Faculty Bibliography

BACKGROUND: The field of positive psychology has grown exponentially within the last decade. To date, however, there have been few empirical initiatives to clarify the constructs within positive psychology as they relate to rehabilitation medicine. Character strengths, and in particular resilience, following neurological trauma are clinically observable within rehabilitation settings, and greater knowledge of the way in which these factors relate to treatment variables may allow for enhanced treatment conceptualization and planning. OBJECTIVE: The goal of this study was to explore the relationships between positive psychology constructs (character strengths, resilience, and positive mood) and rehabilitation-related variables (perceptions of functional ability post-injury and beliefs about treatment) within a baseline data set, a six-month follow-up data set, and longitudinally across time points. METHODS: Pearson correlations and supplementary multiple regression analyses were conducted within and across these time points from a starting sample of thirty-nine individuals with acquired brain injury (ABI) in an outpatient rehabilitation program. RESULTS: Positive psychology constructs were related to rehabilitation-related variables within the baseline data set, within the follow-up data set, and longitudinally between baseline positive psychology variables and follow-up rehabilitation-related data. CONCLUSIONS: These preliminary findings support relationships between character strengths, resilience, and positive mood states with perceptions of functional ability and expectations of treatment, respectively, which are primary factors in treatment success and quality of life outcomes in rehabilitation medicine settings. The results suggest the need for more research in this area, with an ultimate goal of incorporating positive psychology constructs into rehabilitation conceptualization and treatment planning.

Objective: Cognitive and emotional symptoms are primary causes of long-term functional impairment after acquired brain injury (ABI). Although the occurrence of post-ABI emotional difficulties is well-documented, most investigators have focused on the impact of depression on functioning after ABI, with few examining the role of anxiety. Knowledge of the latter's impact is essential for optimal treatment planning in neurorehabilitation settings. The purpose of the present study is therefore to examine the predictive relationships between cognition, anxiety, and functional impairment in an ABI sample. Method: Multiple regression analyses were conducted with a sample of 54 outpatients with ABI. Predictors selected from an archival data set included standardized neuropsychological measures and Beck Anxiety Inventory scores. Dependent variables were caregiver ratings of functional impairments in the Affective/Behavioral, Cognitive, and Physical/Dependency domains. Results: Anxiety predicted a significant proportion of the variance in caregiver-assessed real-life affective/behavioral and cognitive functioning. In contrast, objective neuropsychological test scores did not contribute to the variance in functional impairment. Neither anxiety nor neuropsychological test scores significantly predicted impairment in everyday physical/dependency function. Conclusion: These findings support the role of anxiety in influencing functional outcome post-ABI and suggest the necessity of addressing symptoms of anxiety as an essential component of treatment in outpatient neurorehabilitation. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Purpose: To investigate longitudinal changes in global and regional brain volume in patients 1 year after mild traumatic brain injury (MTBI) and to correlate such changes with clinical and neurocognitive metrics. Materials and Methods: This institutional review board-approved study was HIPAA compliant. Twenty-eight patients with MTBI (with 19 followed up at 1 year) with posttraumatic symptoms after injury and 22 matched control subjects (with 12 followed up at 1 year) were enrolled. Automated segmentation of brain regions to compute regional gray matter (GM) and white matter (WM) volumes was performed by using three-dimensional T1-weighted 3.0-T magnetic resonance imaging, and results were correlated with clinical metrics. Pearson and Spearman rank correlation coefficients were computed between longitudinal brain volume and neurocognitive scores, as well as clinical metrics, over the course of the follow-up period. Results: One year after MTBI, there was measurable global brain atrophy, larger than that in control subjects. The anterior cingulate WM bilaterally and the left cingulate gyrus isthmus WM, as well as the right precuneal GM, showed significant decreases in regional volume in patients with MTBI over the 1st year after injury (corrected P < .05); this was confirmed by means of cross-sectional comparison with data in control subjects (corrected P < .05). Left and right rostral anterior cingulum WM volume loss correlated with changes in neurocognitive measures of memory (r = 0.65, P = .005) and attention (r = 0.60, P = .01). At 1-year follow-up, WM volume in the left cingulate gyrus isthmus correlated with clinical scores of anxiety (Spearman rank correlation r = -0.68, P = .007) and postconcussive symptoms (Spearman rank correlation r = -0.65, P = .01). Conclusion: These observations demonstrate structural changes to the brain 1 year after injury after a single concussive episode. Regional brain atrophy is not exclusive to moderate and severe traumatic brain injury but may be seen after mild injury. In particular, the anterior part of the cingulum and the cingulate gyrus isthmus, as well as the precuneal GM, may be distinctively vulnerable 1 year after MTBI. (c) RSNA, 2013.

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.