Faculty Bibliography

Primary objective: To determine if individuals with brain injury can modify heart rate variability (HRV) through biofeedback and, if so, enhance its pattern to improve emotional regulation and problem-solving ability. Design: A quasi-experimental design with repeated measures was employed. Thirteen individuals aged 23-63 years with severe brain injury (13-40 years post-onset) participating in a community-based programme were enrolled. Main outcomes: Response-to-treatment was measured with HRV indices, Behavior Rating Inventory of Executive Function (BRIEF-A-Informant) and attention/problem-solving tests. Results: At post-treatment, HRV indices (Low Frequency/High Frequency [LF/HF] and coherence ratio) increased significantly. Increased LF/HF values during the second-half of a 10-minute session were associated with higher attention scores. Participants who scored better (by scoring lower) in informant ratings at pre-treatment had highest HRV scores at post-treatment. Accordingly, at post-treatment, families' ratings of participants' emotional control correlated with HRV indices; staffs' ratings of participants' working memory correlated with participants' HRV indices. Self-ratings of the BRIEF-A Task Monitoring scale at post-treatment correlated with family ratings at pre-treatment and post-treatment. Conclusions: Results demonstrate an association between regulation of emotions/cognition and HRV training. Individuals with severe, chronic brain injury can modify HRV through biofeedback. Future research should evaluate the efficacy of this approach for modifying behavioural problems.

While motor and cognitive impairments are common in Multiple Sclerosis (MS) patients, research concerning their relationship in this population has been limited. We aimed to evaluate cross-sectional associations between cognitive functions, walking speed, and falls in patients with MS. Through a retrospective chart review of 81 patients with MS, we examined whether measures of cognitive function predicted walking speed on the Timed 25-Foot Walk and self-reported fall frequency. Hierarchical linear regressions showed that after controlling for age, gender, and disease severity, slower processing speed and IQ predicted slower gait speed, while poorer verbal memory predicted increased frequency of falls. Moreover, a binary logistic regression showed that poorer verbal memory also predicted increased risk of multiple falls. Thus, specific cognitive functions are meaningfully related to mobility limitations in patients with MS. These findings suggest that risk assessment for gait decline and falls should include cognitive assessment in patients with MS.

Multiple sclerosis (MS) is the most common cause of neurologic disease in young and middle-aged adults, and 75% of patients are female. Nearly one in two patients with MS will experience clinically significant depression-approximately three times the prevalence rate in the general population. This study used a cross-sectional approach to examine the link between depression levels and use of interferon medications among individuals with MS. Data were collected from 694 patients of the Multiple Sclerosis Comprehensive Care Center at Holy Name Medical Center in Teaneck, New Jersey. Analysis of variance was used to compare depression scores between patients taking and not taking interferons. Regression analyses with depression scores as the dependent variable were also conducted. The Beck Depression Inventory (BDI) was reduced to a set of dimensions by principal components analysis. Two components were identified, reflecting somatic and cognitive symptoms. The results showed no significant relationship between depression levels and interferon treatment. Significant associations were observed between depression and both age and disability status, with younger, more disabled patients tending to be more depressed.