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Heart Rate Variability Biofeedback for Mental Health Treatment: A Policy Brief

Kim, Sonya
The WHO argues that a pharmacy-first approach should no longer be the reflexive treatment for mental health diagnoses. Heart rate variability biofeedback (HRVB) demonstrably treats various conditions"”especially effective at regulating emotion, particularly managing and alleviating anger, stress, anxiety, and depression, common co-morbid diagnoses for rehabilitation medicine patients. HRVB trains users to study their biofeedback data in real time, alter bodily functions previously believed to be automatic, and garner health benefits. Despite convenience, relatively low cost, and empowering patients to manage their own symptoms, the current lack of reimbursability, and the lack of Phase III RCTs limit HRVB application. Ideally, the confidence of practitioners, patients, and insurers would follow the known efficacy of HRVB for the treatment of mental health conditions.
ISSN: 2372-7322
CID: 5447442

The Impact of Complementary and Integrative Medicine Following Traumatic Brain Injury: A Scoping Review

Kim, Sonya; Mortera, Marianne H; Wen, Pey-Shan; Thompson, Karla L; Lundgren, Kristine; Reed, William R; Sasson, Nicole; Towner Wright, Sarah; Vora, Ariana; Krishnan, Shilpa; Joseph, Justin; Heyn, Patricia; Chin, Bridget S
OBJECTIVE:To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). DATA SOURCES/METHODS:MEDLINE (OvidSP), PubMed (NLM), EMBASE (, CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). DATA EXTRACTION/METHODS:Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. DATA SYNTHESIS/RESULTS:In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. CONCLUSION/CONCLUSIONS:Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.
PMID: 35452024
ISSN: 1550-509x
CID: 5206322

Perceptions and use of complementary and integrative health practices among rehabilitation professionals: A survey

Wen, Pey Shan; Vora, Ariana; Mortera, Marianne; Sasson, Nicole; Reed, William R.; Ehsanian, Reza; Galantino, Mary Lou; Erb, Matt; Hu, Xiaolei; Kim, Sonya
Introduction: Despite increasing use of complementary and integrative health (CIH) by rehabilitation providers, information on rehabilitation professionals"™ perceptions and utilization of CIH is limited. The purpose of this study was to investigate rehabilitation professionals"™ perceptions, utilization, barriers and research of CIH in the United States. Methods: A cross-sectional online survey was conducted on the perceptions, utilization, barriers and research regarding CIH. Survey invitations were posted on community boards of rehabilitation associations and sent to rehabilitation institutions listserv in 2020. Results: Of 405 respondents, the majority of respondents were physical therapists (PTs) (34%), then, occupational therapists (OTs) (20%), and physicians (16.8%). Most respondents (68%) worked in settings offering integrative health. Forty three percent of respondents were trained and 22% were certified in CIH practice. Breathing exercises, meditation, massage, and yoga were the most commonly utilized practices for self-care and patient care. Physicians and PTs were more likely than OTs to initiate discussion about CIH with patients (p=.001 and p=.046 respectively), and senior practitioners were more likely to initiate these discussions than junior practitioners (p=.037 and p<.001, respectively). Peer-reviewed publications, clinical experience, and personal experience with CIH were the most selected factors affecting respondents"™ attitudes toward CIH practices. Rehabilitation clinicians reported that insufficient provider reimbursement and insufficient skills were the primary obstacles to CIH practice. Rehabilitation researchers reported that insufficient funding as the primary obstacle to conducting CIH research. Conclusions: Rehabilitation professionals commonly utilize CIH in practices for self-care and patient care, and they perceive insufficient training, clinical reimbursement and research funding as the main barriers to advancing CIH.
ISSN: 1876-3820
CID: 5311582

An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury

Kim, Sonya; Mortera, Marianne; Heyn, Patricia; Sood, Pallavi; Wen, Pey-Shan; Chen Wong, Diana; Tanveer, Sarah; Hu, Xiaolei
BACKGROUND/UNASSIGNED:There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI. OBJECTIVES/UNASSIGNED:To summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality. METHODS/UNASSIGNED:Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2. RESULTS/UNASSIGNED:Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management. RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate-to-high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations. CONCLUSIONS/UNASSIGNED:PROSPERO-Registration: CRD42015017355.
PMID: 35708261
ISSN: 1362-301x
CID: 5249902

The Utopia of Disability Inclusion in the Rehabilitation Sciences: An Insider's Perspective

Kim, Sonya; Rizzo, John-Ross; Forber-Pratt, Anjali J; Capo-Lugo, Carmen; Heyn, Patricia C
The inclusion of people with disabilities has historically been, and continues to be, challenging work. In the health professions, the practice of inclusion should promote and advance the dissemination of efforts to decrease the impact of societal and physical barriers on the lives of people with disability, as well as promote innovative approaches to effectively foster an inclusive society. In addition to a focus on concepts such as the intact abilities of people with disabilities and the facilitation of community participation, an important shift in inclusion-related research requires listening to the lived experience of individuals with disabilities. Listening to their lived experiences and including the valuable insights gleaned from their insider's perspective can enrich efforts to evaluate clinical and educational programs, define population needs, and set research agendas and rehabilitation goals. Building on seminal work from Tamara Dembo, Beatrice Wright, and Margaret Brown, this communication from the Disability Representation Task Force at the American Congress of Rehabilitation Medicine also explores how healthcare providers living with a disability can make a significant contribution to rehabilitation treatment by analyzing how their own experience applies to clinical practice.
PMID: 36473220
ISSN: 1945-404x
CID: 5381692

Complementary and integrative medicine

Chapter by: Kim, Sonya; Van De Winckel, Ann; Thompson, Karla L.; Heyn, Patricia C.
in: Brain Injury Medicine, Third Edition: Principles and Practice by
[S.l.] : Springer Publishing Company, 2021
pp. 1185-1206
ISBN: 9780826143051
CID: 5369002

Measuring personal growth in partners of persons with multiple sclerosis: A new scale

Kim, Sonya; Zemon, Vance; Foley, Frederick W
OBJECTIVE:The purpose of this study was to describe the development and validation of a personal growth scale in caregiving partners of persons with multiple sclerosis (MS). METHOD/METHODS:= 315), and the instrument's psychometric properties were assessed. RESULTS:Study 2 sample was suitable for principal component analysis (PCA), and PCA was performed with oblique rotation. A 6-component solution was deemed most parsimonious and interpretable. Subscales were formed and labeled as follows: Positivity, Appreciation, Acceptance, Insight, Independence, and Spirituality. Reliability analysis of the subscales showed acceptable to high internal consistency. A secondary PCA was performed on mean subscale scores. Five of the six subscales clustered together along one dimension, and the sixth, Spirituality, was found to be distinct as represented in a loading plot. This subscale was retained as an independent measure; the remaining subscale scores were summed to create a total score. Measures of convergent and discriminant validity evaluated against existing instruments yielded findings in the expected directions. CONCLUSIONS:The dimensionality and structure of personal growth in caregiving partners of persons with MS were delineated in a novel instrument. Future studies should confirm its structure, establish classification criteria, and standardize it as an assessment tool. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
PMID: 31855017
ISSN: 1939-1544
CID: 4271602

Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine

Kim, Sonya; Capo-Lugo, Carmen; Reed, William R; Vora, Ariana; Ehsanian, Reza; Krishnan, Shilpa; Hu, Xiaolei; Galantino, Mary Lou; Mortera, Marianne H; Beattie, Aaron; Sasson, Nicole; Theodore, Brian R; Erb, Matt; Heyn, Patricia
PMID: 32302490
ISSN: 1557-7708
CID: 4401832

Emotion regulation after acquired brain injury: a study of heart rate variability, attentional control, and psychophysiology

Kim, Sonya; Zemon, Vance; Lehrer, Paul; McCraty, Rollin; Cavallo, Marie M; Raghavan, Preeti; Ginsberg, Jay Jp; Foley, Frederick W
PRIMARY OBJECTIVE/OBJECTIVE:To examine the efficacy of heart rate variability biofeedback (HRV-BF) to treat emotional dysregulation in persons with acquired brain injury. DESIGN/METHODS:A secondary analysis of a quasi-experimental study which enrolled 13 individuals with severe chronic acquired brain injury participating in a community-based programme. Response-to-treatment was measured with two HRV resonance indices (low frequency activity [LF] and low frequency/high frequency ratio [LF/HF]). MAIN OUTCOME/RESULTS:Behavior Rating Inventory of Executive Function-informant report (emotional control subscale [EC]). RESULTS:Results show significant correlation between LF and EC with higher LF activity associated with greater emotional control; the association between LF/HF pre-post-change score and EC is not statistically significant. A moderation model, however, demonstrates a significant influence of attention on the relation between LF/HF change and EC when attention level is high, with an increase in LF/HF activity associated with greater emotional control. CONCLUSIONS:HRV-BF is associated with large increases in HRV, and it appears to be useful for the treatment of emotional dysregulation in individuals with severe acquired brain injury. Attention training may enhance an individual's emotional control.
PMID: 30907142
ISSN: 1362-301x
CID: 3778692

Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes

Kim, Sonya; Mortera, Marianne; Hu, Xiaolei; Krishnan, Shilpa; Hoffecker, Lilian; Herrold, Amy; Terhorst, Lauren; King, Laurie; Machtinger, Joseph; Zumsteg, Jennifer M; Negm, Ahmed; Heyn, Patricia
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.
PMID: 30694081
ISSN: 1362-301x
CID: 3626552