Faculty Bibliography

The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.

OBJECTIVE:To examine how positive affect influences ability to benefit from heart rate variability (HRV) biofeedback treatment for individuals with severe brain injury. METHOD/METHODS:Secondary data analysis of a nonrandomized experimental study that assessed the efficacy of biofeedback treatment for executive dysfunction in 13 individuals with chronic severe brain injury. RESULTS:Bivariate correlations between the predictors (levels of HRV and positive affect) and the outcome (change in Category Test errors) showed large effect sizes for higher levels of HRV coherence (r = -.495, p = .085) but not for positive affect (r = .069, p = .824). Although positive affect had a negligible effect on Category Test improvements by itself, positive affect played a moderating role that complemented the effect of HRV coherence. HRV coherence had a stronger effect on Category Test performance among those participants who demonstrated higher positive affect. A regression model was fit that included main effects for HRV coherence and positive affect, as well as their interaction. The interaction term was significant in a 1-tailed test (b = -3.902, SE = 1.914, p = .072). CONCLUSIONS:Participants who had the most positive emotions made the most gains in the HRV biofeedback training and performed better posttreatment on a test designed to measure problem-solving ability. Results indicate that positive affect can improve cognition, specifically mental flexibility and abstract thinking. Addressing factors that shape negative affect such as irrational beliefs and self-doubt is an important target for therapeutic intervention even in those with severe, chronic deficits. (PsycINFO Database Record

BACKGROUND: Cognitive impairments are common in individuals with MS and adversely affect functioning. Early detection of cognitive impairment, therefore, would enable earlier, and possibly more effective, treatment. We sought to compare self-reports with a short neuropsychological test as possible screening tools for cognitive impairment. METHODS: One hundred patients with MS were tested with the Minimal Assessment of Cognitive Function in Multiple Sclerosis; z scores were used to derive the Cognitive Index (CI). Receiver operator characteristic curve analyses were performed, with criteria for impairment set at -1.5 and -2.0 SD below the mean. Scores from two self-reports (the Multiple Sclerosis Neuropsychological Screening Questionnaire-Patient Version and the Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A]) and a neuropsychological test (the Symbol Digit Modalities Test [SDMT]) were entered as test variables. Exploratory regression analyses were conducted with 1) CI and self-reports and 2) CI and the Problem-Solving Inventory (PSI). RESULTS: Classification accuracy was high or moderately high for SDMT when the criterion was -2.0 or -1.5 SD, respectively, but low for the self-reports. Hierarchical linear regression showed that the SDMT alone was the best predictor of cognitive impairment; adding the self-reports did not improve the model. Exploratory analyses indicated that certain self-reports (BRIEF-A, PSI) provided some explanatory power in separate models. CONCLUSIONS: The SDMT is a more accurate screening tool for cognitive impairment; however, self-reports provide additional information and may complement objective testing. Results suggest that screening for cognitive impairment may require a multidimensional approach.

OBJECTIVE: Cognitive dysfunction is prevalent in multiple sclerosis. As self-reported cognitive functioning is unreliable, brief objective screening measures are needed. Utilizing widely used full-length neuropsychological tests, this study aimed to establish the criterion validity of highly abbreviated versions of the Brief Visuospatial Memory Test - Revised (BVMT-R), Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (D-KEFS) Sorting Test, and Controlled Oral Word Association Test (COWAT) in order to begin developing an MS-specific screening battery. METHOD: Participants from Holy Name Medical Center and the Kessler Foundation were administered one or more of these four measures. Using test-specific criterion to identify impairment at both -1.5 and -2.0 SD, receiver-operating-characteristic (ROC) analyses of BVMT-R Trial 1, Trial 2, and Trial 1 + 2 raw data (N = 286) were run to calculate the classification accuracy of the abbreviated version, as well as the sensitivity and specificity. The same methods were used for SDMT 30-s and 60-s (N = 321), D-KEFS Sorting Free Card Sort 1 (N = 120), and COWAT letters F and A (N = 298). RESULTS: Using these definitions of impairment, each analysis yielded high classification accuracy (89.3 to 94.3%). CONCLUSIONS: BVMT-R Trial 1, SDMT 30-s, D-KEFS Free Card Sort 1, and COWAT F possess good criterion validity in detecting impairment on their respective overall measure, capturing much of the same information as the full version. Along with the first two trials of the California Verbal Learning Test - Second Edition (CVLT-II), these five highly abbreviated measures may be used to develop a brief screening battery.

Objective(s): To determine if relationship between heart rate variability/ HRV and problem-solving is moderated by positive affect. Design: Quasi-experimental. Setting: Community-based structured day program. Participants: Thirteen individuals, aged 23-63 years with severe, chronic brain injury (13-40 years post-onset). Interventions: HRV biofeedback. Main Outcome Measure(s): PANAS positive affect/PANAS-PA; category test/CT; HRV- index (coherence ratio/CR). Results: Bivariate regression using HRV-CR to predict CT revealed moderately-large effect size, with trend towards significance, p=.085, ES(r) =.50. Similar overall interaction effect was observed when PANAS-PA was added as moderator, p=.07, ES (R²) =.23. Johnson Neyman technique revealed that when PANAS-PA was low, coherence did not have significant relationship with improvements in CT. However, when PANAS-PA was >5.79 above the mean (>36.64), the effect of coherence was in the expected negative direction (lower scores in CT reflect better performance) and significant, with large effect size, p<.05, ES(r) >.60. Conclusions: Published studies demonstrate significant association between problem-solving and HRV (Thayer, 2006; Porges, 2001). This sample demonstrated moderate-to-large main effect for HRV, which did not reach statistical significance. Taking into account levels of positive affect clarified the relationship and revealed that the effect of HRV on problem-solving was larged and statistically significantd when positive affect was high. The significant role of PANAS-PA in moderating problem solving performance is consistent with literature which found positive affect increases mental flexibility, creativity, and coping behaviors (Ashby, 1999; Damasio & Carvalho, 2013). Results are conceptually congruent with contemporary problem-solving cognitive rehabilitation models (e.g., Rath et al., 2011) and consistent with Shewchuk et al.'s (2000) study of healthy adults where negative problem-orientationdbeliefs and attitudes about one's own problem-solving abilitydimpeded objective performance on CT. These findings have important implications for addressing affect and problem-orientation in cognitive rehabilitation; dispositions to harbor pessimism about self might impede motivation for/attainment of meaningful, goal-directed behavior