Clinical psychology | EPFL Graph Search

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession. The field is generally considered to have begun in 1896 with the opening of the first psychological clinic at the University of Pennsylvania by Lightner Witmer. In the first half of the 20th century, clinical psychology was focused on psychological assessment, with little attention given to treatment. This changed after the 1940s when World War II resulted in the need for a large increase in the numb

Tissue engineering for prenatal applications

Anna-Sofia Johanna Kiveliö

Fetal therapies have become available for a restricted number of life-threatening clinical conditions. Harnessing tissue engineering for prenatal applications has not been widely pursued even though isolating cells from fetal and extraembryonic tissues has been routinely done for years. The objectives of this thesis were twofold: i) the development of materials based and tissue engineering based strategies to prevent iatrogenic preterm prelabour rupture of fetal membranes (iPPROM) after diagnostic or therapeutic interventions into the amniotic cavity and ii) the generation of tissue substitutes from patient derived fetal cells, which can be employed for prenatal or perinanal transplantation to restore or replace defective tissues. For the prevention of iPPROM, mussel-mimetic tissue adhesive (mussel glue) a biomaterial which was recently described to not compromise cell viability and to have good tissue sealing capability was compared to fibrin glue. In this in vivo study we assessed whether in a mid-gestational rabbit model punctured fetal membranes could be efficiently sealed with mussel glue. Mussel glue showed comparable in vivo performance to fibrin glue in sealing fetal membranes though no apparent healing of the membranes could be observed in any of the samples. The limited ability of naturally derived scaffolds to promote fetal membrane healing inspired the engineering of synthetic plugging material with specifically tailored biological and mechanical properties which could activate the cells in the amnion and induce a healing response. In this thesis the modularly designed biomimetic poly(ethylene glycol) (PEG)-based hydrogel platform (called TG-PEG from here on) was used together with fetal cells to demonstrate that upon presentation of appropriate biological cues in 3D tissue mimicking environment, mesenchymal progenitor cells from amnion can be mobilized, induced to proliferate and supported in maintaining their native extracellular matrix production, thus creating a suitable environment for healing to take place. These data provide the basis for future engineering of materials with defined mechanical and biochemical properties and the ability to present migration and proliferation inducing factors, namely PDGF, bFGF, or EGF which could be key in resolving the clinical problem of iPPROM and allowing the field of fetal surgery to move forward. Cleft palate, where the bones of the palatal halves fail to fuse properly, is one of the most common birth defects. Tissue engineering has been envisioned as a treatment option but current approaches have been limited by the lack of i) appropriate autologous cell sources and ii) structural organization and vascularization. Tissue engineering of cleft palates using of autologous amniocentesis-derived and thus ethically unproblematic fetal amniotic fluid cells (AFCs) could be done parallel to the ongoing pregnancy with living reconstruction material being ready when the child is born. We describe using TG-PEG hydrogels to first evaluate 3D osteogenic differentiation of AFCs and creation of vascular structures from AFC derived endothelial cells (enAFC) and undifferentiated AFC either in random or organized channel cocultures in vitro and in vivo. Next, these approaches were combined in an osteogenic matrix with a channel perfused with enAFC and finally the integration and functional properties of these fetal bone constructs was tested in ectopic mouse model.

EPFL2015

Instrumented 5-Time Sit-To-Stand Test: Parameters Predicting Serious Falls beyond the Duration of the Test

Kamiar Aminian, Arash Atrsaei, Yves Henchoz, Anisoara Ionescu

Background: Falls are a major cause of injuries in older adults. To evaluate the risk of falls in older adults, clinical assessments such as the 5-time sit-to-stand (5xSTS) test can be performed. The development of inertial measurement units (IMUs) has provided the possibility of a more in-depth analysis of the movements’ biomechanical characteristics during this test. The goal of the present study was to investigate whether an instrumented 5xSTS test provides additional information to predict multiple or serious falls compared to the conventional stopwatch-based method. Methods: Data from 458 community-dwelling older adults were analyzed. The participants were equipped with an IMU on the trunk to extract temporal, kinematic, kinetic, and smoothness movement parameters in addition to the total duration of the test by the stopwatch. Results: The total duration of the test obtained by the IMU and the stopwatch was in excellent agreement (Pearson’s correlation coefficient: 0.99), while the total duration obtained by the IMU was systematically 0.52 s longer than the stopwatch. In multivariable analyses that adjusted for potential confounders, fallers had slower vertical velocity, reduced vertical acceleration, lower vertical power, and lower vertical jerk than nonfallers. In contrast, the total duration of the test measured by either the IMU or the stopwatch did not differ between the 2 groups. Conclusions: An instrumented 5xSTS test provides additional information that better discriminates among older adults those at risk of multiple or serious falls than the conventional stopwatch-based assessment.

2021

Toward an objective assessment of mobility in clinical and daily activity settings

Arash Atrsaei

Quantification of mobility is the key to monitor the progression of mobility disorders as well as the effect of an intervention. Inertial measurement units (IMUs) with dedicated algorithms can quantify postural transitions and gait as the two key aspects of mobility in an objective and continuous manner. IMU-based mobility assessments can be performed by either functional tests in the clinic or through daily activities. Assessments performed in the clinic are more indicative of peoples best performance or capacity, while assessments performed at home represent mostly their actual performance. Yet the relationship between these two settings is not fully understood, both due to the existing gaps in technical algorithms as well as challenges in comparing two inherently different domains. To this end, in this thesis, I firstly focused on developing and validating algorithms to quantify mobility in both clinical and domestic environments. The added clinical value of these IMU-based mobility assessments was shown in several populations with mobility impairments. Finally, by proposing novel approaches, I focused to bridge the gap between clinical and daily activity assessments. The previous approaches to quantify mobility are mostly based on algorithms that are validated only during clinical or lab-based assessments. Opposed to daily activities, lab assessments contain simple and single-task activities. Therefore, it is important to design algorithms robust to the complex context of daily life setting while being unobtrusive to daily activities. A new algorithm was introduced to detect and characterize postural transitions, i.e., sitting and standing. Next, machine-learning-based algorithms were developed to detect walking bouts and estimate gait speed. The proposed postural transition and gait quantification algorithms were based on a single IMU on the lower back which is unobtrusive to daily activities. The novelty of the algorithms is their robustness to sensor placement changes during daily activities. The proposed algorithms demonstrated high performance during both clinical and daily activity assessments whether on healthy individuals or participants with mobility impairments. Next, through several analyses, I demonstrated how such instrumented mobility assessments can discriminate different patient populations. For instance, IMU-derived mobility parameters could differentiate older adults with and without risk of falls as well as patients with moderate or severe stages of multiple sclerosis. Moreover, the aforementioned parameters were compared between clinical and daily activity assessments. By this comparison, clinicians can have a better understanding of patients capacity through a remote assessment of mobility. Finally, it was shown how clinical and daily activity assessments can provide complementary information to each other. For instance, by introducing novel approaches to compare gait speed between clinical and daily activity assessments, the effect of the medication in Parkinsons disease (PD) was traceable during daily activities. The findings can lead to better optimization of the medication dose in PD. Overall, this thesis provided a framework that can help clinicians with an objective assessment of mobility. Furthermore, the approaches introduced in this thesis can help for better management of intervention and tracking its effects where both clinical and daily activity assessments exist.

EPFL2021