A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. ClinicalTrials.gov identifier: NCT00177489.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p = .022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p = .034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored.

A new approach to the rehabilitation of movement, based primarily on the principles of operant conditioning, was derived from research with deafferented monkeys. The analysis suggests that a certain proportion of excess motor disability after certain types of injury involves a learned suppression of movement and may be termed learned nonuse. Learned nonuse can be overcome by changing the contingencies of reinforcement so that they strongly favor use of an affected upper extremity in the chronic postinjury situation. The techniques employed here involved 2 weeks of restricting movement of the opposite (unaffected) extremity and training of the affected limb. Initial work with humans has been with chronic stroke patients for whom the approach has yielded large improvements in motor ability and functional independence. We report here preliminary data suggesting that shaping with verbal feedback further enhances the motor recovery.Key words: shaping, training, restriction, somatosensory deafferentation, stroke, rehabilitation medicine, impaired movement, monkeys, humans This article describes a new approach to the rehabilitation of movement in physical medicine. It is based in its essential features on the principles of operant conditioning. It is fitting that it appear in a tribute to Joseph V. Brady, because he persuasively endorsed the relevance and importance of applying the principles of the experimental analysis of behavior to new areas and in this way strongly influenced the development of this work. Experiments with Deafferented MonkeysAlthough the present approach is fundamentally behavioral, the original observations were made in the context of studies of the neurophysiology of motor control and the role of sensory feedback in movement and learning. The spinal nerves, which are fundamental for these functions, emerge from the spinal cord in two roots. The dorsal root is sensory. Thus, animal-research enterprise, responded by saying, to quote him, "They will get those monkeys over my dead body." As a result, the monkeys were preserved so that significant experiments could be carried out (Pons et al., 1991;Rausell, Cusick, Taub, & Jones, 1992). These experiments will not be described here because their subject matter is not directly relevant to the main theme of this paper, but there is widespread recognition of their potential practical importance for the fields of cortical plasticity and physical rehabilitation (Barinaga, 1992;Palca, 1991;Stephens, 1991). Thus, Joe Brady resisted pressure that very few could have withstood, and thereby achieved a significant victory for animal research on several levels. However, his role in this incident is largely unknown. He is an unsung hero. It is hoped that this account will help to some extent to begin to rectify this situation.

OBJECTIVES To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN Randomized, multisite clinical trial. SETTING CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief “check-in” telephone calls during this 6-month period. MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.