Parasitism can affect every aspect of wildlife ecology, from predator avoidance and competition for food to migrations and reproduction. In the wild, these ecological effects can have implications for host fitness and parasite dynamics. In contrast, domestic environments are typically characterised by high host densities, low host diversity, and veterinary interventions, and are not subject to processes like predation, competition, and migration. When wild and domesticated hosts interact via shared parasite populations, understanding and predicting the outcomes of parasite ecology and evolution for wildlife conservation and sustainable farming can be a challenge. We describe the ecology and evolution of ectoparasitic sea lice that are shared by farmed and wild salmon and the insights that experiments, fieldwork, and mathematical modelling have generated for theory and applied problems of host–parasite interactions over the course of a long-term study in Pacific Canada. The salmon–sea lice host–parasite system provides a rich case study to examine the ecological context of host–parasite interactions and to shed light on the principal challenges of parasite management for wildlife health and conservation.

Introduction

The Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation opened in 1996 and was modelled on the American holistic programmes developed by Yehuda Ben-Yishay and George Prigatano. It was named after Oliver Louis Zangwill, Professor of Psychology at Cambridge University between 1954 and 1984. He was also a pioneer of brain injury rehabilitation in Great Britain during the Second World War when he worked in Edinburgh with brain injured soldiers. The Centre follows many of the principles laid down by Ben-Yishay (1978), Prigatano et al. (1986) and Christensen and Teasdale (1995), and is also significantly influenced by the critical ‘scientist practitioner’ model of clinical psychology adopted in the United Kingdom.

A holistic approach to brain injury rehabilitation ‘… consists of well-integrated interventions that exceed in scope, as well as in kind, those highly specific and circumscribed interventions which are usually subsumed under the term “cognitive remediation”’ (Ben-Yishay and Prigatano, 1990; p. 40). The holistic approach recognizes that it does not make sense to separate the cognitive, emotional and social consequences of brain injury as how we feel and think affects how we behave. Ben-Yishay's (1978) model follows a hierarchy of stages through which the patient or client should work in rehabilitation. These stages are engagement, awareness, mastery, control, acceptance and identity. Individual and group sessions are provided to enable patients to work through these stages.

The origins of the OZC go back to 1993 when one of us (BAW) spent several weeks at Prigatano's unit in Phoenix Arizona.

Introduction

Previous chapters have described the principles of neuro psychological rehabilitation and outlined the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation programme providing descriptions of groups developed to address specific types of difficulties experienced by many individuals following acquired brain injury. In addition, within a holistic neuropsychological rehabilitation setting, other groups may be run according to shared needs of the individuals undertaking the programme at any one time. This chapter aims to identify some of the types of groups that have been utilized and discusses the format, content and ways in which such group work can be integrated within individual rehabilitation programmes. Group attendance is discussed and agreed as plans of action towards individualized client goals, which help to co-ordinate the activities of the clinical team.

Within society, people are members of one group or another, within the home, at work or in recreational and social interests. Groups provide us with a shared identity and roles, in addition to peer support, and we know that many people experience a loss of role and purpose and a sense of isolation after brain injury. Klinger (2005), summarizing the results of a qualitative study with traumatic brain injury participants, notes: ‘participants had to learn a new way of “being” in order to move on to a new way of “doing”’ (p. 14). A similar finding is reported by Gracey et al. (2008). Group activity is thus of central importance to the programme especially the ‘therapeutic milieu’ core component.

Introduction

This chapter describes the significant gains that can still be made by clients in rehabilitation several years post-injury through thorough assessment and tailored intervention. An in-depth interdisciplinary assessment and formulation of the client's difficulties was carried out at the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation prior to intervention that, as with Malcolm (Chapter 20) and Kate (Chapter 21), did not entail attending the OZC intensive programme. Instead, once Adam had completed the assessments in Ely, including a two-week period of work testing out specific rehabilitation approaches, two team members, an occupational therapist and clinical psychologist, provided appointments in Adam's home. The therapists provided eight individual day sessions targeting specific daily living goals through the use of errorless learning methods. We have included a description of this case to also emphasize our view that the core components of rehabilitation described in Chapter 4 can be recreated, in a less intensive way, through active involvement of family and carers in the community.

History of injury

Adam was involved in a road traffic accident in 1999. He was the driver of a car that was struck on the driver's side by another vehicle and subsequently admitted to Intensive Care. On admission, his Glasgow Coma Scale was measured at 3/15, indicating severe brain injury. A CT scan showed a left frontal haemorrhage and right-sided contusion. He had also suffered additional multiple orthopaedic injuries. He was transferred to a Neurosurgical Unit where he underwent a craniotomy and evacuation of a left frontal haematoma.

Introduction

The Understanding Brain Injury (UBI) Group, it could be argued, is the most important group of the programme at the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation. It is, perhaps, the main way of helping clients understand what has happened to them, how they have been affected by their brain injuries and what kind of recovery to expect. This information forms the basis of increasing awareness and self-esteem, and significantly contributes to the process of developing both a ‘shared understanding’ and a safe ‘therapeutic milieu’ as described in Chapter 4. Although the consequences of brain injury (e.g. memory, attention and emotional problems) are covered in more detail in other groups, without the knowledge and acceptance that we try to instil in the UBI Group, the other groups are thought to be less likely to succeed.

Central to the philosophy of the Centre is giving clients, where possible, the opportunity to develop good awareness of their strengths and weaknesses, and learn to self-advocate. Brain injury can be a bewildering experience, particularly in the context of cognitive impairments that make it more difficult to notice, understand or respond to problems. For the vast majority of clients, knowledge of brain injury and its consequences is limited to the client's own prior experience of it. One of the aims of the UBI Group is to normalize the consequences of brain injury; the educational, seminar-style format is used to describe how the brain works and how it may be affected by injury.

Introduction

Through the course of this book the approaches to comprehensive neuropsychological rehabilitation that have been discussed demonstrate numerous elements constituting an entire package of rehabilitation which can be described as holistic in its coverage. Outcome of rehabilitation may be conceptualized in terms of objective or observable changes in behaviour, or changes in subjective experience applied to either the client or family members. The focus of outcome measurement may be on the ultimate aims of rehabilitation (e.g. social participation-related goals) or the processes hypothesized to underpin change (e.g. awareness, learning compensatory strategy use, improved confidence, better family relationships). Methods of measurement may equally vary to include observation, questionnaire ratings, or experimental or standardized ‘implicit’ methods designed to elucidate non-conscious processes (such as cognitive and emotional processes).

Within the programme, the range of individual interventions requires a range of methodologies to address the different types of questions concerning effectiveness. Individual elements can be subject to specific outcome evaluations, as illustrated in Chapter 6 about attention and goal management. Similarly, individual patient outcomes can be examined, as illustrated in the case studies. As discussed in our case study chapters, however, the individual elements assessed in the context of a holistic programme need to be seen as parts of the whole process and this means that it is often hard to isolate the efficacy of individual elements.

Studies that have evaluated comparable comprehensive holistic cognitive rehabilitation programmes include Parente and Stapleton (1999); Salazar et al. (2000); Klonoff et al. (2001); Malec (2001).