Sunday, 21 May 2017

2017-The road to resilience





The Road to Resilience

American Psychological Association

http://www.apa.org/helpcenter/road-resilience.aspx

How do people deal with difficult events that change their lives? The death of a loved one, loss of a job, serious illness, terrorist attacks and other traumatic events: these are all examples of very challenging life experiences. Many people react to such circumstances with a flood of strong emotions and a sense of uncertainty.

Yet people generally adapt well over time to life-changing situations and stressful conditions. What enables them to do so? It involves resilience, an ongoing process that requires time and effort and engages people in taking a number of steps.

This brochure is intended to help readers with taking their own road to resilience. The information within describes resilience and some factors that affect how people deal with hardship. Much of the brochure focuses on developing and using a personal strategy for enhancing resilience.

What is resilience?

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences.

Research has shown that resilience is ordinary, not extraordinary. People commonly demonstrate resilience. One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals' efforts to rebuild their lives.

Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.

Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone.

Factors in Resilience

A combination of factors contributes to resilience. Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience.

Several additional factors are associated with resilience, including:

  • The capacity to make realistic plans and take steps to carry them out.
  • A positive view of yourself and confidence in your strengths and abilities.
  • Skills in communication and problem solving.
  • The capacity to manage strong feelings and impulses.

All of these are factors that people can develop in themselves.

Strategies For Building Resilience

Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies.

Some variation may reflect cultural differences. A person's culture might have an impact on how he or she communicates feelings and deals with adversity — for example, whether and how a person connects with significant others, including extended family members and community resources. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience.

Some or many of the ways to build resilience in the following pages may be appropriate to consider in developing your personal strategy.

10 ways to build resilience

Make connections. Good relationships with close family members, friends or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.

Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.

Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.

Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope.

The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

Learning from your past

Focusing on past experiences and sources of personal strength can help you learn about what strategies for building resilience might work for you. By exploring answers to the following questions about yourself and your reactions to challenging life events, you may discover how you can respond effectively to difficult situations in your life.

Consider the following:

  • What kinds of events have been most stressful for me?
  • How have those events typically affected me?
  • Have I found it helpful to think of important people in my life when I am distressed?
  • To whom have I reached out for support in working through a traumatic or stressful experience?
  • What have I learned about myself and my interactions with others during difficult times?
  • Has it been helpful for me to assist someone else going through a similar experience?
  • Have I been able to overcome obstacles, and if so, how?
  • What has helped make me feel more hopeful about the future?

Staying flexible

Resilience involves maintaining flexibility and balance in your life as you deal with stressful circumstances and traumatic events. This happens in several ways, including:

  • Letting yourself experience strong emotions, and also realizing when you may need to avoid experiencing them at times in order to continue functioning.
  • Stepping forward and taking action to deal with your problems and meet the demands of daily living, and also stepping back to rest and reenergize yourself.
  • Spending time with loved ones to gain support and encouragement, and also nurturing yourself.
  • Relying on others, and also relying on yourself.

Places to look for help

Getting help when you need it is crucial in building your resilience. Beyond caring family members and friends, people often find it helpful to turn to:

  • Self-help and support groups. Such community groups can aid people struggling with hardships such as the death of a loved one. By sharing information, ideas and emotions, group participants can assist one another and find comfort in knowing that they are not alone in experiencing difficulty.
  • Books and other publications by people who have successfully managed adverse situations such as surviving cancer. These stories can motivate readers to find a strategy that might work for them personally.
  • Online resources. Information on the web can be a helpful source of ideas, though the quality of information varies among sources.

For many people, using their own resources and the kinds of help listed above may be sufficient for building resilience. At times, however, an individual might get stuck or have difficulty making progress on the road to resilience.


Different people tend to be comfortable with somewhat different styles of interaction. A person should feel at ease and have good rapport in working with a mental health professional or participating in a support group.

Continuing on your journey

To help summarize several of the main points in this brochure, think of resilience as similar to taking a raft trip down a river.

On a river, you may encounter rapids, turns, slow water and shallows. As in life, the changes you experience affect you differently along the way.

In traveling the river, it helps to have knowledge about it and past experience in dealing with it. Your journey should be guided by a plan, a strategy that you consider likely to work well for you.

Perseverance and trust in your ability to work your way around boulders and other obstacles are important. You can gain courage and insight by successfully navigating your way through white water.

Trusted companions who accompany you on the journey can be especially helpful for dealing with rapids, upstream currents and other difficult stretches of the river.

You can climb out to rest alongside the river. But to get to the end of your journey, you need to get back in the raft and continue.

Information contained in this brochure should not be used as a substitute for professional health and mental health care or consultation. Individuals who believe they may need or benefit from care should consult a psychologist or other licensed health/mental health professional.

Acknowledgments:

APA gratefully acknowledges the following contributors to this publication:


  • Lillian Comas-Diaz, PhD, Director, Transcultural Mental Health Institute, Washington, D.C.
  • Suniya S. Luthar, PhD, Teachers College, Columbia University, New York City, N.Y.
  • Salvatore R. Maddi, PhD, The Hardiness Institute, Inc., University of California at Irvine, Newport Beach, Calif.
  • H. Katherine (Kit) O'Neill, PhD, North Dakota State University and Knowlton, O'Neill and Associates, Fargo, N.D.
  • Karen W. Saakvitne, PhD, Traumatic Stress Institute/Center for Adult & Adolescent Psychotherapy, South Windsor, Conn.
  • Richard Glenn Tedeschi, PhD, Department of Psychology, University of North Carolina at Charlotte
American Psychological Association

APA, located in Washington, D.C., is the leading scientific and professional organization representing psychology in the United States. APA works to advance psychology as a science and profession and as a means of promoting health and human welfare.
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Sunday, 22 January 2017

2017 - Military medicine provides ‘world-class solutions for combat casualties

Military medicine provides ‘world-class solutions for combat casualties’

By Military Health System Communications Office- Jan 17th, 2017

Health.Mil-The official website of the Military Health System and the Defense Health Agency.






Osseointegration, a process which attaches a prosthetic limb directly to the skeleton, can be an alternative option to traditional socket-based prosthetics for qualified patients. It is currently undergoing clinical trials at Walter Reed National Military Medical Center in Bethesda, Maryland. (U.S. Navy photo by Mass Communication Specialist 2nd Class Joshua D. Sheppard)

Experts across the Military Health System are collaborating with civilian researchers on an advanced alternative to socket-based prosthetics for some amputees. Osseointegration, a process that attaches the prosthesis directly to the skeleton, can improve comfort and mobility for qualified patients with amputations.


Navy Cmdr. (Dr.) Jonathan A. Forsberg, an orthopedic oncologist at Walter Reed National Military Medical Center in Bethesda, Maryland, and an investigator at the Naval Medical Research Center, said he treats patients who are newly injured and those who have been living with amputations for many years.

“Developing osseointegration as a capability within the Department of Defense makes good on our commitment to provide world-class solutions for combat casualties throughout the entire spectrum of care,” said Forsberg. Although clinical trials for osseointegration have been performed elsewhere around the world, the clinical trial at Walter Reed is the first of its kind to be performed in the United States.



The initial surgery for osseointegration attaches a fixture or implant onto or within the bone, and the bone takes about three months to grow into the implant. The second surgery prepares the soft tissue for an attachment, called an abutment, which protrudes through the skin. Similar to the way a dental implant is secured to the jaw bone, a prosthetic limb is attached directly to the abutment. (Courtesy graphic)

The Osseointegration Program within the Uniformed Services University of Health Sciences-Walter Reed Department of Surgery, is headed by Forsberg and Army Lt. Col. (Dr.) Benjamin Kyle Potter, chief of orthopedics at Walter Reed. They hope to improve function and quality of life while minimizing risk for these wounded warriors who have suffered visible and devastating injuries, said Potter.

“We’re unique here at Walter Reed and San Antonio within the military system to have these amputee centers of excellence,” said Potter. “This is one of several technologies that are here, or on the near horizon, and have the potential to dramatically improve the outcomes following amputation.”

A four-year Food and Drug Administration clinical trial began in October using the Osseointegration Prosthesis for the Rehabilitation of Amputees (OPRA) – one of two implants currently available. At the moment, the study involves patients with transhumeral, or above elbow, amputations. However, Walter Reed is also looking at transfemoral, or above knee, amputees, said Potter.

"Traditional socket-based prosthesis rely on soft tissue to transfer the weight of the load from the ground to the skeleton,” said Forsberg. “Osseointegration eliminates the need for soft tissue attachment.”

The initial surgery for osseointegration attaches a fixture or implant onto or within the bone, and the bone takes about three months to grow into the implant. The second surgery prepares the soft tissue for an attachment, called an abutment, which protrudes through the skin. Similar to the way a dental implant is secured to the jaw bone, a prosthetic limb is attached directly to the abutment. Over the next six months, the patient progressively transfers force to the skeleton in a controlled manner so that no loosening of any part occurs.

Earlier this year, the program’s first patient, former Marine Sgt. Michael Frazier, received another type of osseointegrated implant from Potter and Forsberg: the DoD-funded Compress® Transdermal Implant. In May 2011, Frazier stepped on an improvised explosive device in Trek Nawa, Afghanistan, losing both legs to the blast.

"Being in a wheelchair 24/7 started to take a toll on my mind and body, so I needed a change, to get up and walk again,” said Frazier, who medically retired in December 2012. He was walking around in about a month after the procedure, and felt more comfortable and confident, he said. “[The leg is] easier to put on and you have so much more control and feeling because it’s pretty much a part of your body.”

Many institutions are collaborating with Walter Reed’s osseointegration program, including the Office of Naval Research, Uniformed Services University of the Health Sciences, University of California - San Francisco, and several other universities.

"By centralizing osseointegration at one DoD institution, which is at Walter Reed right now, we are able to standardize certain processes – patient selection, evaluation, surgery, rehabilitation – before pushing it out to the rest of the DoD community,” said Forsberg.










DARPA provides groundbreaking bionic arms to Walter Reed

By Cheryl Pellerin, Defense Media Activity- December 28th,2016

US Department of Defense.

https://www.defense.gov/News/Article/Article/1037447/darpa-provides-groundbreaking-bionic-arms-to-walter-reed





Dr. Justin Sanchez, director of the Defense Advanced Research Projects Agency’s Biological Technologies Office, fist-bumps with one of the first two advanced “LUKE” arms to be delivered from a new production line during a ceremony at Walter Reed National Military Medical Center in Bethesda, Maryland. (DoD photo)

WASHINGTON  — The Defense Advanced Research Projects Agency is making available to military amputees the first production versions of a groundbreaking upper-limb prosthesis, according to a DARPA press release. 

Dr. Justin Sanchez, director of DARPA’s Biological Technologies Office, delivered the first two advanced “LUKE” arms from a new production line during a ceremony yesterday – evidence that the fast-track DARPA research effort has completed its transition into a commercial enterprise, DARPA officials said. 

The ceremony took place at Walter Reed National Military Medical Center in Bethesda, Maryland

“The commercial production and availability of these remarkable arms for patients marks a major milestone in the [DARPA] Revolutionizing Prosthetics program and most importantly an opportunity for our wounded warriors to enjoy a major enhancement in their quality of life,” Sanchez said, “and we are not stopping here.” 

The RP program is supporting initial production of the bionic arms and is making progress restoring upper-arm control, he added. 

“Ultimately we envision these limbs providing even greater dexterity and highly refined sensory experiences by connecting them directly to users’ peripheral and central nervous systems,” Sanchez said. 


Arms for Service Members 

As part of the production transition process, DARPA is collaborating with Walter Reed to make the bionic arms available to service members and veterans who are rehabilitating after suffering upper-limb loss, DARPA says. 

LUKE stands for “life under kinetic evolution” but is also a passing reference to the limb that Luke Skywalker wore in Star Wars: Episode V, The Empire Strikes Back. 

The limbs are being manufactured by Mobius Bionics LLC, of Manchester, New Hampshire, a company created to market the technology developed by DEKA Integrated Solutions Corp., also of Manchester, under DARPA’s Revolutionizing Prosthetics program. 



The first production versions of “LUKE” arms, a groundbreaking upper-limb prostheses, were on display during a ceremony at Walter Reed National Military Medical Center. The Defense Advanced Research Projects Agency is collaborating with Walter Reed to make the bionic arms available to service members and veterans who are rehabilitating after suffering upper-limb loss. (DoD photo)

The prosthetic system allows very dexterous arm and hand movement with grip force feedback through a simple intuitive control system, DARPA says. 

The modular battery-powered limb is near-natural size and weight. Its hand has six user-chosen grips and an arm that allows for simultaneous control of multiple joints using inputs that include wireless signals generated by innovative sensors worn on a user’s feet. 


Revolutionizing Prosthetics 

The technology that powers prosthetic legs has advanced steadily over the past two decades but prosthetic arms and hands are a tougher challenge, in part because of the need for greater degrees of dexterity, DARPA says. 

When the LUKE arm first went into development, people who had lost upper limbs had to use a relatively primitive split-hook device that hadn’t changed much since it was introduced in 1912. 

DARPA launched the Revolutionizing Prosthetics program with a goal of getting U.S. Food and Drug Administration approval for an advanced electromechanical prosthetic upper limb with near-natural control that enhances independence and improves quality of life for amputees. LUKE received FDA approval less than eight years after the effort began, DARPA says. 

Under a recently finalized agreement between DARPA and Walter Reed, DARPA will transfer LUKE arms from an initial production run to the medical center for prescription to patients. Mobius Bionics will train the Walter Reed staff to fit, service and support the arms.