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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
Overview of Common Complementary and Integrative Approaches to Managing Chronic Pain: A Guide for Patients With Chronic Pain
Krishnan, Shilpa; Anderson, Dustin; Chan, Sophia; Kim, Sonya; Reistetter, Timothy; Sood, Pallavi; Mortera, Marianne H; Heesakker, Justin M; Heyn, Patricia C
PMID: 30055791
ISSN: 1532-821x
CID: 3629942
Problem solving, biofeedback, and severe brain injury: The moderating role of positive affect
Kim, Sonya; Rath, Joseph F; Zemon, Vance; Cavallo, Marie M; McCraty, Rollin; Sostre, Ana; Foley, Frederick W
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
PMID: 29553790
ISSN: 1939-1544
CID: 2995482
Complementary and Integrative Medicine Utilization Among Rehabilitation Professionals: Attitudes and Practice
Kim, Sonya; Theodore, Brian; Capo-Lugo, Carmen; Krishnan, Shilpa; Ehsanian, Reza; Hu, Xiaolei; Beatie, Aaron; Vora, Ariana; Mortera, Marianne; Chan, Sophia; Sasson, Nicole; Tyson, Allan; Ginsberg, Jp; Appel, Philip; Tibbett, Jacqueline; Heyn, Patricia
ORIGINAL:0013237
ISSN: 0003-9993
CID: 3629952
An Umbrella Review of Systematic Reviews of Pharmacological Treatments Post-TBI
Kim, Sonya; Mortera, Marianne; Hoffecker, Lilian; Herrold, Amy; King, Laurie; Terhorst, Lauren; Hu, Xiaolei; Krishnan, Shilpa; Machtinger, Joseph; Heyn, Patricia
CINAHL:125310531
ISSN: 0003-9993
CID: 2735452
Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis
Kim, Sonya; Zemon, Vance; Rath, Joseph F; Picone, MaryAnn; Gromisch, Elizabeth S; Glubo, Heather; Smith-Wexler, Lucia; Foley, Frederick W
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.
PMCID:5315317
PMID: 28243180
ISSN: 1537-2073
CID: 2482902
Assessing the criterion validity of four highly abbreviated measures from the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS)
Gromisch, Elizabeth S; Zemon, Vance; Holtzer, Roee; Chiaravalloti, Nancy D; DeLuca, John; Beier, Meghan; Farrell, Eileen; Snyder, Stacey; Schairer, Laura C; Glukhovsky, Lisa; Botvinick, Jason; Sloan, Jessica; Picone, Mary Ann; Kim, Sonya; Foley, Frederick W
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.
PMID: 27279357
ISSN: 1744-4144
CID: 2136472
TBI and identity : The unmaking and remaking of the self
Kim, Sonya
ORIGINAL:0011628
ISSN: n/a
CID: 2297812
Heart rate variability biofeedback, self-regulation, and severe brain injury
Kim, Sonya; Rath, Joseph F; McCraty, Rollin; Zemon, Vance; Cavallo, Marie M; Foley, Frederick W
This article describes a study using heart rate variability (HRV) biofeedback to treat emotional dysregulation in 13 individuals with severe chronic brain injury. Measures included HRV indices, tests of attention and problem solving, and informant reports of behavioral regulation. Results demonstrated that individuals with severe brain injury were able to learn HRV biofeedback and increase coherence between the parasympathetic and sympathetic nervous systems. Individuals who attained the greatest coherence were rated as being able to best regulate their emotions and behavior.
PSYCH:2015-21901-003
ISSN: 2158-348x
CID: 1666892