The reliability of the wolf motor function test for assessing upper extremity function after stroke.

OBJECTIVE: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. DESIGN: Interrater and test-retest reliability. SETTING: A clinical research laboratory at a university medical center. PATIENTS: A sample of convenience of 24 subjects with chronic hemiplegia (onset >1yr), showing moderate motor impairment. INTERVENTION: The WMFT includes 15 functional tasks. Performances were timed and rated by using a 6-point functional ability scale. The WMFT was administered to subjects twice with a 2-week interval between administrations. All test sessions were videotaped for scoring at a later time by blinded and trained experienced therapists. MAIN OUTCOME MEASURE: Interrater reliability was examined by using intraclass correlation coefficients and internal consistency by using Cronbach's alpha. RESULTS: Interrater reliability was.97 or greater for performance time and.88 or greater for functional ability. Internal consistency for test 1 was.92 for performance time and.92 for functional ability; for test 2, it was.86 for performance time and.92 for functional ability. Test-retest reliability was.90 for performance time and.95 for functional ability. Absolute scores for subjects were stable over the 2 test administrations. CONCLUSION: The WMFT is an instrument with high interrater reliability, internal consistency, test-retest reliability, and adequate stability.

Independence of valence modulation and prepulse inhibition of startle.

This study sought to determine whether prepulse inhibition and valence modulation of startle are independent, both within and across individuals. Acoustic probes (105 dB) were delivered as 68 undergraduates viewed pleasant, neutral, and unpleasant pictures. Weak acoustic stimuli (8 dB above background) preceded half of the probes by 120 ms. As expected, startles were larger during unpleasant than during pleasant pictures, and smaller on prepulse than no-prepulse trials. In general, valence modulation and prepulse inhibition of startle were unrelated. That is, prepulse inhibition was consistent across affective states, valence modulation did not differ between no-prepulse and prepulse trials, and valence modulation and prepulse inhibition effects were uncorrelated across individuals. Analysis of raw and percent modification scores generally led to similar conclusions. It is concluded that valence modulation and prepulse inhibition are independent startle modulatory phenomena, although this conclusion is tempered by a finding of poor internal consistency reliability for valence modulation.

Anxiety in adult fixed-wing air transport patients.

INTRODUCTION: Critically ill patients may experience anxiety because of the method of transport, possibly having an impact on both patients and their health care providers. The purpose of this research was to study the presence and degree of anxiety in fixed-wing air transport patients. METHODS: Subjects were 41 patients 25 to 79 years of age. Self-ratings of anxiety were obtained and vital signs were recorded at five predesignated points before, during, and after the flight. Additional questions addressed current and previous experiences and perceptions of flying. RESULTS: Anxiety ratings were generally low, averaging approximately 1.9 on a 1 ("worry-free") to 10 ("completely terrified") scale. Anxiety was greatest in anticipation of the flight. Fourteen percent of patients had never flown before; patients with little or no flight experience had significantly higher anxiety ratings. However, in all cases anxiety declined steadily as the flight progressed. Most patients (82%) reported greater worry about their medical condition than about the flight. CONCLUSION: Anxiety is generally low among adult fixed-wing air transport patients and decreases further over time. This decrease was true even for patients who initially reported high levels of anxiety before the flight. The data suggest that previous flight experience can be used to predict anxiety during air medical transport.

Affective modulation of tactile startle.

Two studies were conducted to investigate affective modulation of startle responses to unilateral tactile probes and to determine whether such modulation is lateralized. Right-handed undergraduates received airpuffs to the left or right temple while viewing pleasant, neutral, and unpleasant pictures. Side of probe presentation was varied between the two trial blocks of the experiment in Study 1 (n = 48) but varied randomly within trial blocks in Study 2 (n = 48). Primary results were consistent across studies. Replicating and extending the findings for acoustic probes, eyeblink responses to tactile probes were larger during unpleasant than during pleasant pictures. However, affective modulation of startle did not differ reliably between the two sides of probe presentation (sensory laterality) or the two sides of the response (motor laterality) in either study or in a combined analysis.

Relationships between startle and cardiovascular reactivity.

Although startle and cardiovascular reactivity have been studied extensively, little is known about their relationship. In the present study, we examined cardiovascular responses and affective startle modulation in 112 normotensive individuals varying in self-reported fearfulness and parental cardiovascular health history. An initial intense noise burst elicited a phasic cardiac acceleration that was larger for fearful individuals. Startle blink responses were larger during aversive than during pleasant relaxing imagery but did not differ with fear group. Cognitive challenge tasks elicited heart rate and blood pressure increases that were unrelated to fearfulness or parental health history. However, greater startle potentiation by aversive imagery predicted larger pressor responses to cognitive challenge, especially among men. The observed relationship between startle and cardiovascular reactivity suggests a common mechanism for their affective modulation.

Impact of irritable bowel syndrome on quality of life.

The aims of this study were to determine the impact of irritable bowel syndrome on quality of life using a well-standardized measure, the SF-36, and to determine whether apparent impairments may be due to neuroticism. Undergraduate students with irritable bowel syndrome who had consulted a physician (41 females, 42 males), students with irritable bowel who had not consulted a physician (91 females, 74 males), and asymptomatic controls (52 females, 70 males) completed questionnaires on quality of life, neuroticism, and psychological distress. Patients showed greater impairment in quality of life than nonconsulters, who in turn showed greater impairment than controls. Neuroticism and psychological distress were correlated with all quality-of-life measures. However, when neuroticism and psychological distress were statistically partialed out, irritable bowel syndrome still had a significant negative impact. The SF-36 may be a useful outcome measure in treatment studies, but investigators will need to correct for confounding influences of neuroticism.

Irritable bowel syndrome defined by factor analysis. Gender and race comparisons.

To examine the applicability across subgroups of the Manning criteria commonly used to diagnose the irritable bowel syndrome, a 22-item symptom questionnaire was administered to male and female African-American and Caucasian adults (N = 1344). Principal components factor analysis with varimax rotation was used to identify symptom clusters. Consistent with the findings of a previous factor analytic study, three of the six Manning symptoms (loose stools and more frequent bowel movement with onset of pain, pain relieved by defecation) formed a cluster corresponding to the irritable bowel syndrome in all subgroups. It is concluded that: (1) The three core Manning symptoms have equal applicability to both genders and to African-Americans as well as to Caucasians. They useful symptom criteria for the diagnosis of IBS when used in conjunction with medical evaluation. (2) Three of the six Manning symptoms rarely correlate with the others; if confirmed in patient samples, this would indicate that these three symptoms are not useful for making a diagnosis of the irritable bowel syndrome.

Involuntary memories during severe physical illness or injury.

This paper reports an analysis of the features of 122 cases of persons who became ill or even came close to death, but who survived and afterward reported that during the experience they recalled memories of earlier events in their lives. The life review varied widely in its form; the number of memories recalled ranged from only one or two to the subject's entire life. Moreover, few of the subjects reported seeing earlier events of their life "all at once," which makes the popular phrase "panoramic memory" a misnomer. One group of 54 cases was compared with a group of 54 other cases in which the feature of the life review did not occur. There were no significant differences between the two groups with regard to nine common features. The life review occurs as one feature among several others of equal or greater importance in the total experience. Its function, if any, remains to be elucidated by further research.

Spontaneous swallowing rate and emotional state. Possible mechanism for stress-related gastrointestinal disorders.

Excessive spontaneous swallowing has been associated with a variety of common gastrointestinal symptoms including abdominal pain, heartburn, and bloating and may contribute to disorders such as hiatus hernia, duodenal ulcer, and irritable bowel syndrome. The present study investigated the hypothesis that changes in emotional state alter spontaneous swallowing rate. Subjects were 38 generally healthy undergraduates assigned to either a pleasant low arousal, neutral, or aversive high arousal condition. Each experimental session was divided into 30-min baseline and arousal manipulation periods. Spontaneous swallowing rate increased significantly with emotional arousal: for low, neutral, and high arousal groups, means were 7.9 +/- 1.9 (SE), 15.8 +/- 2.4, and 23.7 +/- 3.6 swallows/30 min, respectively. Other physiological and self-report measures, used to check the effectiveness of the arousal manipulation, varied appropriately with experimental procedures. These results indicate that changes in emotional state alter spontaneous swallowing rate in generally healthy individuals. Further research with patients is needed to establish whether stress-induced increases in swallowing rate produce or exacerbate clinically significant gastrointestinal symptomatology.

An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping.

A new approach to the rehabilitation of movement, based primarily on the principles of operant conditioning, was derived from research with deafferented monkeys. The analysis suggests that a certain proportion of excess motor disability after certain types of injury involves a learned suppression of movement and may be termed learned nonuse. Learned nonuse can be overcome by changing the contingencies of reinforcement so that they strongly favor use of an affected upper extremity in the chronic postinjury situation. The techniques employed here involved 2 weeks of restricting movement of the opposite (unaffected) extremity and training of the affected limb. Initial work with humans has been with chronic stroke patients for whom the approach has yielded large improvements in motor ability and functional independence. We report here preliminary data suggesting that shaping with verbal feedback further enhances the motor recovery.

Behavioral assessments of two drug combinations for oral sedation.

This study compares the efficacy of two drug regimens used for oral sedation in pediatric dental patients: chloral hydrate (50 mg/kg)/promethazine (1 mg/kg) and meperidine (1 mg/kg)/promethazine (1 mg/kg). Twenty-four pediatric dental patients, ASA Class I, were evaluated in this double-blind, randomized study. The patients ranged in age from 18 to 48 months. Each dental procedure under sedation was videotaped and rated independently by two raters. Intraoperative ratings of sleep, movement, crying, an overall behavior score for each treatment interval, and an overall behavior score for each sedation were also evaluated. No treatment was aborted for either regimen. In all cases, chloral hydrate/promethazine sedations had significantly better results for sleep (P = 0.0001), movement (P = 0.0168), crying (P = 0.0041), and overall behavior score (P = 0.0186) for the sedations compared to meperidine/promethazine sedations. Although chloral hydrate/promethazine sedations produced significantly better results, clinically, both drug regimens were equally effective.

Technique to improve chronic motor deficit after stroke.

The unaffected upper extremity of chronic stroke patients was restrained in a sling during waking hours for 14 days; on ten of those days, these patients were given six hours of practice in using the impaired upper extremity. An attention-comparison group received several procedures designed to focus attention on use of the impaired upper extremity. The restraint subjects improved on each of the laboratory measures of motor function used--in most cases markedly. Extensive improvement, from a multi-year plateau of greatly impaired motor function, was also noted for the restraint group in the life situation and these gains were maintained during a two-year period of follow-up. For the comparison group only one measure showed small to moderate improvement, and this was lost during the follow-up period; there was essentially no overlap between the individuals of the two groups. Thus, prolonged restraint of an unaffected upper extremity and practice of functional movements with the impaired limb proved to be an effective means of restoring substantial motor function in stroke patients with chronic motor impairment identified by the inclusion criteria of this project.

Fearfulness and startle potentiation during aversive visual stimuli.

Recent experimental research suggests an association between negative affect and potentiation of the human startle reflex, as well as enhancement of this effect among fearful compared to low fear subjects. In the present study, 32 undergraduates were selected for high or low total Fear Survey Schedule scores. Acoustic startle probes were presented while subjects received warned presentations of aversive and neutral photographic slides. High fear but not low fear subjects showed potentiated short-latency cardiac acceleration and blink magnitude, and reduced blink latency, during aversive compared to neutral slides. These results support the hypothesis that affective modulation of startle is enhanced among high fear compared to low fear subjects. Considered in the context of prior findings, the results suggest that this individual difference effect generalizes across psychophysiological components of the startle reflex and diverse procedures for manipulating affect.

Digital filtering: background and tutorial for psychophysiologists.

Digital filtering offers more to psychophysiologists than is commonly appreciated. An introduction is offered here to foster the explicit design and use of digital filters. Because of considerable confusion in the literature about terminology important to both analog and digital filtering, basic concepts are reviewed and clarified. Because some time series concepts are fundamental to digital filtering, these are also presented. Examples of filters commonly used in psychophysiology are given, and procedures are presented for the design and use of one type of digital filter. Properties of some types of digital filters are described, and the relative advantages of simple analog and digital filters are discussed.

The effects of aerobic exercise on cardiovascular, facial EMG, and self-report responses to emotional imagery.

This study examined the effects of exercise on subsequent psychophysiological and self-report responses to emotional imagery, using excitation-transfer theory as a guiding conceptual model. Twenty-four female undergraduates engaged in aerobic exercise (stationary cycling) for 15 minutes, and an equal number of subjects rested quietly for the same time period. All subjects then engaged in anger and sadness imagery trials. Cardiovascular, facial electromyographic, and self-report responses to the imagery were assessed. The results indicated that the subjects in the exercise group showed less peripheral vasoconstriction in response to the imagery than did the quiet rest subjects. Subjects in both groups displayed greater electromyographic activity in the depressor and zygomatic muscle regions during anger than sadness imagery, and subjects in the exercise group tended to show greater corrugator tension during sadness than during anger imagery. Few differences between the groups were found on self-report measures. These findings are discussed with reference to previous research, theoretical implications, and future directions.

Affective individual differences and startle reflex modulation.

Potentiation of startle has been demonstrated in experimentally produced aversive emotional states, and clinical reports suggest that potentiated startle may be associated with fear or anxiety. To test the generalizability of startle potentiation across a variety of emotional states as well as its sensitivity to individual differences in fearfulness, the acoustic startle response of 17 high- and 15 low-fear adult subjects was assessed during fear, anger, joy, sadness, pleasant relaxation, and neutral imagery. Startle responses were larger in all aversive affective states than during pleasant imagery. This effect was enhanced among high fear subjects, although followup testing indicated that other affective individual differences (depression and anger) may also be related to increased potentiation of startle in negative affect. Startle latency was reduced during high- rather than low-arousal imagery but was unaffected by emotional valence.

Features of "near-death experience" in relation to whether or not patients were near death.

The medical records of 58 patients, most of whom believed they were near death during an illness or after an injury and all of whom later remembered unusual experiences occurring at the time, were examined. 28 patients were judged to have been so close to death that they would have died without medical intervention; the other 30 patients were not in danger of dying although most of them thought they were. Patients of both groups reported closely similar experiences but patients who really were close to death were more likely than those who were not to report an enhanced perception of light and enhanced cognitive powers. The claim of enhancement of cognitive functions despite the likelihood that brain function had probably become disturbed and possibly diminished, deserves further investigation.