Rehabilitation Research and Practice

Healing Pathways: A Program for Women with Physical Disabilities and Depression

Dena Hassouneh, Thuan Nguyen, Zunqiu Chen, and Elizabeth McNeff — Thu, 02 May 2013 11:31:41 +0000

Objective. The objective of this study was to test the efficacy of the Healing Pathways (HP) program in reducing clinically significantly depressive symptoms in women with physical disabilities (WPD). Healing Pathways is a peer-implemented group mental health treatment program targeting WPD who have clinically significant cooccurring depressive symptoms. Participants. Eighty women were randomized in this trial. Design. This study used a community-based participatory intervention research design. Using community-based recruiting methods, participants were recruited from Centers for Independent Living, local disability service organizations, via Craig's list as well as other community locations such as grocery stores and bus stops. Women participated in the HP program for 14 weeks. Results. The primary outcome variable for this study was reduction in depressive symptoms as measured by the Center for Epidemiologic Depression Scale (CES-D). We found that there was a significant interaction effect of treatment by time on depression scores, F(3,210) = 9.51, , partial . Investigation of the predicted mean profile over time in the intervention group demonstrated that depression scores decreased greatly from baseline to the first posttest and remained stable in the two followups, whereas there was a little change in the mean profile over time in the control group. Conclusion. The HP program has demonstrated initial efficacy in reducing depressive symptoms in women with physical disabilities.

Normative Data for the Balance Error Scoring System in Adults

Grant L. Iverson and Michael S. Koehle — Mon, 18 Mar 2013 14:50:49 +0000

Background. The balance error scoring system (BESS) is a brief, easily administered test of static balance. The purpose of this study is to develop normative data for this test. Study Design. Cross-sectional, descriptive, and cohort design. Methods. The sample was drawn from a population of clients taking part in a comprehensive preventive health screen at a multidisciplinary healthcare center. Community-dwelling adults aged 20–69 () were administered the BESS within the context of a fitness evaluation. They did not have significant medical, neurological, or lower extremity problems that might have an adverse effect on balance. Results. There was a significant positive correlation between BESS scores and age (). BESS performance was similar for participants between the ages of 20 and 49 and significantly declined between ages 50 and 69. Men performed slightly better than women on the BESS. Women who were overweight performed significantly more poorly on the test compared to women who were not overweight (; Cohen's ). The BESS normative data are stratified by age and sex. Conclusions. These normative data provide a frame of reference for interpreting BESS performance in adults who sustain traumatic brain injuries and adults with diverse neurological or vestibular problems.

Cognitive Impairment Affects Physical Recovery of Patients with Heart Failure Undergoing Intensive Cardiac Rehabilitation

Sun, 30 Dec 2012 16:36:38 +0000

Purpose. To determine whether the presence of cognitive impairment (CI) affects physical recovery of patients with chronic heart failure (CHF) undergoing a cardiac rehabilitation program (CRP). Methods. We enrolled 80 CHF patients (M/F = 53/27). CI was evaluated by means of the Mini-Mental State Examination (MMSE), exercise tolerance was evaluated by six-minute walking test (6 mwt). All patients underwent a 6-week CRP program at 50–70% of maximal . Patients were divided into two groups according to their MMSE (group 1: 16–23; group 2: 24–30). Results. MMSE resulted directly related to ejection fraction (; ), and it was inversely related to creatinine (; ). At 6 week group 1 had a lower increase in distance walked at 6 MWT than group 2 (). At multivariate logistic regression MMSE 16–23 predicted a reduced exercise recovery in the overall population (OR = 1.84; 95% CI = 1.50–2.18) and in women (OR = 1.42; 95% CI = 1.22–1.75), while it was not predicted in males. Conclusions. CI is a marker of advanced CHF and is an independent predictor of lower exercise recovery after CRP.

Cognitive Remediation and Psychosocial Rehabilitation for Individuals with Severe Mental Illness

Susan R. McGurk, Shaun M. Eack, Matthew Kurtz, and Kim T. Mueser — Mon, 24 Dec 2012 11:08:23 +0000

The Use of NeuroAiD (MLC601) in Postischemic Stroke Patients

Jose C. Navarro, Mark C. Molina, Alejandro C. Baroque II, and Johnny K. Lokin — Thu, 13 Dec 2012 16:22:06 +0000

Aim. We aimed to assess the efficacy of MLC601 on functional recovery in patients given MLC601 after an ischemic stroke. Methods. This is a retrospective cohort study comparing poststroke patients given open-label MLC601 (; 9 female) for three months and matching patients who did not receive MLC601 from our Stroke Data Bank. Outcome assessed was modified Rankin Scale (mRS) at three months and analyzed according to: (1) achieving a score of 0-2, (2) achieving a score of 0-1, and (3) mean change in scores from baseline. Results. At three months, 21 patients on MLC601 became independent as compared to 17 patients not on MLC601 (OR 1.79; 95% CI 0.62–5.2; ). There were twice as many patients () on MLC601 who attained mRS scores similar to their prestroke state than in the non-MLC601 group () (OR 3.14; 95% CI 1.1–9.27; ). Mean improvement in mRS from baseline was better in the MLC601 group than in the non-MLC601 group (−1.7 versus −0.9; mean difference −0.73; 95% CI −1.09 to −0.38; ). Conclusion. MLC601 improves functional recovery at 3 months postischemic stroke. An ongoing large randomized control trial of MLC601 will help validate these results.

A Comparison between Two Instruments for Assessing Dependency in Daily Activities: Agreement of the Northwick Park Dependency Score with the Functional Independence Measure

Siv Svensson and Katharina Stibrant Sunnerhagen — Sun, 18 Nov 2012 18:05:59 +0000

Background. There is a need for tools to assess dependency among persons with severe impairments. Objectives. The aim was to compare the Functional Independence Measure (FIM) and the Northwick Park Dependency Score (NPDS), in a sample from in-patient rehabilitation. Material and Methods. Data from 115 persons (20 to 65 years of age) with neurological impairments was gathered. Analyses were made of sensitivity, specificity, positive predictive value, and negative predictive value. Agreement of the scales was assessed with kappa and concordance with Goodman-Kruskal’s gamma. Scale structures were explored using the Rank-Transformable Pattern of Agreement (RTPA). Content validation was performed. Results. The sensitivity of the NPDS as compared to FIM varied between 0.53 (feeding) and 1.0 (mobility) and specificity between 0.64 (mobility) and 1.0 (bladder). The positive predictive value varied from 0.62 (mobility) to 1.0 (bladder), and the negative predictive value varied from 0.48 (bowel) to 1.0 (mobility). Agreement between the scales was moderate to good (four items) and excellent (three items). Concordance was good, with a gamma of −.856, an asymptotic error (ase) of .025, and . The parallel reliability between the FIM and the NPDS showed a tendency for NPDS to be more sensitive (having more categories) when dependency is high. Conclusion. FIM and NPDS complement each other. NPDS can be used as a measure for severely injured patients who are sensitive when there is a high need of nursing time.

Reliability of Measuring the Cervical Sagittal Translation Mobility with a Simple Method in a Clinical Setting

Yvonne Severinsson, Lena Elisson, and Olle Bunketorp — Sun, 04 Nov 2012 10:07:37 +0000

Introduction. The cervical sagittal translation mobility is related to neck pain. A practical method for measuring the specific cervical mobility is needed. The aim was to describe a simple method for measuring the cervical sagittal translation mobility and to evaluate its reliability in a clinical setting. Method. The head protraction and retraction ranges of thirty healthy seated subjects were measured from a dorsal reference plane by two physiotherapists utilizing a tape measure. A standard inclinometer/goniometer was used to minimize angular movements of the head during the translational movements. The measurements were made twice for each subject with a two-hours interval between each measurement. The inter-rater and intra-rater agreements were evaluated with intraclass correlation coefficients (ICCs) and with the distribution of the difference of the measurements. The systematic differences were analysed with the Wilcoxon signed rank test. Results. The intra-rater agreement was good. The inter-rater agreement was moderate in the first measurement and good in the second. A systematic difference was noted between raters in the first measurement but not in the second, possibly indicating a learning effect. Discussion. The method used in the study is simple and reliable and can be recommended for clinical use.

Impact of “Sick” and “Recovery” Roles on Brain Injury Rehabilitation Outcomes

David A. Barclay — Mon, 15 Oct 2012 16:59:05 +0000

This study utilizes a multivariate, correlational, expost facto research design to examine Parsons’ “sick role” as a dynamic, time-sensitive process of “sick role” and “recovery role” and the impact of this process on goal attainment (H1) and psychosocial distress (H2) of adult survivors of acquired brain injury. Measures used include the Brief Symptom Inventory-18, a Goal Attainment Scale, and an original instrument to measure sick role process. 60 survivors of ABI enrolled in community reentry rehabilitation participated. Stepwise regression analyses did not fully support the multivariate hypotheses. Two models emerged from the stepwise analyses. Goal attainment, gender, and postrehab responsibilities accounted for 40% of the shared variance of psychosocial distress. Anxiety and depression accounted for 22% of the shared variance of goal attainment with anxiety contributing to the majority of the explained variance. Bivariate analysis found sick role variables, anxiety, somatization, depression, gender, and goal attainment as significant. The study has implications for ABI rehabilitation in placing greater emphasis on sick role processes, anxiety, gender, and goal attainment in guiding program planning and future research with survivors of ABI.

Mild Brain Injury

Brian D. Greenwald, Anne Felicia Ambrose, and Gina P. Armstrong — Sat, 13 Oct 2012 15:13:29 +0000

Evaluation of Strength and Irradiated Movement Pattern Resulting from Trunk Motions of the Proprioceptive Neuromuscular Facilitation

Thu, 04 Oct 2012 14:59:16 +0000

Introduction. The proprioceptive neuromuscular facilitation (PNF) is a physiotherapeutic concept based on muscle and joint proprioceptive stimulation. Among its principles, the irradiation is the reaction of the distinct regional muscle contractions to the position of the application of the motions. Objective. To investigate the presence of irradiated dorsiflexion and plantar flexion and the existing strength generated by them during application of PNF trunk motions. Methods. The study was conducted with 30 sedentary and female volunteers, the PNF motions of trunk flexion, and extension with the foot (right and left) positioned in a developed equipment coupled to the load cell, which measured the strength irradiated in Newton. Results. Most of the volunteers irradiated dorsal flexion in the performance of the flexion and plantar flexion during the extension motion, both presenting an average force of 8.942 N and 10.193 N, respectively. Conclusion. The distal irradiation in lower limbs became evident, reinforcing the therapeutic actions to the PNF indirect muscular activation.

Barriers and Facilitators to Community Mobility for Assistive Technology Users

Natasha Layton — Thu, 13 Sep 2012 14:41:14 +0000

Mobility is frequently described in terms of individual body function and structures however contemporary views of disability also recognise the role of environment in creating disability. Aim. To identify consumer perspectives regarding barriers and facilitators to optimal mobility for a heterogeneous population of impaired Victorians who use assistive technology in their daily lives. Method. An accessible survey investigated the impact of supports or facilitators upon actual and desired life outcomes and health-related quality of life, from 100 AT users in Victoria, Australia. This paper reports upon data pertaining to community mobility. Results. A range of barriers and enablers to community mobility were identified including access to AT devices, environmental interventions, public transport, and inclusive community environs. Substantial levels of unmet need result in limited personal mobility and community participation. Outcomes fall short of many principles enshrined in current policy and human rights frameworks. Conclusion. AT devices as well as accessible and inclusive home and community environs are essential to maximizing mobility for many. Given the impact of the environment upon the capacity of individuals to realise community mobility, this raises the question as to whether rehabilitation practitioners, as well as prescribing AT devices, should work to build accessible communities via systemic advocacy.

Two Different Protocols for Knee Joint Motion Analyses in the Stance Phase of Gait: Correlation of the Rigid Marker Set and the Point Cluster Technique

Takashi Fukaya, Hirotaka Mutsuzaki, Hirofumi Ida, and Yasuyoshi Wadano — Thu, 13 Sep 2012 09:08:00 +0000

Objective. There are no reports comparing the protocols provided by rigid marker set (RMS) and point cluster technique (PCT), which are similar in terms of estimating anatomical landmarks based on markers attached to a segment. The purpose of this study was to clarify the correlation of the two different protocols, which are protocols for knee motion in gait, and identify whether measurement errors arose at particular periods during the stance phase. Methods. The study subjects were 10 healthy adults. All estimated anatomical landmarks were which their positions, calculated by each protocol of the PCT and RMS, were compared using Pearson’s product correlation coefficients. To examine the reliability of the angle changes of the knee joint measured by RMS and the PCT, the coefficient of multiple correlations (CMCs) was used. Results. Although the estimates of the anatomical landmarks showed high correlations of >0.90 (𝑃<0.01) for the Y- and Z-coordinates, the correlations were low for the X-coordinates at all anatomical landmarks. The CMC was 0.94 for flexion/extension, 0.74 for abduction/adduction, and 0.71 for external/internal rotation. Conclusion. Flexion/extension and abduction/adduction of the knee by two different protocols had comparatively little error and good reliability after 30% of the stance phase.

An Individualized and Everyday Life Approach to Cognitive Rehabilitation in Schizophrenia: A Case Illustration

Mon, 10 Sep 2012 09:03:48 +0000

Objective. The effectiveness of an individualized and everyday approach to cognitive rehabilitation for schizophrenia was examined in a case study. Method. After cognitive and functional assessment, concrete objectives were targeted for the person’s everyday complaints. Strategies were constructed based on an analysis of the cognitive profile, daily life functioning, and processes involved in activities. They included a memory strategy for reading, a diary to compensate memory difficulties, and working memory exercises to improve immediate processing of information when reading and following conversations. Efficacy was assessed with outcome measures. Results. The program had beneficial effects on the person’s cognitive and everyday functioning, which persisted at a 3-year follow-up. Conclusion. Findings provide suggestive evidence that an individualized and everyday approach may be a useful alternative in order to obtain a meaningfully lasting transfer of training to daily life, compared to the nomothetic ones which dominate the field.

Therapeutic Management of the Hallux Rigidus

Anoop Aggarwal, Suraj Kumar, and Ratnesh Kumar — Wed, 05 Sep 2012 13:30:26 +0000

Background. Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. Objective. Aim of the present paper was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. Methods. To view the hallux rigidus and its rehabilitation, a webbased published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in August 2010 using 4 specific keywords “hallux rigidus, physical therapy, chiropractic, and manual therapy” typed in exactly same manner in the search column of the databases. Result. the review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic, or physiotherapeutic management of the hallux rigidus. Conclusion. Review conclude that conservative programs for hallux rigidus consists of comprehensive intervention program that includes great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long MTP joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus.

Obstacles to Obtaining Optimal Physiotherapy Services in a Rural Community in Southeastern Nigeria

Chinonso Igwesi-Chidobe — Thu, 30 Aug 2012 16:29:14 +0000

Background. Many people continue to live with physical disabilities across the globe, especially in rural Africa despite expertise of Physiotherapists and available evidence of effectiveness of Physiotherapy. Objective. To determine the obstacles to obtaining Optimal Physiotherapy services in a rural community in Southeastern Nigeria. Methods. Population-based cross-sectional study of individuals and health facilities in a rural community in Southeastern Nigeria. Results. The obstacles to obtaining optimal physiotherapy services in this community were unavailability of physiotherapy services, poor knowledge of health workers and community dwellers of the roles and scope of physiotherapy, poor health care seeking behavior of community dwellers, patronage of traditional health workers, and poor referral practices by health workers. Conclusion. Rural health workers in Nkanu West Local Government and other rural communities in Nigeria and Africa should be educated on the roles and scope of physiotherapy. There is a need for raising awareness of the management options for movement/functional problems for rural indigenous communities in Nigeria in particular and Africa in general. Physiotherapists should be made aware of the growing need for physiotherapy in rural areas of Nigeria and Africa largely comprising of the elderly.

Balance, Falls-Related Self-Efficacy, and Psychological Factors amongst Older Women with Chronic Low Back Pain: A Preliminary Case-Control Study

Annick Champagne, François Prince, Vicky Bouffard, and Danik Lafond — Thu, 09 Aug 2012 12:10:57 +0000

Objective. To investigate balance functions in older women and evaluate the association of the fear-avoidance beliefs model (FABM) factors with balance and mobility performance. Participants. Fifteen older women with CLBP was compared with age-matched pain-free controls (𝑛=15). Main Outcome Measures. Pain intensity, falls-related self-efficacy and intrinsic constructs in the FABM were evaluated. Postural steadiness (centre of pressure (COP)) and mobility functions were assessed. Linear relationships of FABM variables with COP and mobility score were estimated. Results. CLBP showed lower mobility score compared to controls. CLBP presented lower falls-related self-efficacy and it was associated with reduced mobility scores. FABM variables and falls-related self-efficacy were correlated with postural steadiness. Physical activity was reduced in CLBP, but no between-group difference was evident for knee extensor strength. No systematic linkages were observed between FABM variables with mobility score or postural steadiness. Conclusions. Back pain status affects balance and mobility functions in older women. Falls-related self-efficacy is lower in CLBP and is associated with reduced mobility. Disuse syndrome in CLBP elderly is partly supported by the results of this preliminary study.

Electromyographical Comparison of Four Common Shoulder Exercises in Unstable and Stable Shoulders

Aaron Sciascia, Nina Kuschinsky, Arthur J. Nitz, Scott D. Mair, and Tim L. Uhl — Tue, 07 Aug 2012 08:40:41 +0000

This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (𝑛=10), anterior instability (𝑛=9), generalized laxity (𝑛=10), or a healthy shoulder (𝑛=10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the primary musculature targeted in each exercise equally among all groups. The serratus anterior generated high activity (50–80% MVIC) during a push-up plus, while the infraspinatus and teres major generated moderate-to-high activity (30–80% MVIC) during both the prone horizontal and prone external rotation exercises. Scaption exercise generated moderate activity (20–50% MVIC) in both rotator cuff and scapular musculature. Clinicians should feel confident in prescribing these shoulder-strengthening exercises in patients with shoulder instability as the activation levels are comparable to previous findings regarding EMG amplitudes and should improve the dynamic stabilization capability of both rotator cuff and scapular muscles using exercises designed to address glenohumeral joint instability.

Concerns of Indian Mothers with Children Having Severe-to-Profound Hearing Impairment at Diagnosis and after 1–3 Years of Therapy

Nachiketa Rout and Megha Khanna — Sun, 05 Aug 2012 10:53:21 +0000

Counseling training in graduate programs continues to be underrepresented. If parental queries are not addressed adequately, they keep visiting one doctor after another. Objective. The aim of the study is to identify maternal needs of children with hearing impairment at two stages of habilitation, that is, just after diagnosis (group I) and after receiving 1 to 3 years of language therapy (group II). Methods. Two groups of mothers were asked to speak their queries about aural habilitation of their children. Queries were recorded, summarized, and categorized as per their priorities. Results. Group I mothers wanted to know about how the child would learn to listen and speak (45%), causes of hearing loss (33.7%), understanding the ear and hearing (10.2%), understanding the audiogram (7%), and coping with emotional aspects of hearing loss (5%), while group II parents had priorities concerning speech development (24.5%) followed by child independence and employment (17.3%), schooling (15.6%), problem behaviors (11%), amplification device (9.4%), duration of therapy (8%), future of the child (8%), and questions about how can my child get adjusted to the “normal” world (6%). Conclusions. Culture- and language-specific materials to explain these issues need to be developed.

Determining the Needs, Priorities, and Desired Rehabilitation Outcomes of Young Adults Who Have Had a Stroke

Maggie Lawrence and Sue Kinn — Wed, 18 Jul 2012 11:11:35 +0000

Background. Guidelines state that young adults' (aged 18–55 years) rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities. Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes. Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction. Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes. Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory.

Manual Wheelchair Use: Bouts of Mobility in Everyday Life

Sharon Eve Sonenblum, Stephen Sprigle, and Ricardo A. Lopez — Sun, 15 Jul 2012 10:12:33 +0000

Background. This study aimed to describe how people move about in manual wheelchairs (MWCs) during everyday life by evaluating bouts of mobility or continuous periods of movement. Methods. A convenience sample of 28 MWC users was recruited. Participants' everyday mobility was measured using a wheel-mounted accelerometer and seat occupancy switch for 1-2 weeks. Bouts of mobility were recorded and characterized. Results. Across 29,200 bouts, the median bout lasted 21 seconds and traveled 8.6 m at 0.43 m/s. 85% of recorded bouts lasted less than 1 minute and traveled less than 30 meters. Participants' daily wheelchair activity included 90 bouts and 1.6 km over 54 minutes. Average daily occupancy time was 11 hours during which participants wheeled 10 bouts/hour and spent 10% of their time wheeling. Spearman-Brown Prophecy analysis suggested that 7 days were sufficient to achieve a reliability of 0.8 for all bout variables. Conclusions. Short, slow bouts dominate wheelchair usage in a natural environment. Therefore, clinical evaluations and biomechanical research should reflect this by concentrating on initiating movement, maneuvering wheelchairs, and stopping. Bouts of mobility provide greater depth to our understanding of wheelchair use and are a more stable metric (day-to-day) than distance or time wheeled.

Traumatic Brain Injury in Sports: A Review

Christopher S. Sahler and Brian D. Greenwald — Mon, 09 Jul 2012 10:25:52 +0000

Traumatic brain injury (TBI) is a clinical diagnosis of neurological dysfunction following head trauma, typically presenting with acute symptoms of some degree of cognitive impairment. There are an estimated 1.7 to 3.8 million TBIs each year in the United States, approximately 10 percent of which are due to sports and recreational activities. Most brain injuries are self-limited with symptom resolution within one week, however, a growing amount of data is now establishing significant sequelae from even minor impacts such as headaches, prolonged cognitive impairments, or even death. Appropriate diagnosis and treatment according to standardized guidelines are crucial when treating athletes who may be subjected to future head trauma, possibly increasing their likelihood of long-term impairments.

Self-Paced Walking within a Diverse Topographical Environment Elicits an Appropriate Training Stimulus for Cardiac Rehabilitation Patients

James Faulkner, Johannes Gerhard, Lee Stoner, and Danielle Lambrick — Mon, 09 Jul 2012 09:13:27 +0000

Purpose. To assess the effect of a self-paced walking intervention within a topographically varied outdoor environment on physiological and perceptual markers in cardiac rehabilitation (CR) patients. Methods. Sixteen phase II CR patients completed twelve self-paced one-mile walking sessions over a four-week period within a community-based CR programme. Walking velocity, heart rate (HR), and ratings of perceived exertion (RPE) were reported at eight stages throughout the self-paced walks. Results. The study showed a significant increase in walking velocity from week 1 (~4.5 km/h) to week 4 (~5.1 km/h) of the self-paced walking programme (𝑃<.05). A significantly higher HR was also observed in week 4 (111±13 b·min−1; ~69% of maximal HR) compared to week 1 (106±14 b·min−1; ~65% of maximal HR, 𝑃<.001). There were no changes in the average RPE across the course of the 4-week self-paced walking programme (𝑃>.05). Conclusion. A self-paced walking programme may elicit an appropriate training stimulus for CR patients when exercising within a diverse topographical environment. Participants completed a one-mile walk within a shorter period of time and at a higher physiological intensity than that elicited at the onset of the programme, despite no observed changes in participants' subjective perception of exertion.

The Integration of Cognitive Remediation Therapy into the Whole Psychosocial Rehabilitation Process: An Evidence-Based and Person-Centered Approach

Mon, 02 Jul 2012 10:17:22 +0000

Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.

Enhancing Work-Focused Supports for People with Severe Mental Illnesses in Australia

Sun, 01 Jul 2012 10:33:48 +0000

Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI.

The Relationship between Beliefs about Pain and Functioning with Rheumatologic Conditions

Tracey Pons, Edward Shipton, and Rodger Mulder — Tue, 26 Jun 2012 08:55:50 +0000

Pain beliefs influence understanding of pain mechanisms and outcomes. This study in rheumatologic conditions sought to determine a relationship between beliefs about pain and functioning. Participants in Arthritis New Zealand’s (ANZ) exercise and education programmes were used. Demographic data and validated instruments used included the Arthritis Impact Measurement Scale 2nd version-Short Form (AIMS2-SF) to measure functioning, and two scales of organic and psychological beliefs in Pain Beliefs Questionnaires (PBQ) to measure pain beliefs. 236 Members of ANZ were surveyed anonymously with AIMS2-SF and PBQ, with a 61% response rate; 144 responses were entered into the database. This study used α of 0.05 and a 1-β of 0.8 to detect for significant effect size estimated to be 𝑟=0.25. Analysis revealed a significant relationship between organic beliefs scale of PBQ and functioning of AIMS2-SF, with an 𝑟 value of 0.32 and 𝑃 value of 0.00008. No relationship was found between psychological beliefs scale of PBQ and AIMS2-SF. Organic pain beliefs are associated with poorer functioning. Psychological pain beliefs are not. Beliefs might have been modified by ANZ programmes. Clinicians should address organic pain beliefs early in consultation. Causal links between organic pain beliefs and functioning should be clarified.

Can Social Functioning in Schizophrenia Be Improved through Targeted Social Cognitive Intervention?

David L. Roberts and Dawn I. Velligan — Wed, 13 Jun 2012 09:44:26 +0000

Efforts to use cognitive remediation in psychosocial intervention for schizophrenia have increasingly incorporated social cognition as a treatment target. A distinction can be made in this work between “broad-based” interventions, which integrate social cognitive training within a multicomponent suite of intervention techniques and “targeted” interventions; which aim to enhance social cognition alone. Targeted interventions have the potential advantage of being more efficient than broad-based interventions; however, they also face difficult challenges. In particular, targeted interventions may be less likely to achieve maintenance and generalization of gains made in treatment. A novel potential solution to this problem is described which draws on the social psychological literature on social cognition.

Postconcussion Symptoms in Patients with Injury-Related Chronic Pain

Britt Marie Stålnacke — Tue, 22 May 2012 14:16:56 +0000

Background. Postconcussion symptoms (PCSs)—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs). Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods. This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ), pain intensity (Visual Analogue Scale), depression, anxiety (Hospital, Anxiety, and Depression Scale), and posttraumatic stress (Impact of Event Scale). Results. Fatigue (90.7%), sleep disturbance (84.9%), headache (73.5%), poor concentration (88.2%), and poor memory (67.1%) were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion. To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.

Additional Interventions to Enhance the Effectiveness of Individual Placement and Support: A Rapid Evidence Assessment

Naomi Boycott, Justine Schneider, and Mary McMurran — Tue, 22 May 2012 09:40:31 +0000

Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS). Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion. Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

Substance Use and Mild Traumatic Brain Injury Risk Reduction and Prevention: A Novel Model for Treatment

Thu, 17 May 2012 14:34:51 +0000

Traumatic brain injury (TBI) and substance use disorders (SUDs) frequently co-occur. Individuals with histories of alcohol or other drug use are at greater risk for sustaining TBI, and individuals with TBI frequently misuse substances before and after injury. Further, a growing body of literature supports the relationship between comorbid histories of mild TBI (mTBI) and SUDs and negative outcomes. Alcohol and other drug use are strongly associated with risk taking. Disinhibition, impaired executive function, and/or impulsivity as a result of mTBI also contribute to an individual’s proclivity towards risk-taking. Risk-taking behavior may therefore, be a direct result of SUD and/or history of mTBI, and risky behaviors may predispose individuals for subsequent injury or continued use of substances. Based on these findings, evaluation of risk-taking behavior associated with the co-occurrence of SUD and mTBI should be a standard clinical practice. Interventions aimed at reducing risky behavior among members of this population may assist in decreasing negative outcomes. A novel intervention (Substance Use and Traumatic Brain Injury Risk Reduction and Prevention (STRRP)) for reducing and preventing risky behaviors among individuals with co-occurring mTBI and SUD is presented. Areas for further research are discussed.

Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis

Angélique Slijper, Anna Danielsson, and Carin Willén — Thu, 17 May 2012 10:01:53 +0000

Objective. The aim was to compare walking with an individually designed dynamic hinged ankle foot orthosis (DAFO) and a standard carbon composite ankle foot orthosis (C-AFO). Methods. Twelve participants, mean age 56 years (range 26–72), with hemiparesis due to stroke were included in the study. During the six-minute walk test (6MW), walking velocity, the Physiological Cost Index (PCI), and the degree of experienced exertion were measured with a DAFO and C-AFO, respectively, followed by a Stairs Test velocity and perceived confidence was rated. Results. The mean differences in favor for the DAFO were in 6MW 24.3 m (95% confidence interval [CI] 4.90, 43.76), PCI −0.09 beats/m (95% CI −0.27, 0.95), velocity 0.04 m/s (95% CI −0.01, 0.097), and in the Stairs Test −11.8 s (95% CI −19.05, −4.48). All participants except one perceived the degree of experienced exertion lower and felt more confident when walking with the DAFO. Conclusions. Wearing a DAFO resulted in longer walking distance and faster stair climbing compared to walking with a C-AFO. Eleven of twelve participants felt more confident with the DAFO, which may be more important than speed and distance and the most important reason for prescribing an AFO.