain the increased susceptibility of prenatally stressed subjects to mood disorders including depression in later life.

- by Wilma Van De Berg
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- Neuroscience, Medicine, Brain development, Fetal development
- by Wendy Moyle
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- Nursing, Long Term Care, Dementia, Risk assessment
- by M. Wampers and +1
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- Schizophrenia, Clinical Practice, Clinical, cerebral Venous sinus thrombosis

Medical records of five dogs and two cats with bite wounds to the spine were reviewed. All dogs were bitten in the cervical spine and presented as quadriparetic. Both cats were bitten at the lumbar spine; one was paraparetic and the other paraplegic. Concomitant injuries to structures other than the spine were seen in two cases. Radiographic findings included vertebral fractures in all cases. Medical therapy included antibiotics (7/7), methylprednisolone sodium succinate (4/7) and analgesia (7/7). Five cases underwent minor (4/5) or extensive (1/5) surgical debridement. All cervical fractures were stabilized with fiberglass casts and animals with lumbar injury were cage rested for a month. Six of the cases survived, five of which regained good to excellent ambulatory ability within the first month. Although, the numbers of reported cases are limited, this study shows that adequate surgical debridement and wound drainage combined with external coaptation can be sufficient to manage bite wounds that involve the spine.

- by Orit Chai
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- Spine, Treatment Outcome, Veterinary, Cats

Objective The aim of this study was to identify quantitative data on the use of seclusion and restraint in different countries and on initiatives to reduce these interventions. Methods Combined literature review on initiatives to reduce seclusion and restraint, and epidemiological data on the frequency and means of use in the 21st century in different countries. Unpublished study was detected by contacting authors of conference presentations. Minimum requirements for the inclusion of data were reporting the incidence of coercive measures in complete hospital populations for defined periods and related to defined catchment areas. Results There are initiatives to gather data and to develop new clinical practice in several countries. However, data on the use of seclusion and restraint are scarcely available so far. Data fulfilling the inclusion criteria could be detected from 12 different countries, covering single or multiple hospitals in most counties and complete national figures for two countries (Norway, Finland). Both mechanical restraint and seclusion are forbidden in some countries for ethical reasons. Available data suggest that there are huge differences in the percentage of patients subject to and the duration of coercive interventions between countries. Conclusions Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.

- by Trond Hatling and +1
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- Psychology, Cognitive Science, Prejudice, Literature Review

Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings.

- by Candice Oster
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- Psychology, Nursing, Mental Health nursing, Aggression

The present study investigates the effect of Ocimum sanctum seed oil (OSSO) on some immunological parameters in both non-stressed and stressed animals. An attempt has also been made to explore the possible mechanism of immunomodulatory activity. OSSO (3 ml/kg, ip) produced a significant increase in anti-sheep red blood cells (SRBC) antibody titre and a decrease in percentage histamine release from peritoneal mast cells of sensitized rats (humoral immune responses), and decrease in footpad thickness and percentage leucocyte migration inhibition (LMI) (cell-mediated immune responses). Restraint stress (RS) produced a significant reduction in the anti-SRBC antibody titre, foot pad thickness and percentage LMI (% LMI). The effects of RS on humoral as well as cell-mediated immune responses were effectively attenuated by pretreating the animals with OSSO. Co-administration of diazepam (1 mg/kg, sc), a benzodiazepine (BZD), with OSSO (1 ml/kg, ip) enhanced the effect of OSSO on RS-induced changes in both humoral and cell-mediated immune responses. Further, flumazenil (5 mg/kg, ip), a central BZD receptor antagonist inhibited the immunomodulatory action of OSSO on RS-induced immune responsiveness. Thus, OSSO appears to modulate both humoral and cell-mediated immune responsiveness and these immunomodulatory effects may be mediated by GABAergic pathways.

Restraint and seclusion (R&S) are high risk, emergency procedures that are used in response to perceived violent, dangerous situations. They have been employed for years in a variety of settings that serve children, such as psychiatric hospitals and residential treatment facilities, but are now being recognized as used in the public schools. The field of education has begun to examine these practices in response to national scrutiny and a Congressional investigation. The fields of mental health and child welfare were similarly scrutinized 10 years ago following national media attention and have advanced R&S practice through the adoption of a prevention framework and core strategies to prevent and reduce use. A review of the evolution of the national R&S movement, the adverse effects of these procedures, and a comprehensive approach to prevent their use with specific core strategies such as leadership, workforce development, and youth and family involvement in order to facilitate organizational culture and practice change are discussed. Proposed guidelines for R&S use in schools and systemic recommendations to promote R&S practice alignment between the child-serving service sectors are also offered.

- by Wanda Mohr and +1
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- Psychology, Organizational Culture, Schools, United States

Background: Working with surveillance technology as an alternative to traditional restraints creates obvious differences in the way care is organised. It is not clear whether professional caregivers find working with surveillance... more

- by Alistair Niemeijer
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- Nursing, Dementia, Focus Groups, Nursing Homes

Ms. Sarah Dye, a 92-year-old woman with moderate cognitive impairment and multiple chronic illnesses, resides in a nursing home. This morning, as is routine, Ms. Day was awakened early, changed and fed breakfast, bathed, dressed, placed in a wheel chair, secured with a vest restraint and wheeled to the common lounge. She was not alone: of the 30 residents present, 12 others were also tied to their chairs.

- by Lois Evans
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- Nursing, Nursing Research, Geriatric Nursing, Aged

Delivering good care for the elderly with cognitive issues in a large rapidly turning over acute hospital setting is often challenging at
all levels. The elderly patients have multiple medical comorbidities, on multiple medications and often display challenging behaviors
which are not easy to manage, unless the care staffs have received training in Gerontology. The onset of challenging behaviors may
be the harbinger for something more urgent, and time and care should be promptly instituted, instead of managing the behavior
with sedatives or restraints. Diagnosis of delirium is often missed since the symptoms are vague and fluctuate throughout the day.
Nurses are perhaps the best partners for the doctors in screening and diagnosing delirium early.

- by iris publishers
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- Delirium ICU, Acute Care Hospitals, Physical Restraint

CITATIONS 34 READS 880 7 authors, including:

- by Raija Kontio
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- Nursing, Psychiatry, Finland, Social Isolation