Dissociative symptoms have been related to higher rapid eye movement sleep density, a sleep phase during which hyperassociativity may occur. This may enhance artistic creativity during the day. To test this hypothesis, we conducted a creative photo contest to explore the relation between dissociation, sleep, and creativity. During the contest, participants (N = 72) took one photo per day for five consecutive days, based on specific daily themes (consisting of single words) and the instruction to take as creative a photo (...) as possible each day. Furthermore, they completed daily measures of state dissociation and a short sleep diary. The photos and their captions were ranked by two professional photographers and two clinical psychologists based on creativity, originality, bizarreness, and quality. We expected that dissociative people would rank higher in the contest compared with low-dissociative participants, and that the most original photos would be taken on days when the participants scored highest on acute dissociation. We found that acute dissociation predicted a higher ranking on creativity. Poorer sleep quality and fewer hours of sleep predicted more bizarreness in the photos and captions. None of the trait measures could predict creativity. In sum, acute dissociation related to enhanced creativity. These findings contribute to our understanding of dissociative symptomatology. (shrink)

Dissociative symptoms are notorious for their enigmatic, disparate nature encompassing excessive daydreaming, memory problems, absentmindedness, and impairments and discontinuities in perceptions of the self, identity, and the environment. Recent studies (e.g., Koffel & Watson, 2009) have linked dissociative symptoms to vivid dreaming, nightmares, and objective sleep parameters (e.g., lengthening of REM sleep) for discussion, see (Van der Kloet et al., 2013). Germane to this link between dissociative symptomology and sleep, is the idea that in dissociative individuals, the waking state (...) as compared to REM sleep may be marked by an increase in “fluid” and hyperassociative thinking. Against this background, we invited contributions in the following areas: 1) a progressive and enduring de-differentation of wake and dream states of consciousness eventually results in schizophrenia (Llewellyn, 2011); a lesser degree of de-differentiation may have implications for dissociative symptoms; 2) sleep disturbances are not only linked to dissociation but to memory fragmentation also, further fuelling both dissociation and other manifestations of psychopathology; 3) sleep, memory and psychopathologies have complex interlinkages. Our summary below, relates the contributions to our topic to these areas. The contributing articles also give a comprehensive overview on current directions and challenges in these research fields.First, Soffer-Dudek elucidates why heightened sleep experiences (vivid dreams, nightmares, hypnagogic hallucinations) might be particularly associated with psychopathology. She explains how various psychopathologies may represent de-differentiation of the waking and dreaming states through intrusions of wake-like consciousness into sleep and dream-like cognition into wake. With regard to de-differentiation, she discusses theories of transliminality (‘thin boundaries between consciousness states’) and dissociation as potential mechanisms. Lucid dreaming is a hybrid state where wake-like cognition suffuses REM sleep/dreaming (Voss et al. 2009). Mota and colleagues compared the spontaneous occurrence of lucid dreaming in patients with psychotic symptoms (25 with schizophrenia and 20 with bipolar disorder) and 28 non-psychotic subjects. They found lucid dreaming was associated with psychosis- giving some support to the hypothesis of a link between state de-differentiation and psychopathology. In a methodological note, Ribeiro et al, having studied the prevalence of lucid dreaming using two questionnaires, show that the type of methodology used in lucid dreaming studies may have an effect upon their findings. Poerio et al state that both research and theory points to dissociation being engendered by the intrusion of dream-like mentation into waking consciousness. To extend this idea they examine the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). They show the occurrence and content of daydreams may act as potentiating states for heightened, in the moment, dissociation. Sleep paralysis is a dissociated state where a heightened level of wake-like alertness coexists with muscle atonia. Rodrigez de Sa and Mota-Rolim take a broad interdisciplinary perspective on sleep paralysis through reviewing its occurrence in Brazilian folklore by exploring the “Pisadeira” with a sleep science approach and link this with the field of history and art.There is now substantial evidence that active memory processing continues during sleep (see, for example, Rasch and Born (2013)) and dreaming may be involved (Llewellyn, 2013). De-differentiation of the wake, sleep and dream states would disrupt this memory processing fuelling dissociation and other psychopathologies. Horton presents an overview of discontinuity of consciousness in both wake and sleep, focusing on the processes of sleep-dependent memory consolidation and fragmentation. Nakagawa et al focus specifically on working memory and the relation with sleep. With their article, they are the first to investigate differences between verbal working memory (VWM) and visuospatial working memory (VSWM) related to daytime nap duration, nap frequency, and dream content recall frequency (DCRF). They discuss sex-related differences in the effects of sleep habits on VMW and VSWM and ascribe this to differences in underlying neural correlates, and effectiveness of sleep habits in males and females. Rosales-Lagarde and colleagues related to emotional memory by designing an extended International Affective Picture System (IAPS) instrument to measure bizarreness and show some interesting age and gender disparities. Finally, several authors took a developmental approach through focusing on sleep, memory and psychopathology in adolescents. Wang and colleagues show the relation between children and adolescents’ mental health and sleep problems in a 10-year longitudinal trial, and find anxiety, depression, attention problems and aggressive behaviour during childhood to be important predictors for later sleep problems. Importantly, sleep problems are also predictive of behavioural difficulties later in life. Nader, Murkar, and Smith investigated changes in sleep in adolescents between 12 and 19 years old following procedural task training and found that contrary to earlier work, there were no changes in sleep spindle density. Interestingly, participants who successfully learned the task showed no changes in their sleep stage proportions, but participants who were not successful showed a decrease in the proportion of Stage 2 and increases in both SWS and REM sleep, which is in line with the two stage model of sleep and memory by Smith et al. (2004).The self and the world during dreaming differ. The perceived world during waking depends on making sense of external sensory input, which engenders a strong sense of external reality in which the ‘self and its inner-world’ exists. Self-organizing during waking and dreaming enables integration of the self and the world in both states. It is noteworthy, that within this research topic so many novel themes have emerged and new questions and speculations have been posed with regards to relations among unusual sleep experiences – specifically lucid dreaming -, dissociation, psychosis, and memory. It brings together a richness of research by combining fields that originally have worked in isolation from each other. (shrink)

Failings of a categorical systemFor decades, standardized classification systems have attempted to define psychiatric disorders in our mental health care system, with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association (APA), 2013) and International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10; World Health Organization, 2010) being internationally best-known. One of the major advantages of the DSM must be that it has seriously diminished the international linguistic confusion regarding psychiatric disorders. Since (...) its introduction, it contributed extensively towards one common international language for defining and conceptualizing psychiatric disorders. Strikingly, within the field of psychological testing a similar step forward seems to have not yet been taken. At present, there exists no international standard for the use of psychological tests that takes the definition of a specific symptom as listed in DSM-5 as its starting point, and reliably and validly measures this symptom. Rather, the majority of tests are measuring constructs consisting of a multitude of symptoms. For example, the Beck’s Depression Inventory (Beck et al., 1996) measures core symptoms of depression summing up to a depression score. Accordingly, we believe it is time for a change. The diagnostics of psychiatric disorders, where disorders are defined as nosological units with a single cause, a single organic substrate, and a single time course, has been problematic for centuries. The field of psychiatry has always been ambivalent about its desire to follow a medical model (Blaney, 2015), but afflicted due to its definitions of pathology. The definition of a psychiatric disorder in DSM-5 offers little room for a clear cut pathogenesis and harsh demarcation of syndromes. This is reflected in the DSM-5, where it states: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p.20). An unfortunate and recognized consequence of this definition within the current system is that many symptoms overlap within categories of psychiatric disorders and patients end up diagnosed with many co-morbid disorders.Two fundamental problemsRegardless of new attempts to improve the diagnostics of psychiatric disorders, the DSM-5 represents the status quo. Consequently, the distinction between diagnosis and classification remains substantial and more than a discussion on semantics. We identify two fundamental problems within the current framework. Generally, a psychiatric diagnosis is considered to be descriptive (Hengeveld and Schudel, 2003). The clinician will describe a syndrome (its nature, timespan, and severity) within the framework of a disorder, and often include a differential diagnosis, predisposing protective or vulnerability factors, and provoking or maintaining factors. Within the DSM-5 framework, a similar ‘approach to clinical case formulation’ is taken (APA, 2013, p. 19). Evidently, a descriptive diagnosis has a hypothetical character. It consists of the clinician’s hypothesis and is based on his or hers professional considerations according to the abovementioned factors. Once the clinician has formulated a descriptive diagnosis, it is then complementary ‘translated’ into a DSM-5 classification. Herein lies the problem. For the layman, the existence of this distinction between diagnosis and classification is usually unknown. Preceding treatment, the clinician will give the client a classification of the existing psychiatric problems and the client may attribute more meaning to it than appropriate, thereby fostering the risk of reification. Second, the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units – ‘you either have it, or you don’t’. DSM-5 states about this: “(…) scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors (…)”. And “(…) we have come to recognize that the boundaries between disorders are more porous than originally perceived.” (APA, 2013, p. 6). This leads to a fundamental problem. Because the overwhelming majority of psychiatric disorders examined thus far using taxometric methods appear to be dimensional in nature (Haslam, 2003; Widiger and Samuel, 2005), consequently all of their categorizations become artificial and debatable. Even though DSM-5 took a modest step towards a more dimensional approach, its core remains categorical. To illustrate, consider the Borderline Personality Disorder (BPD). This classification consists of nine diagnostic criteria of which a minimum of five need to be present for the diagnosis of BPD. A simple numerical combination algorithm leads to a staggering number of 256 distinct presentations of BPD (Albion et al., 2013). Due to this chameleon-like nature, the disorder’s diagnostic validity becomes questionable. Strikingly, this number is relatively small when compared to other conditions, e.g., there are 636,120 ways to have posttraumatic stress disorder (Galatzer-Levy and Bryant, 2013).DSM-5 does propose an alternative model for personality disorders based on personality functioning and traits (APA, 2013, p. 761), as a possible answer to the problem that most patients fit with multiple co-morbid personality disorders or to the category of personality disorder not otherwise specified. In November 2012, the chair committee of APA decided to move this alternative model to section III of DSM-5 and to sustain the categorical system in section II. A potential solutionDSM-5 and its predecessors have brought about an invaluable improvement regarding the formulation of a common international language for psychiatric disorders. However, the individual disorders fit poorly with its starting point of discrete units and strict boundaries. Van Os (2014) has argued for a better balance between the categorical and personalized aspects of psychiatric disorders. We argue for a two-step approach.Particularly due to the ‘weak boundaries’ between disorders, it might be beneficial to limit ourselves by merely categorizing clients into the main categories of the DSM-5 according to their most prominent symptoms (Van Os, 2014), i.e. their main complaint. In other words, clinicians could first ask themselves whether the symptomatology is concerning a neurodevelopmental disorder, or a bipolar and related disorder, or a depressive disorder, and so on. It will drastically reduce the over 400 classifications in DSM-5 down to 20 categories. Van Os (2014) even argues to combine some of the main categories, reducing this number even further to 15 categories. The advantages of reducing the over 400 classifications are fivefold: 1) a syndrome, being an aggregation of symptoms, creates a false relation between symptoms that are that are already heterogeneous themselves; 2) 15 broad categories are functional: it results into a very heterogeneous group of clients within a category and thus prevents stereotypes and invites further personalizing of complaints; and 3) a dimensional measure of a symptom rather than a syndrome will correspond better with the client regardless of it not providing the complete picture. Focusing on the main complaint will indicate where there is an immediate need for care (Van Os, 2014); 4) it will allow clinicians to recognise subthreshold conditions more easily (Magruder and Calderone, 2000); and 5) it might facilitate the development of clear demarcations between normal and abnormal functioning (Kessler, 2002; Widiger and Samuel, 2005). Please, see also Table 1.This also fits well within scientific advances, as thus far strongest evidence has been found for a distinction between internalizing and externalizing disorders, even superseding these 15 main categories (DSM-5; APA, 2013, p.13, but see Weiss et al., 1998). The second step would concern the personalized aspect, which we argue to define on a level of core symptoms of the specific main category, to be agreed upon later. To assess these core symptoms, the field of psychological testing could develop an internationally applicable instrument to reliably and validly measure each (core) symptom on a dimensional scale. Many of these instruments are readily available and have proven its psychometric properties within scientific research. Elements from these instruments could be easily transformed to work within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. Importantly, current psychological testing mainly implies the use of self-report measures. This leads to an abundance of auto-amnestic information. To increase the reliability and validity of psychological tests to assess DSM-5 symptoms, it may be important to add two additional information resources. This would entail psychological tests where a next of kin answers questions about the symptom of the client, and psychological tests that include the clinicians’ judgment, such as structured clinician-based interviews. Conversely, we also need to acknowledge the well-known limitations of clinical judgment (e.g., Faust, 1986; Garb, 1998). Advantages of a new frameworkThe changes we suggest have big implications and are not easily implemented in the current framework. Clients may prefer the comfort of a single clear label, similar to what they are used to in other areas of medicine. Health insurance providers and policy makers may argue for single labels as well. Therefore, it would require a lot of explanation from our clinicians to promote a change. Our suggestions for broader categories may not disambiguate the current situation better than the existing approach, but it will promote personalisation of health care. Difficulties in diagnostic reliability will remain in disorders that fall on the boundaries of the taxons, e.g., schizoaffective disorder versus bipolar disorder with psychotic characteristics, which may benefit from further study. There are also some politically tinged questions to keep in mind: How will we finance our health care, and how will we ensure a gradual transition from the current financing system, including clients who already have their labels? What about visitations from insurers and health inspection? How can they control for a good standard of quality in health care when considering the increasing heterogeneity? Nevertheless, we argue that the benefits outweigh the disadvantages. We will see a shift from a categorical to a personalized approach, which will lead to less (self) stigmatizing, less estrangement, and it will challenge reification thinking. DSM-V states that “a reformulation of research goals should also keep DSM-5 central to the development of dimensional approaches to diagnosis that will likely supplement or supersede current categorical approaches to diagnosis in coming years” (APA, 2013, p. 13). Our proposition for psychological testing on symptom level could contribute to this development. Furthermore, this new approach will do more justice to the heterogeneity of symptoms within and outside of classification categories, see also Table 1. Moreover, in this new approach we join forces of expert knowledge from the fields of psychiatry and psychological science. Finally, it offers new and potentially better opportunities to map health care needs. This in turn will lead to a better interface for allocation of appropriate treatment. It will present a clearer picture of when preventative care is preferred over treatment and vice versa. Importantly, health care needs will be more closely attuned to the ‘own story’ of the client.We argue for the national and international psychological associations in Europe and the United States of America to support the idea of a collective approach to develop an internationally standardized psychological testing battery to reliably assess all the core symptoms of the main categories in DSM-5. (shrink)

Llewellyn has written a fascinating article about rapid eye movement dreams and how they promote the elaborative encoding of recent memories. The main message of her article is that hyperassociative and fluid cognitive processes during REM dreaming facilitate consolidation. We consider one potential implication of this analysis: the possibility that excessive or out-of-phase REM sleep fuels dissociative symptomatology. Further research is warranted to explore the psychopathological ramifications of Llewellyn's theory.

Insight problem solving is thought to underpin creative thought as it incorporates both divergent (generating multiple ideas and solutions) and convergent (arriving at the optimal solution) thinking approaches. The current literature on schizotypy and creativity is mixed and requires clarification. An alternate approach was employed by designing an exploratory web-based study using only correlates of schizotypal traits (paranoia, dissociation, cognitive failures, fantasy proneness, and unusual sleep experiences) and examining which (if any) predicted optimal performance on an insight problem-solving task. One (...) hundred and twenty-one participants were recruited online from the general population and completed the number reduction task. The discovery of the hidden rule (HR) was used as a measure of insight. Multivariate logistic regression analyses highlighted persecutory ideation to best predict the discovery of the HR (OR = 1.05; 95% CI 1.01–1.10, p = 0.017), with a one-point increase in persecutory ideas corresponding to the participant being 5% more likely to discover the HR. This result suggests that persecutory ideation, above other schizotypy correlates, may be involved in insight problem solving. (shrink)

Pierre Maquet1,2,6, Steven Laureys1,2, Philippe Peigneux1,2,3, Sonia Fuchs1, Christophe Petiau1, Christophe Phillips1,6, Joel Aerts1, Guy Del Fiore1, Christian Degueldre1, Thierry Meulemans3, André Luxen1, Georges Franck1,2, Martial Van Der Linden3, Carlyle Smith4 and Axel Cleeremans5.

Fabi and Goldberg have helpfully shed some light on the wrongs perpetuated by the current funding architecture on research, sponsorship, and career development in the field of bioethics. The...

It is often alleged that Cantor’s views about how the set theoretic universe as a whole should be considered are fundamentally unclear. In this article we argue that Cantor’s views on this subject, at least up until around 1896, are relatively clear, coherent, and interesting. We then go on to argue that Cantor’s views about the set theoretic universe as a whole have implications for theology that have hitherto not been sufficiently recognised. However, the theological implications in question, at least (...) as articulated here, would not have satisfied Cantor himself. (shrink)

In cognitive neuroscience, dissociating the brain networks that ing—has thus become one of the best empirical situations subtend conscious and nonconscious memories constitutes a through which to study the mechanisms of implicit learning, very complex issue, both conceptually and methodologically.

Emotional expressions constitute a rich source of information. Integrating theorizing on attribution, appraisal processes, and the use of emotions as social information, we examined how emotional expressions influence attributions of agency and responsibility under conditions of ambiguity. Three vignette studies involving different scenarios indicate that participants used information about others’ emotional expressions to make sense of ambiguous social situations. Expressions of regret fueled inferences that the expresser was responsible for an adverse situation, whereas expressions of anger fueled inferences that someone (...) else was responsible. Also, expressions of anger were interpreted as a sign of injustice, and expressions of disappointment increased prosocial intentions (i.e., to help the expresser). The results show that emotional expressions can help people understand ambiguous social situations by informing attributions that correspond with each emotion’s associated appraisal structures. The findings advance understanding of the ways in which emotional expressions help individuals understand and coordinate social life. (shrink)

The standard process for starting anamnesis in the follow-up cancer consultation is for the doctor to ask a ‘How are you?’ question. This question gives the patient the opportunity to give a gloss of their general condition and offer the first topic of discussion. Findings in earlier analyses of US and UK data in a broad array of medical contexts show that the question is ambiguous and hence patients may interpret it as social rather than medical. A discourse analysis of (...) a corpus of 28 video-taped consultations shows that the ‘How are you?’ question in the context of Dutch follow-up cancer consultations is consistently interpreted by both doctor and patients as a holistic medical question, making relevant a – frequently complex and nuanced – medically oriented response. We suggest that this difference may have to do with the interactional norms of hospital visits in the Netherlands, and with the specific contextual parameters of return visits, more specifically with follow-up cancer consultations, which affect the way the HAY question is placed, intended and understood. (shrink)

Some observers regard South Africa as one of the most violent, lawless and morally depraved societies in the world. Several other countries around the world can be shown to be similarly afflicted. In South Africa's case, this condition might be because of political transformation, particularly the lingering effects of the struggle against past injustices inflicted on sections of the population. The social instability has been exacerbated by an influx of migrants and a resultant increase in diversity. One way of attempting (...) to assuage this situation is to harness the school subject known as 'citizenship education' for guiding the upcoming generations into committing to a new moral compass, that is, awareness or consciousness with a conscience, and to an accompanying new social contract. Finding a rationale for such a moral compass and social contract that all the citizens of South Africa and of other similarly stricken countries would be prepared to commit to is a daunting task because people tend to be subjective in reflecting about their personal and group views, particularly about their religious beliefs and convictions. Closer examination reveals, however, that despite all the diversity, differences and conflict prevalent in societies, people are potentially able to share a set of basic values that arguably could form the core of the sought-for moral compass. Citizenship education could be functional in bringing home to the next generation the notion of henceforth living in accordance with the precepts of such a moral compass and social contract. (shrink)

One of the key concepts of Paul Ricoeur’s hermeneutics is the notion of distanciation. In this article we show that Ricoeur introduces this notion as a correction of Heidegger’s focus on being-in and Gadamer’s emphasis on belonging . Ricoeur argues that distanciation does not lead to the uprooting of our belonging to a tradition. Rather, distanciation is an integral part of the dynamics that constitutes tradition. We discuss the different senses in which Ricoeur understands distanciation as a positive and productive (...) aspect of tradition. In particular, we discuss the ontological aspect of distanciation. In his discussion of both the long way of hermeneutics and the creative dimension of distanciation in fiction, Ricoeur argues that it is distanciation that opens up the possibility of understanding our own being-in-the-world. This involvement of distanciation in the disclosure and understanding of being allows us to show that distanciation determines what “kind” of being is understood: what is interpreted in hermeneutics and disclosed in poetics is never being as such, but “being-interpreted” and “being-as,” respectively. This leads us to a description of the difference between Ricoeur’s and Heidegger’s thought concerning the ontological dimension of their hermeneutics. (shrink)

The incarnation of the missio Dei practice model for the Dutch Reformed Church of Africa. The decline of the church in the West is of great concern to many today. The Netherdutch Reformed Church of Africa (NRCA), experiences the same tendency. We are living in a time when survival is on the mind of most mainline congregations and denominations. The question is what shall we do to turn this situation around? The answer is to be found in the rediscovery of (...) what it means for the church to be missional. The knowledge about how the early church functioned helps us to rediscover the character of early Christian mission, much of what is drawn together in the concept of incarnational mission. This article examines incarnational mission as the understanding and practise of Christian witness that is rooted in and shaped by the life, ministry, suffering, death and resurrection of Jesus. Understanding mission incarnationally in this manner is an integrative way to approach the church’s missionary vocation and to avoid the typical Western reduction of mission to one of the many programms of the church. The article, by exploring the meaning of incarnational mission, endeavours to be both constructive with regard to the biblical and theological understanding of the message, and polemical with regard to the context and history of mission, especially in the Western tradition. This article follows Darrell Guder in arguing that the historical ‘happenedness’ of Jesus’ life both enables and defines Christian witness. In exploring the missional ignificance of the incarnation, the article tries to avoid any dilution of the centrality of the incarnation event. (shrink)

Lieven Boeve seems to take it for granted that there is an opposition between the 'modern' concern for universality and our 'postmodern' awareness of invincible particularity. Christian religion however is, according to Whitehead, 'a religion seeking a metaphysics'. Starting from its particular experience it throws light upon our existence as a whole and even upon cosmic reality . If the God of Israel is the true God, He is also the God of heaven and earth. There is in christian religion (...) itself an unavoidable drive towards universality . Lieven Boeve agrees that religion should not be relegated to orthopraxis and revelational positivism. True religion cannot give up its claim 'to be true'. Religion focusses more on particularity; philosophy strives for a wider generality. But the two should not be opposed. (shrink)

Harry van der Linden's review of: Welfare in the Kantian State. By Alexander Kaufman. Oxford: Oxford University Press, 1999. Pp.xii, 179. ISBN 0-19-829467-0. £42.50, $45.00.

The focus of this article is on the incarnation of Jesus Christ, the Word become flesh, as a way of talking about and understanding mission and addresses at least two concerns in the contemporary debate about the missional church. Many missionary methods and strategies have contradicted both the teaching and actions of Jesus as he trained his disciples to continue his ministry. The message may have been the gospel, but the way the message was made known was often not congruent (...) with the gospel. The attempt to interpret mission in terms of the incarnation of Jesus suggests that the earlier forms of mission strategies should be replaced by a theology and praxis rooted in and defined by the life and ministry of Jesus. Ephesians 4 provides the key to the theology and praxis by giving us a direct link backward into the ministry that infused and led the early church in the life and the ministry of Jesus. (shrink)

The regulative and semantic ‘distance’ of electronic conferencing may impede the topical alignment and the unambiguous interpretation of messages, hindering collaborative learning processes. Compared to a face-to-face environment, in electronic conferencing this distance may be caused by a reduced strength of online ‘context’. Explicitly defining the context of messages in an electronic environment may increase the writers’ co-intentionality and co-reference. An annotation tool is presented, strengthening the context by providing a document under discussion and enabling users to anchor their messages (...) in specific passages of the document. Preliminary results indicate that the tool does indeed reinforce the context, focusing the online discussion around a certain topic (increasing co-intentionality) and providing a frame of reference for single messages (increasing co-reference). (shrink)

BackgroundThe interpretation of clinical gait data in children with cerebral palsy (CP) is time-consuming, requires extensive expertise and often lacks transparency. Here we aimed to develop a set of look-up tables to support this process, linking typical gait features as present in CP to their potential underlying impairments.MethodsWe developed an initial core set of gait features and their potential underlying impairments based on biomechanical reasoning, literature and clinical experience. This core set was further specified through a Delphi process in a (...) multidisciplinary group of experts in gait analysis of children with CP and evaluated on 20 patient cases. The likelihood of the listed gait feature–impairment relationships was scored by the expert panel on a five-point scale.ResultsThe final core set included 120 relevant gait feature–impairment relations including likelihood scores. This set was presented in the form of look-up tables in both directions, i.e., sorted by gait features with potential underlying impairment, and sorted by impairments with potential related gait features. The average likelihood score for the relations was 3.5 ± 0.6 (range 2.1–4.6).ConclusionThe developed set of look-up tables linking gait features and impairments, can assist gait analysts and clinicians in standardized biomechanical reasoning, to support treatment decision-making for gait impairments in children with CP. (shrink)