Impact of comprehensive gynecologic services on health maintenance behaviours among women with spinal cord injury.

PURPOSE: Women with spinal cord injury (SCI) and other physical disabilities often lack access to appropriate gynecologic health care and may be at higher risk for preventable gynecologic diseases and other health problems. The purpose of this study was to investigate the effects of a women's health clinic that was established to meet the needs of women with SCI and other disabilities. Specifically, this study examined the effect of clinic participation upon the rate of preventive gynecologic health care behaviours and assessed the relationship between physical and emotional functioning in women with SCI and other disabilities. METHOD: Participants (n =28) were women who completed surveys immediately prior to participation in the clinic, and at 3 and 12 month follow-ups. RESULTS: Results indicated a trend towards increased frequency of breast self-exam three months after initial participation in the clinic (p =0.11). Other rates of health promoting behaviours (exercise, diet and mammography) did not increase. Results also indicated that although physical functioning and life satisfaction were not related, women in this study did experience moderate to high levels of psychological distress. CONCLUSION: Results indicate that whole-woman health care may be important to increasing certain health behaviours among women with disabilities. Implications for comprehensive treatment are discussed.

Neuropsychological predictors of distress following traumatic brain injury.

Emotional and behavioural difficulties are one of the most common difficulties following traumatic brain injury (TBI), although it is not clear which individuals with TBI become most distressed. Numerous factors contribute to adjustment following TBI, and the current study examined degree of cognitive decline as one potential contributor to distress following TBI. The relationship between cognitive functioning and distress may be conceptualized as being related to (a) an individual's absolute level of cognitive ability following TBI, or (b) relative degree of decline following TBI (i.e. the greater the decline, the greater the distress, regardless of absolute level of ability). The current study tested these hypotheses by comparing a measure of global emotional distress with measures of absolute level of neuropsychological functioning and indices of cognitive decline. In contrast to hypotheses, regression analyses indicated that estimated pre-morbid ability accounted for more variance in distress following TBI than either absolute level of functioning or indices of cognitive decline, with individuals with higher estimated pre-morbid abilities reporting lower levels of distress. Treatment implications are discussed.

Multidimensional telecare strategies for rural residents with brain injury.

Rural residents with brain injury have difficulty in accessing care from qualified psychologists for consequent cognitive, emotional and behavioural symptoms. We examined high-quality videoconferencing to enhance care for persons with brain injury in three areas: cognitive assessment, psychotherapy and rural mental health training. The assessment study evaluated 52 outpatients seen for diagnostic visits over videoconferencing, and compared their experiences with those of 52 age- and diagnosis-matched controls seen in person. Persons seen via telemedicine were more likely than controls to want to repeat their experience and more satisfied than were the neuropsychologists who examined them. In the psychotherapy study, neurorehabilitation patients were seen via videoconferencing for therapy related to brain injury or stroke. Persons receiving psychotherapy were less likely than persons receiving assessment services to want to repeat their experience. In the training study, 39 rural mental health providers were trained via videoconferencing, and trainees demonstrated significant improvement on tests of knowledge about brain injury. Trainees formed a network of mental health provider referrals for persons with brain injury in a wide geographic area. Given adequate training and ongoing support, rural clinicians can treat many brain-injury adjustment issues locally, reserving specialist consultation for emergency or complex problems.

Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services.

OBJECTIVE: To determine the relationship among neuropsychological variables, vocational outcomes, and vocational costs for Missouri Division of Vocational Rehabilitation (MO-DVR) clients with traumatic brain injury (TBI). DESIGN: Clients referred for neuropsychological evaluations were followed until DVR case closure. Subjects were grouped according to the following DVR status at case closure: Successfully Employed, Services Interrupted, and No Services Provided. Spearman correlations with Bonferroni corrections were calculated to determine relationships among variables, and Kruskal-Wallis nonparametric one-way analyses of variance (ANOVAs) were conducted to evaluate differences in DVR group status in terms of neuropsychological variables and DVR costs. SETTING: All evaluations were completed through a Midwestern university neuropsychology laboratory. PATIENTS: 110 consecutively referred DVR clients with nonacute TBI referred for neuropsychological evaluation. MAIN OUTCOME MEASURES: Absolute level (ie, raw/standard scores) of neuropsychological functioning and relative degree of decline in: intelligence (WAIS-R), memory (WMS-R General and Delayed Memory Indices), attention (WMS-R Attention Index), speed of processing (Trails A), and cognitive flexibility (Trails B); DVR costs at closure. RESULTS: 1) Surprisingly, the Successfully Employed group had significantly greater neuropsychological impairments; 2) Greater decline in delayed memory was associated with higher DVR costs (r = -0.30, P <.05); and 3) More indices of relative decline were significantly correlated with vocational outcomes (5/6) than were indices of absolute functioning (3/6). CONCLUSIONS: DVR is effective in providing services to individuals with the most significant neuropsychological deficits; it is important to consider both absolute level of functioning and relative decline in functioning when evaluating TBI.

Disease and family contributors to adaptation in juvenile rheumatoid arthritis and juvenile diabetes.

OBJECTIVE: Research in the areas of pediatric rheumatology and pediatric chronic illness has emphasized comprehensive models of adaptation involving risk and resistance factors. This study examined adaptation, within this framework, among a large sample of children with chronic illness and children without chronic illness. METHODS: A comprehensive battery of adaptation measures was administered to a sample of 107 children with juvenile rheumatoid arthritis, 114 children with insulin-dependent diabetes mellitus, and 88 healthy controls. RESULTS: Medical diagnosis was associated with mothers' depression and a composite measure of parental (mother and father) distress and passive coping. Children's emotional and behavioral functioning was not related to medical diagnosis, but mothers' depression and parental distress were associated with child behavior problems. CONCLUSION: Because parental distress was associated with child functioning, interventions to ameliorate parental distress may have beneficial effects on the children's behavior and on parents' reactions to their children.

Trajectories of adaptation in pediatric chronic illness: the importance of the individual.

This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.

Utility of a seven-subtest version of the WAIS-R among an Alzheimer's disease sample.

Recent health care sector changes have created a need for shorter, more focused neuropsychological assessments. The WAIS-R provides useful information on patients' general cognitive abilities, but poses problems in that it is time-consuming and may contribute to fatigue, especially among geriatric patients with dementia. This study evaluated Ward's (1990) 7-subtest version of the WAIS-R among 32 patients with presumptive Alzheimer's disease. Among all patients, the abbreviated test underestimated full WAIS-R scores by an average of 2.0, 0.2, and 1.8 points for the Verbal Intelligence Quotient (VIQ), Performance Intelligent Quotient (PIQ), and Full-Scale Intelligence Quotient (FSIQ). This general finding held true regardless of whether scores were generated using the standard WAIS-R method (for patients age 75 and younger) or using age corrections (i.e., Mayo Older Americans' Normative Studies [MOANS]) for older patients. Most patients scored within the mean standard errors of measurement defined in the WAIS-R manual for VIQ, PIQ, and FSIQ. In general, the 7-subtest and full versions of the WAIS-R yielded similar findings among this closely screened sample, but further testing among a more typical sample of patients with multiple risk factors for dementing conditions is needed.

Clinical utility of a seven subtest WAIS-R short form in the neuropsychological assessment of traumatic brain injury.

Comparison of IQ scores from the standard Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Ward (1990) seven-subtest short form (WAIS-R/7 SF) was performed on a sample of 459 patients with traumatic brain injury due to head trauma. The results indicate that this short form provides Verbal, Performance, and Full Scale IQ scores that vary little from the complete WAIS-R, at approximately one-half the typical administration time. The seven subtest short form predicted WAIS-R Full Scale IQ within 6 points in 95% of this clinical sample, with Verbal-Performance IQ discrepancies that were highly correlated (r(s) =.85, p <.0001). No differential gender effect in proration of IQs was found. Applications and pitfalls of abbreviated neuropsychological testing batteries are discussed, with utilization of the WAIS-R/7 SF offered as a means to reduce intelligence testing time while maintaining the ability to detect subtle information processing abnormalities with appropriate supplemental tasks.

Determining neuropsychological impairment using estimates of premorbid intelligence: comparing methods based on level of education versus reading scores.

When inferring brain dysfunction, test scores are typically compared to normative data based on estimates of premorbid intelligence (e.g., by educational level or reading scores). However, these methods are likely to lead to differing results, with important diagnostic and forensic implications. The current study compared estimates of impairment (reported in z-scores) based on educational level versus reading scores in a population with traumatic brain injury. The study included 174 patients (M age = 27.3; M education = 12.3) evaluated as outpatients at a university hospital rehabilitation department. Wilcoxen ranked sign tests indicated that the two methods yielded estimates that were statistically different (p <.0001) for all variables. The education based method yielded greater estimates of impairment than the reading score method for WAIS-R FIQ. Grip Strength, and Finger Tapping, with a pattern of generally consistent impairment across cognitive/motor areas (z-score range = -0.59 to -.97). In contrast, the reading score based method yielded greater estimates of impairment in processing speed (Trails A) and flexibility (Trails B), with a wider range of impairment noted between cognitive and motor domains (z-score range = +0.21 to -2.95). Clinical implications are discussed.

Managed care and rehabilitation: issues related to cognitive rehabilitation.

Managed care has affected the delivery of services in all health care sectors, although its impact on rehabilitation has been slower to take effect. These changes have required clinicians to provide more efficient services that are demonstrated to have an impact on functional outcome. However, in order to be reimbursed for specific rehabilitation services, such as cognitive rehabilitation, it is necessary for clinicians to become more knowledgeable regarding managed care, service delivery, and reimbursement issues. This article describes the impact of managed care on health care in general and on rehabilitation specifically. In addition, current billing procedures and reimbursement issues as they relate to cognitive rehabilitation are discussed, and suggestions for ways to secure reimbursement are presented for all disciplines providing cognitive rehabilitation services.

Predicting pain among children with juvenile rheumatoid arthritis.

OBJECTIVE: Children and adolescents with juvenile rheumatoid arthritis (JRA) often report pain as a major symptom that affects their daily activities. Little is known about the factors that contribute to pain, however. Demographic, disease status, and social-psychologic variables were used to predict pain of JRA. METHODS: Participants were 37 girls and 23 boys who were 7 to 17 years old. Measures included the Hopelessness Scale for Children, the Sadness Scale from the Differential Emotions Scale--IV, and the Social Support Questionnaire--Revised. A pain visual analogue scale served as the criterion measure. RESULTS: Reported pain was modestly correlated with disease duration and age. A hierarchical regression indicated that the predictor variables accounted for a modest amount of variance in pain scores. CONCLUSIONS: The results suggest that the factors contributing to pain in children with JRA are different from those in adults with rheumatoid arthritis (RA). Research is needed to identify the psychologic and socioenvironmental variables that influence pain among children with JRA.

Psychometric properties of a cognitive measure of personality disorders.

This study evaluated the internal consistency, 1-month test-retest reliability, and validity of a cognitive measure of personality disorders, the Belief Questionnaire (BQ; Beck, 1990). A large, nonclinical sample of college undergraduates completed the BQ, the MMPI-Personality Disorder scales (MMPI-PD; Morey, Waugh, & Blashfield, 1985), and the Personality Diagnostic Questionnaire-Revised (PDQ-R; Hyler & Rieder, 1987) at two times separated by 1 month. Results indicated high internal consistency and test-retest reliability for the BQ subscales. Validity results, however, were not so strong. The BQ scales were highly positively intercorrelated, and only moderate correspondence between BQ scores and corresponding scores from the MMPI-PD and PDQ-R was found.