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Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
This chapter reviews the major advances in autosomal recessive and autosomal dominant ataxias, discusses the use of genetic tests in these disorders, and summarizes some current ideas regarding pathogenesis. It also presents a list of the autosomal recessive ataxias that have been genotypically characterized to date. Mutations in ataxia with isolated vitamin E deficiency (AVED) are scattered throughout the gene and some of them may be associated with a mild phenotype, late onset, retinitis pigmentosa, and retained reflexes. A syndrome of ataxia associated with optic atrophy, visual loss, and cochlear degeneration has been mapped to chromosome. The spinocerebellar ataxia (SCAs) exhibits many phenotypic similarities so that it is almost impossible to diagnose the genotype from the phenotype alone. Many persons from families with ataxia will request predictive testing and occasionally prenatal testing. Disease-modifying therapies are under investigation and include antioxidants and drugs that may modify excitotoxicity or apoptosis.
By
Ammar Al-Chalabi, Department of Neurology, Institute of Psychiatry, London, UK,
Robert H. Brown, Cecil B. Day Neuromuscular Laboratory, Massachusetts General Hospital East, Charlestown, MA, USA
The genetics of a disease such as amyotrophic lateral sclerosis (ALS) require some flexibility in thinking about familiality compared with the genetics of isolated cases. About 10% of the time, an individual who develops ALS also has first-degree relatives who have been affected. For the remainder, the disease is said to be sporadic, but detailed investigation of the family tree may occasionally reveal that cousins or other more distant relatives have been affected. ALS can therefore be seen as a disease with an inheritance pattern that lies on a continuum from sporadic disease, to familial clustering to clear Mendelian familiality. For simplicity we have maintained the conventional separation of familial and sporadic disease, but as will become obvious, this distinction is largely artificial.
Familial ALS and the first descriptions
The concepts of genetics were coming into being at about the same time as the earliest descriptions of motor neuron diseases. Mendel presented his classic paper in 1865 (Mendel, 1865) in which he described his famous sweet pea hybridization experiments. He did not use the term gene or genetic to describe the heritable units but called them “formative elements.” Cambridge Professor of Biology William Bateson coined the term “genetics” (from the Greek “to generate”) in 1905 when applying for a university chair in a letter to the Cambridge zoologist, Adam Sedgwick. He wrote, “Such a word is badly wanted and if it were desirable to coin one, Genetics might do.”
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