Accelerated Aging after Traumatic Brain Injury: An ENIGMA Multi-Cohort Mega-Analysis.

OBJECTIVE: The long-term consequences of traumatic brain injury (TBI) on brain structure remain uncertain. Given evidence that a single significant brain injury event increases the risk of dementia, brain-age estimation could provide a novel and efficient indexing of the long-term consequences of TBI. Brain-age procedures use predictive modeling to calculate brain-age scores for an individual using structural magnetic resonance imaging (MRI) data. Complicated mild, moderate, and severe TBI (cmsTBI) is associated with a higher predicted age difference (PAD), but the progression of PAD over time remains unclear. We sought to examine whether PAD increases as a function of time since injury (TSI) and if injury severity and sex interacted to influence this progression. METHODS: Through the ENIGMA Adult Moderate and Severe (AMS)-TBI working group, we examine the largest TBI sample to date (n = 343), along with controls, for a total sample size of n = 540, to replicate and extend prior findings in the study of TBI brain age. Cross-sectional T1w-MRI data were aggregated across 7 cohorts, and brain age was established using a similar brain age algorithm to prior work in TBI. RESULTS: Findings show that PAD widens with longer TSI, and there was evidence for differences between sexes in PAD, with men showing more advanced brain age. We did not find strong evidence supporting a link between PAD and cognitive performance. INTERPRETATION: This work provides evidence that changes in brain structure after cmsTBI are dynamic, with an initial period of change, followed by relative stability in brain morphometry, eventually leading to further changes in the decades after a single cmsTBI. ANN NEUROL 2024.

A Combined Interventional Approach to Train Interview Skills in Autistic Transition-Age Youth.

BACKGROUND: The job interview can be challenging for autistic adolescents considering the required social communication skills. Further, having decreased awareness of personal strengths may make it difficult to advocate for oneself to a future employer. The purpose of the current pilot randomized controlled trial (RCT) is to examine the preliminary efficacy and feasibility of a combined interventional approach using: the Virtual Interview Tool for Autistic Transition-Age Youth (VIT-TAY) and Kessler Foundation Strength Identification and Expression (KF-STRIDE). METHOD: Twenty autistic transition-age youth (TAY) were randomly assigned to two groups: an intervention group (n = 10) that received 9 h of VIT-TAY (interviewing practice with a virtual human), and three lessons of KF-STRIDE (positive psychology intervention to learn and discuss one's personal character strengths) and a services-as-usual (SAU) group (n = 10). The primary outcome was measured using a video-recorded mock job interview performed at pre- and post-test, which was rated by blinded assessors. Secondary outcomes included self-reports of job interview skill, interview anxiety, work readiness and recent job search behavior. RESULTS: Paired samples t-tests revealed significant differences between pre- and post-test in the intervention group (but not the control group) on the mock interview total score (p = 0.02, d = 0.76) and self-reported job interview skills total score (p = 0.02, d = 0.75). The intervention group (but not the control group) had improvements in work-readiness (p = 0.06, d = 0.53) and job search behavior (p = 0.07, d = 0.52) that were characterized by medium effect sizes. CONCLUSIONS: This pilot study suggests that combining VIT-TAY with KF-STRIDE leads to improvements in performance-based and self-reported job interview skills.

An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis.

IMPORTANCE: This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events. OBJECTIVE: To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic. DESIGN: An online survey administered during the COVID-19 pandemic. PARTICIPANTS: Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups. OUTCOMES AND MEASURES: The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed. RESULTS: Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes. CONCLUSIONS AND RELEVANCE: Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.

Evaluating the effects of brain injury, disease and tasks on cognitive fatigue.

Because cognitive fatigue (CF) is common and debilitating following brain injury or disease we investigated the relationships among CF, behavioral performance, and cerebral activation within and across populations by combining the data from two cross-sectional studies. Individuals with multiple sclerosis (MS) were included to model CF resulting from neurological disease; individuals who had sustained a traumatic brain injury (TBI) were included to model CF resulting from neurological insult; both groups were compared with a control group (Controls). CF was induced while neuroimaging data was acquired using two different tasks. CF significantly differed between the groups, with the clinical groups reporting more CF than Controls-a difference that was statistically significant for the TBI group and trended towards significance for the MS group. The accrual of CF did not differ across the three groups; and CF ratings were consistent across tasks. Increasing CF was associated with longer response time for all groups. The brain activation in the caudate nucleus and the thalamus was consistently correlated with CF in all three groups, while more dorsally in the caudate, activation differed across the groups. These results suggest the caudate and thalamus to be central to CF while more dorsal aspects of the caudate may be sensitive to damage associated with particular types of insult.

Psychometric properties of the mock interview rating scale for autistic transition-age youth.

Background: Employment is a major contributor to quality of life. However, autistic people are often unemployed and underemployed. One potential barrier to employment is the job interview. However, the availability of psychometrically-evaluated assessments of job interviewing skills is limited for autism services providers and researchers. Objective: We analyzed the psychometric properties of the Mock Interview Rating Scale that was adapted for research with autistic transition-age youth (A-MIRS; a comprehensive assessment of video-recorded job interview role-play scenarios using anchor-based ratings for 14 scripted job scenarios). Methods: Eighty-five transition-age youth with autism completed one of two randomized controlled trials to test the effectiveness of two interventions focused on job interview skills. All participants completed a single job interview role-play at pre-test that was scored by raters using the A-MIRS. We analyzed the structure of the A-MIRS using classical test theory, which involved conducting both exploratory and confirmatory factor analyzes, Rasch model analysis and calibration techniques. We then assessed internal consistency, inter-rater reliability, and test-retest reliability. Pearson correlations were used to assess the A-MIRS' construct, convergent, divergent, criterion, and predictive validities by comparing it to demographic, clinical, cognitive, work history measures, and employment outcomes. Results: Results revealed an 11-item unidimensional construct with strong internal consistency, inter-rater reliability, and test-retest reliability. Construct [pragmatic social skills (r = 0.61, p < 0.001), self-reported interview skills (r = 0.34, p = 0.001)], divergent [e.g., age (r = -0.13, p = 0.26), race (r = 0.02, p = 0.87)], and predictive validities [competitive employment (r = 0.31, p = 0.03)] received initial support via study correlations, while convergent [e.g., intrinsic motivation (r = 0.32, p = 0.007), job interview anxiety (r = -0.19, p = 0.08)] and criterion [e.g., prior employment (r = 0.22, p = 0.046), current employment (r = 0.21, p = 0.054)] validities were limited. Conclusion: The psychometric properties of the 11-item A-MIRS ranged from strong-to-acceptable, indicating it may have utility as a reliable and valid method for assessing the job interview skills of autistic transition-age youth.

Development and adaptation of a strength-based job interview training tool for transition age youth on the autism spectrum using community engaged methods.

Introduction: Kessler Foundation Strength Identification and Expression (KF-STRIDE) is a strength-based job interview training tool developed for young adults on the autism spectrum. The intervention is based on a positive psychology framework to increase knowledge of character strengths, and how to relate them to a future employer. The current study sought to evaluate the acceptability, usability and feasibility of KF-STRIDE, as well as to guide adaptations to improve the tool's ability to meet the needs of those on the spectrum. Methods: Mixed methods (post-intervention surveys, and semi-structured interviews with key stakeholders) were used to inform the evaluation and consequent adaptations of KF-STRIDE. Results: The major findings of the study were that KF-STRIDE was found to be largely acceptable and usable. Importantly, however, our qualitative analysis revealed modifications that could help to better suit the needs of young adults on the spectrum, which included the incorporation of additional skills (i.e. etiquette, practicing hygiene) and more opportunities to practice job interviewing. Thus, we altered the implementation of the intervention to be web-based to improve accessibility. We incorporated the presence of an animated character to deliver the content, to eliminate the need for a highly trained interventionist. Discussion: KF-STRIDE was modified to increase access by incorporating feedback from the autism community. Future directions include assessing the efficacy of KF-STRIDE in young adults on the spectrum to identify whether employment outcomes are improved after using the tool.

Bridging Big Data: Procedures for Combining Non-equivalent Cognitive Measures from the ENIGMA Consortium.

Investigators in neuroscience have turned to Big Data to address replication and reliability issues by increasing sample sizes, statistical power, and representativeness of data. These efforts unveil new questions about integrating data arising from distinct sources and instruments. We focus on the most frequently assessed cognitive domain - memory testing - and demonstrate a process for reliable data harmonization across three common measures. We aggregated global raw data from 53 studies totaling N = 10,505 individuals. A mega-analysis was conducted using empirical bayes harmonization to remove site effects, followed by linear models adjusting for common covariates. A continuous item response theory (IRT) model estimated each individual's latent verbal learning ability while accounting for item difficulties. Harmonization significantly reduced inter-site variance while preserving covariate effects, and our conversion tool is freely available online. This demonstrates that large-scale data sharing and harmonization initiatives can address reproducibility and integration challenges across the behavioral sciences.

Associations between smartphone keystroke dynamics and cognition in MS.

Objective: Examine the associations between smartphone keystroke dynamics and cognitive functioning among persons with multiple sclerosis (MS). Methods: Sixteen persons with MS with no self-reported upper extremity or typing difficulties and 10 healthy controls (HCs) completed six weeks of remote monitoring of their keystroke dynamics (i.e., how they typed on their smartphone keyboards). They also completed a comprehensive neuropsychological assessment and symptom ratings about fatigue, depression, and anxiety at baseline. Results: A total of 1,335,787 keystrokes were collected, which were part of 30,968 typing sessions. The MS group typed slower (P < .001) and more variably (P = .032) than the HC group. Faster typing speed was associated with better performance on measures of processing speed (P = .016), attention (P = .022), and executive functioning (cognitive flexibility: P = .029; behavioral inhibition: P = .002; verbal fluency: P = .039), as well as less severe impact from fatigue (P < .001) and less severe anxiety symptoms (P = .007). Those with better cognitive functioning and less severe symptoms showed a stronger correlation between the use of backspace and autocorrection events (P < .001). Conclusion: Typing speed may be sensitive to cognitive functions subserved by the frontal-subcortical brain circuits. Individuals with better cognitive functioning and less severe symptoms may be better at monitoring their typing errors. Keystroke dynamics have the potential to be used as an unobtrusive remote monitoring method for real-life cognitive functioning among persons with MS, which may improve the detection of relapses, evaluate treatment efficacy, and track disability progression.

Fatigue Across the Lifespan in Men and Women: State vs. Trait.

Objective: Fatigue is commonly thought to worsen with age, but the literature is mixed: some studies show that older individuals experience more fatigue, others report the reverse. Some inconsistencies in the literature may be related to gender differences in fatigue while others may be due to differences in the instruments used to study fatigue, since the correlation between state (in the moment) and trait (over an extended period of time) measures of fatigue has been shown to be weak. The purpose of the current study was to examine both state and trait fatigue across age and gender using neuroimaging and self-report data. Methods: We investigated the effects of age and gender in 43 healthy individuals on self-reported fatigue using the Modified Fatigue Impact Scale (MFIS), a measure of trait fatigue. We also conducted fMRI scans on these individuals and collected self-reported measures of state fatigue using the visual analog scale of fatigue (VAS-F) during a fatiguing task. Results: There was no correlation between age and total MFIS score (trait fatigue) (r = -0.029, p = 0.873), nor was there an effect of gender [F (1,31) < 1]. However, for state fatigue, increasing age was associated with less fatigue [F (1,35) = 9.19, p < 0.01, coefficient = -0.4]. In the neuroimaging data, age interacted with VAS-F in the middle frontal gyrus. In younger individuals (20-32), more activation was associated with less fatigue, for individuals aged 33-48 there was no relationship, and for older individuals (55+) more activation was associated with more fatigue. Gender also interacted with VAS-F in several areas including the orbital, middle, and inferior frontal gyri. For women, more activation was associated with less fatigue while for men, more activation was associated with more fatigue. Conclusion: Older individuals reported less fatigue during task performance (state measures). The neuroimaging data indicate that the role of middle frontal areas change across age: younger individuals may use these areas to combat fatigue, but this is not the case with older individuals. Moreover, these results may suggest greater resilience in females than males when faced with a fatiguing task.

Signal Detection Theory as a Novel Tool to Understand Cognitive Fatigue in Individuals With Multiple Sclerosis.

Multiple Sclerosis (MS) affects 2.8 million persons worldwide. One of the most persistent, pervasive, and debilitating symptoms of MS is cognitive fatigue. While this has been known for over a century, cognitive fatigue has been difficult to study because patients' subjective (self-reported) cognitive fatigue has consistently failed to correlate with more objective measures, such as reaction time (RT) and accuracy. Here, we investigated whether more nuanced metrics of performance, specifically the metrics of Signal Detection Theory (SDT), would show a relationship to cognitive fatigue even if RT and accuracy did not. We also measured brain activation to see whether SDT metrics were related to activation in brain areas that have been shown to be sensitive to cognitive fatigue. Fifty participants (30 MS, 20 controls) took part in this study and cognitive fatigue was induced using four blocks of a demanding working memory paradigm. Participants reported their fatigue before and after each block, and their performance was used to calculate SDT metrics (Perceptual Certainty and Criterion) and RT and accuracy. The results showed that the SDT metric of Criterion (i.e., response bias) was positively correlated with subjective cognitive fatigue. Moreover, the activation in brain areas previously shown to be related to cognitive fatigue, such as the striatum, was also related to Criterion. These results suggest that the metrics of SDT may represent a novel tool with which to study cognitive fatigue in MS and other neurological populations. These results hold promise for characterizing cognitive fatigue in MS and developing effective interventions in the future.

Improving mental health in Multiple Sclerosis with an interpersonal emotion regulation intervention: A prospective, randomized controlled trial.

BACKGROUND: Over a third of people with Multiple Sclerosis (PwMS) struggle with poor mental health, which exacerbates physical symptoms and complicates clinical treatment. To address this, we tested the efficacy of an interpersonal emotion regulation intervention: this intervention seeks to improve mental health by teaching participants to use emotion regulation strategies which leverage social support (e.g., reaching out to others for comfort when experiencing a stressful event). METHOD: Nineteen PwMS completed this prospective, blinded randomized controlled trial (intervention n = 10; control n = 9). Intervention participants met with an interventionist over six weeks to discuss their emotional challenges and develop goals to use interpersonal emotion regulation strategies. Participants in the control condition met with the interventionist on the same schedule but their emotion regulation strategies were only measured and not manipulated. Pre-registered primary outcomes were self-reported depression, stress, and quality of life (QoL). The pre-registered secondary outcome was self-reported social support. RESULTS: Intervention participants' depression scores improved from time 1 to time 2 (mean difference=3.60, 95% CI [0.44-6.76]), yet remained unchanged for the control group (mean difference=-1.67, 95% CI [-5.00-1.67], overall interaction, F(1,17)=5.84, p=.027, ηp2=.256). The remaining primary (stress and QoL) and secondary (social support) outcomes did not show a significant effect of the intervention (stress: p=.601, ηp2=.016; QoL: p=.179, ηp2=.104; social support: p=.140, ηp2=.124). CONCLUSION: Interpersonal emotion regulation is beneficial in improving depression in PwMS. Consequently, these strategies can be implemented in conjunction with existing mental health treatments in a holistic approach to improving well-being.

Aquatic exercise for persons with MS: Patient-reported preferences, obstacles and recommendations.

BACKGROUND: Many persons with multiple sclerosis (MS) have difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability. Aquatic exercise may be a suitable alternative for these individuals, preventing overheating and enabling a range of movements that were otherwise difficult on land. The objective of the current study was to understand why some persons with MS prefer aquatic exercise while others prefer non-aquatic exercise, which will inform recommendations. METHODS: A total of 179 persons with MS completed a brief online survey (∼10 min) about their exercise routines between October 2020 and April 2021. RESULTS: Fifty-sex percent of respondents reported that they only engaged in non-aquatic exercise (i.e., land-based activities such as jogging), followed by 36% of respondents who reported that they engaged in both aquatic and non-aquatic exercise, and 7% of respondents who participated in aquatic exercise only. The most frequently reported barriers for aquatic exercise were lack of access to pools and its associated expense. Among individuals who had tried aquatic exercise, aquatic exercise was preferred over non-aquatic exercise, and 100% reported that they would recommend aquatic exercise to other persons with MS. Finally, the majority of respondents reported exercising less during the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSION: Aquatic exercise is well liked among persons with MS who have tried it; however, it may not be feasible for economically disadvantaged persons with MS. Local charities and health organizations may consider financially sponsoring aquatic exercise programs to encourage participation in physical activity for the MS population. Due to the negative impact of the pandemic on exercise routines, MS clinicians should encourage their patients to resume their exercise routines once the pandemic subsides.

Character Strengths Across Disabilities: An International Exploratory Study and Implications for Positive Psychiatry and Psychology.

The purpose of this study was to examine the differences in character strengths for people with disabilities by using an international dataset by the VIA Institiute on Character. Specifically, we aimed to explore (a) the top and bottom five character strengths reported by different disability groups and all people with disabilities more broadly, and (b) group differences in each character strength and total character strengths. The investigator contacted the VIA Institute on Character (http://www.viacharacter.org/) for obtaining the dataset for the current study. After data cleaning, our sample size resulted in 11,699 people with disabilities. Among most people with disabilities, the top five character strengths scores were love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and prudence. Knowing that there is heterogeneity in character strengths across groups gives us a better understanding of the areas that people with different disabilities and conditions might thrive and provides clinicians and practitioners with a more nuanced understanding for how to possibly intervene with their clients. Positive psychiatry and psychology implications are discussed.

The impact of the COVID-19 pandemic on engagement in activities of daily living in persons with acquired brain injury.

PRIMARY OBJECTIVES: This study examined (a) the impact of coronavirus disease-2019 (COVID-19) pandemic on engagement in activity participation in persons with acquired brain injury (ABI); and (b) whether changes in activity participation during the pandemic were associated participants' health-related quality of life (HRQoL). RESEARCH DESIGN: Exploratory online survey study. METHODS: Eighty-seven respondents with ABI and 98 healthy adults (HA) participated in this study. Engagement in activity participation during COVID-19 was calculated as a percentage of the activities participants performed before the pandemic. MAIN RESULTS: Participants with ABI modified their activities less than HA in order to maintain level of engagement in activity participation. They stopped performing more activities during the pandemic compared to HA and compared to their pre-pandemic engagement. Both groups continued to do similar percentage of activities without modifications compared to before the pandemic. Better HRQoL in both groups was predicted by a larger percentage of activities continued and fewer activities stopped. CONCLUSION: Results emphasize the importance of addressing activity participation changes during situations where there are disruptions of the individual's habits and routines in order to minimize negative consequences of such changes.

Relationships between changes in daily occupations and health-related quality of life in persons with multiple sclerosis during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic provided a unique opportunity to explore the impact of the mandated lockdown and social distancing policies on engagement in daily occupations for individuals with multiple sclerosis (MS) and able bodied (i.e. healthy) adults. The study also examined whether the changes in daily occupations were associated with health-related quality of life (HrQOL). METHODS: Between the spring and early fall of 2020, 69 persons with MS and 95 healthy adults completed an online survey that included measurements of 26 activities of daily life. For each activity, participants reported whether they continued to perform the activity (with or without adjustments), whether they stopped, or started to perform the activity during the pandemic. Social support, HrQOL, and demographics, including financial distress were also obtained. RESULTS: Participants with MS and healthy adults both reduced the number of activities performed during the pandemic. Healthy adults continued to do more activities with and without adjustments compared with participants with MS. In both groups, better HrQOL was associated with the number of activities participants continued to do with and without adjustments, and worse HrQOL with the number of activities they stopped doing. CONCLUSIONS: Fewer persons with MS engaged in everyday occupations than healthy adults following the COVID-19 pandemic. The ability to maintain occupational engagement and to participate in social and daily activities is important for maintaining high HrQOL in both groups. Thus, these results call for attention in treatment and self-management of MS symptomatology.

Healthcare Disruptions and Use of Telehealth Services Among People With Multiple Sclerosis During the COVID-19 Pandemic.

OBJECTIVE: The current study examined health care disruptions and use of telehealth services among people with multiple sclerosis (pwMS) during the COVID-19 pandemic. DESIGN: Cross-sectional survey. SETTING: General community. PARTICIPANTS: Participants (N=163) included 70 pwMS and 93 healthy controls (HCs). The majority of respondents were from the United States (88%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rates of health care disruptions (eg, missing/canceling appointments, experiencing delays) and telehealth use for MS and non-MS medical care and mental health care. RESULTS: In this U.S. majority, predominantly White, and high socioeconomic status sample, 38% to 50% of pwMS reported experiencing disruptions in their MS and non-MS medical care and 20% to 33% reported disruptions in their mental health care; this was significantly lower than the rates observed among HCs. Compared with HCs, pwMS were more likely to use telehealth than in-person services, especially for mental health care. The majority of pwMS and HCs reported being satisfied with telehealth services. Individuals with higher degrees of functional limitation experienced more health care disruptions and were more likely to use telehealth services than individuals with lower degrees of functional limitation. CONCLUSIONS: Despite high health care disruption rates, pwMS frequently used and were highly satisfied with telehealth services during the COVID-19 pandemic. Due to physical limitations commonly observed in the MS population that may preclude travel, telehealth services should be continued even after resolution of the pandemic to expand access and reduce health care disparities.

Emotional processing intervention (EMOPRINT): A blinded randomized control trial to treat facial affect recognition deficits in multiple sclerosis.

OBJECTIVE: Facial affect recognition deficits have been noted in persons with MS, however there is no treatment for these impairments. We investigated the efficacy of the Emotional Processing Intervention (EMOPRINT), a 12-session behavioral intervention teaching facial affect recognition skills and mimicry to improve facial affect recognition abilities in persons with MS. METHODS: This double blind, placebo-controlled, randomized clinical trial with two time points (pre-treatment; post-treatment) included 36 participants with clinically definite MS, 21 in the treatment group and 15 in the placebo control group. Participants completed a pre-test and post-test neuropsychological assessment, which consisted of tasks of facial affect recognition (primary outcome measure) and questionnaires to assess quality of life and emotional functioning (secondary outcome measures). We hypothesized that improvements in facial affect recognition skills would be observed following treatment. We also examined changes to quality of life and social functioning. Changes in outcome measures were analyzed using a mixed-method analysis of variance. RESULTS: The treatment group showed significantly improved facial affect recognition skills relative to the placebo group post-treatment, F(1,34)=5.91, p=.022, partial ꞃ2=0.146. No significant change was noted on secondary outcomes. The majority of the participants in the intervention group reported that the intervention was helpful and that they used the skills learned in their daily interactions. CONCLUSION: EMOPRINT is effective for improving facial affect recognition skills in MS.

Differential Impact of the COVID-19 Pandemic on Health Care Utilization Disruption for Community-Dwelling Individuals With and Without Acquired Brain Injury.

OBJECTIVE: To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL). DESIGN: Cross-sectional survey. SETTING: General community. PARTICIPANTS: Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F2,95=16.82, P<.001, R 2=0.262), and disruption in mental health care explained 14.8% of the variance (F1,51=8.86, P=.004, R 2=0.148). CONCLUSIONS: Individuals with and without ABI experienced pronounced disruption in health care utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental health care were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but limitations included difficulty with technology, difficulty with comprehensive examination, and decreased rapport with providers.

Effects of walking exercise training on learning and memory and hippocampal neuroimaging outcomes in MS: A targeted, pilot randomized controlled trial.

PURPOSE: The current pilot study involved a single-blind, randomized controlled trial (RCT) on the effects of treadmill walking exercise training compared with an active control condition on learning and memory (L/M) and hippocampal neuroimaging outcomes in 11 fully-ambulatory persons with multiple sclerosis (MS) who demonstrated impairments in new learning. METHODS: The study protocol is registered at clinicaltrials.gov: NCT03319771 (February 2018). Eleven fully-ambulatory persons with MS-related impairments in new learning were randomly assigned into either 12-weeks of supervised, treadmill walking exercise training or 12-weeks of low-intensity resistive exercise (active control condition). Participants underwent neuropsychological tests of L/M and hippocampal neuroimaging before and after the 12-week study period; outcomes were administered by treatment-blinded assessors. RESULTS: There were moderate-to-large intervention effects on measures of verbal L/M (ηp2 = 0.11, d = 0.63, 95% CI: -0.61, 1.83), whereby those in the intervention condition demonstrated improvement in California Verbal Learning Test-II (CVLT-II) scores compared with the control condition. There were smaller effects on a composite L/M measure (ηp2 = 0.02, d = 0.28, 95% CI: -0.93, 1.46). There were large intervention effects on normalized hippocampal volume (ηp2 = 0.36, d = 1.13, 95% CI: 0.09, 2.82), whereby hippocampal volume was preserved in the intervention condition, compared with hippocampal atrophy in the control condition. By comparison, there were no intervention effects on hippocampal resting-state functional connectivity. CONCLUSIONS: Collectively, this study provides initial proof-of-concept data for further examining treadmill walking exercise training as a possible behavioral approach for managing L/M impairment and preserving hippocampal volume as common and debilitating manifestations of MS.

The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood.

This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.