Ethnoracial Disparities in Perinatal Outcomes Among Women Veterans.

Objective: Non-Hispanic Black women have increased rates of preterm birth and low infant birth weight. However, we do not know if these disparities replicate in women veterans, a population that may be at further risk for poor perinatal outcomes. This study sought to examine ethnoracial differences in preterm birth and low infant birth weight in veterans. Methods: A national sample of randomly chosen women veterans (i.e., oversampled for residency in high crime neighborhoods) reported information about all pregnancies they have had in their life, demographic characteristics, and history of childhood trauma exposures. The analytic sample was limited to individuals who identified as Hispanic/Latinx, Black, or White (n = 972). Mixed-effects regression models were used to examine ethnoracial differences in gestational age at delivery and infant birth weight, controlling for age at pregnancy, childhood trauma exposure, pregnancy during military service, income, and education. Results: Both Black and Hispanic/Latinx veterans were significantly more likely to have an infant born at lower gestational age (B = -1.04 and B = -1.11, respectively) and lower infant birth weight (B = -195.83 and B = -144.27, respectively) as compared with White veterans in covariate-adjusted models. Black (odds ratio = 3.24, confidence interval = 1.16, 9.09) veterans were more likely to meet the clinical definition of preterm birth as compared with White veterans. Conclusions: Results align with what is seen in the general population regarding ethnoracial disparities in gestational age at delivery and infant birth weight. Findings highlight the critical need for more research on mechanisms and prevention efforts for ethnoracial disparities in perinatal outcomes.

Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women.

Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.

The association between lifetime trauma exposure typologies and mental health outcomes among veterans.

We know little about veterans' lifetime trauma exposure patterns and how such patterns are associated with mental health outcomes. This study sought to identify lifetime trauma exposure typologies among veterans and examine associations between these typologies and mental health outcomes. It used baseline data from a national longitudinal mail-based survey of 3,544 veterans and oversampled for women (51.6%) and veterans living in high crime areas (67.6%). Most veterans (94.2%) reported trauma exposure, and 80.1% reported exposure to two or more traumas. Prevalence of mental health outcomes was: 27.7% anxiety, 31.3% depression, 37.9% posttraumatic stress disorder, 44.4% alcohol use disorder, 10.4% suicide attempt, and 33.5% mental health comorbidity. Latent class analysis was used to identify patterns of lifetime trauma exposure and logistic regression was used to examine the odds of mental health outcomes as a function of class membership. Five lifetime trauma exposure typologies emerged: (1) low trauma; (2) high combat and community violence; (3) intimate partner violence trauma; (4) high global physical assault; and (5) high trauma. Classes showed differential associations with mental health outcomes. Findings have implications for clinical practice including informing providers' mental health treatment plans to correspond to each veteran's trauma exposure typology.

Relationship of perceived neighborhood danger with depression and PTSD among veterans: The moderating role of social support and neighborhood cohesion.

Little is known about the impact of perceived neighborhood danger on military veterans' mental health, a population potentially at higher risk for this experience, or whether interpersonal social support and neighborhood cohesion can help buffer against poor mental health. This study examined: (1) the impact of perceived neighborhood danger on depression and posttraumatic stress disorder (PTSD) among veterans; (2) whether interpersonal social support and neighborhood cohesion can mitigate these effects; and (3) how prior trauma history may interact with these factors. Six moderation models were examined using data from 3049 veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma study, a mail-based survey that oversampled for veterans in high crime neighborhoods. Most notably, results indicated that perceived neighborhood danger was associated with increased depression and PTSD (all p < .001). Interpersonal social support or neighborhood cohesion mitigated the effect of perceived neighborhood danger on veterans' depression, but, only for those without prior trauma (all p < .011). For trauma-exposed veterans, interpersonal social support was more effective in mitigating the effect of perceived neighborhood danger on depression than neighborhood cohesion (p = .006). Findings help inform interventions to improve the mental health of veterans living in high crime neighborhoods.

Risk and resilience correlates of reading among adolescents with language-based learning disabilities during COVID-19.

Students with language-based learning disabilities (LBLD) can face elevated socio-emotional well-being challenges in addition to literacy challenges. We examined the prevalence of risk and resilience factors among adolescents with LBLD (N = 93), ages 16-18, and the association with reading performance during the COVID-19 pandemic. Data were collected at the start and end of the first fully remote academic year of COVID-19 (2020-2021). Participants completed standardized word and text reading measures, as well as self-report surveys of executive functions (EF), and socio-emotional skills associated with resilience (grit, growth mindset, self-management, self-efficacy, and social awareness) or risk (anxiety, depression, COVID-19 related PTSD, and perceived COVID-19 impact). Survey data at the start of the school year (Time 1) captured three underlying factors associated with socioemotional risk, socioemotional resilience, and regulation (i.e., EF). Path analyses revealed that students' Time 2 oral reading scores were significantly and uniquely predicted by socioemotional resilience, even when controlling for word-level reading at Time 1. Socioemotional risk, EF, and perceived COVID-19 impact were not directly related to Time 2 oral reading scores; however, students' resilience mediated the associations between risk and reading outcomes. These results demonstrate that adolescents' mental health concerns, self-regulatory ability, and socioemotional resilience were all associated with their experiences of the COVID-19-related stress. However, despite the high-risk context of the pandemic, and socio-emotional challenges faced by students with LBLD, our findings indicate that resilience directly predicts end-of-year reading outcomes and mediates the impact of socioemotional risk on achievement. Supplementary Information: The online version contains supplementary material available at 10.1007/s11145-022-10361-8.

The relationship between mental illness stigma and self-labeling.

OBJECTIVE: One way that stigma may interfere with treatment-seeking is its impact on whether an individual self-labels as someone with mental illness (MI). While identifying and labeling oneself as experiencing MI is an important early step in seeking treatment, self-labeling may also make individuals more susceptible to the negative effects of internalized, anticipated, and experienced stigma. In the present study, we examined the relationship between MI stigma and self-labeling. We hypothesized that endorsement of stereotypes, prejudice, and discrimination would be higher among those individuals who do not self-label and that those who did self-label would endorse higher levels of anticipated, internalized, and experienced stigma. METHOD: We conducted a survey of stigma and mental health via MTurk. The sample included 257 individuals who met criteria for a current probable diagnosis of depression, generalized anxiety, or posttraumatic stress disorder (PTSD). We compared those individuals who responded "yes" to ever experiencing MI (n = 202) to those who responded "no" (n = 52) on demographic variables, mental health symptoms and treatment history, and stigma. RESULTS: Individuals who did not self-label as having MI were more likely to be younger, male, and single. They also endorsed higher levels of stereotypes, prejudice, discrimination, and experienced stigma. Self-labelers endorsed more internalized stigma than those who did not self-label. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings suggest that associations between stigma and self-labeling are complex. Consistent with modified labeling theory, stigma may both act as a barrier to adopting a label of MI and increase vulnerability to stigma if the label is adopted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use": Correction.

Reports an error in "The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use" by Kelly L. Harper, Dawne Vogt, Annie Fox, Yael I. Nillni and Tara Galovski (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Sep 29, 2022, np). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2023-05302-001). OBJECTIVE: Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD: Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS: For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS: Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use.

[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Nov 07 2022 (see record 2023-15574-001). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected.] Objective: Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD: Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS: For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS: Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PTSD and Depression Symptoms Increase Women's Risk for Experiencing Future Intimate Partner Violence.

Psychological distress may impact women's risk for future intimate partner violence (IPV). Yet, limited research has utilized longitudinal research designs and there is a scarcity of research looking at the three most commonly implicated mental health factors-posttraumatic stress disorder (PTSD), depression, and alcohol use-within the same study. Research is especially scarce for women veterans, who experience substantial risk for these mental health concerns and experiencing IPV. This study examined the role of PTSD symptoms, depression symptoms, and alcohol use in increasing risk for experiencing future IPV while simultaneously accounting for the impact of recent IPV experience on subsequent mental health. This study included a sample of 1921 women veterans (Mage = 36.5), who were asked to complete three mail surveys over the course of 8 months as part of a larger longitudinal survey study of US veterans' health and well-being. The survey assessed experiences of IPV, PTSD symptoms (PCL-5), depression symptoms (PHQ-9), and alcohol use (AUDIT-C) at each of the three time points. Results from separate path analysis models provided support for the role of PTSD symptoms and depression symptoms (but not alcohol use) in increasing risk for IPV experience over time. However, the path analysis models provided little support, with the exception of PTSD, for the impact of IPV experience on subsequent mental health symptoms. Findings point to the importance of better understanding the mechanisms by which PTSD and depression symptoms can increase risk for IPV to inform theory and prevention and treatment efforts. Detection and treatment of PTSD and depression symptoms among women may help reduce risk for future violence in intimate relationships.

Integrating time into stigma and health research.

Stigma changes over time: it waxes and wanes through history, is manifested within humans who develop over time and is tied to statuses (such as attributes, illnesses and identities) that have varying courses. Despite the inherent fluidity of stigma, theories, research and interventions typically treat associations between stigma and health as stagnant. Consequently, the literature provides little insight into when experiences of stigma are most harmful to health and when stigma interventions should be implemented. In this Perspective, we argue that integrating time into stigma research can accelerate progress towards understanding and intervening in associations between stigma and health inequities. We situate time in relation to key concepts in stigma research, identify three timescales that are relevant for understanding stigma (historical context, human development and status course), and outline a time-based research agenda to improve scientists' ability to understand and address stigma to improve health.

Daily Phonotrauma Index: An Objective Indicator of Large Differences in Self-Reported Vocal Status in the Daily Life of Females With Phonotraumatic Vocal Hyperfunction.

PURPOSE: The purpose of this study is to evaluate if the Daily Phonotrauma Index (DPI) can quantitatively discriminate large differences in overall vocal status in the daily life of patients with phonotraumatic vocal hyperfunction (PVH). METHOD: For 1-4 weeks, 23 females with PVH wore an ambulatory voice monitor and answered three vocal status questions (i.e., difficulty producing soft, high-pitched phonation; discomfort; and fatigue) at the beginning, at 5-hr intervals, and the end of each day. DPI values were obtained for each patient's time periods of worst and best self-rated vocal status, and data for the group were analyzed for significant changes using a linear mixed-effects regression model. RESULTS: The DPI was significantly lower during periods self-rated as "best vocal status" compared to during periods self-rated as "worst vocal status" (mean difference in DPI = 0.53) with a medium-to-large effect size (Cohen's d = -0.68). CONCLUSIONS: In a group of patients with phonotraumatic lesions, the DPI indicated lower potential for phonotrauma during time periods of better vocal status compared to time periods of worse vocal status. Assuming that a large portion of variance in vocal status for patients with PVH is associated with the extent to which voicing is phonotraumatic, these results support the validity of obtaining estimates of DPI for much shorter time periods (i.e., an estimate every 2 min of voicing) than previous studies (i.e., a single estimate for the entire day or week). Future work can investigate the DPI's use for in-clinic assessment/treatment and ambulatory biofeedback and can gain further insights into phonatory mechanisms that underlie DPI via comparisons with other physiologically relevant measures and computational vocal fold modeling.

Artificial Grammar Learning in Children With Developmental Language Disorder.

PURPOSE: The purpose of the study was to evaluate implicit learning in children with developmental language disorder (DLD) by employing a visual artificial grammar learning task. METHOD: Thirteen children with DLD and 24 children with typical language development between the ages of 8 and 12 years completed a visual artificial grammar learning task. During the training phase of the task, participants were presented with strings of shapes that followed the underlying structure of a finite grammar. During the testing phase, participants were asked to judge whether new strings were grammatical or nongrammatical. Grammatical judgment of new strings served to measure generalization of the underlying grammatical structure. Endorsement based on chunk strength, or similarity to training exemplars, served to evaluate the extent to which children relied on surface features to guide their task performance. RESULTS: As a group, children with typical development performed better on the artificial grammar learning task, compared with children with DLD, and accepted more grammatical strings regardless of their similarity to training exemplars. Task performance in both groups was not affected by surface features. Performance of children with DLD whose test accuracy exceeded the learning threshold of 0.5 was consistent with a generalization of the underlying grammatical structure that was unaffected by surface features. CONCLUSIONS: The study found group differences in learning outcomes between children with and without DLD. Consistent with previous reports, children with typical development correctly endorsed more grammatical strings than children with DLD, suggesting a better acquisition of the grammatical structure. However, there was no evidence to suggest that children in the DLD group (learners and nonlearners) relied on surface features (i.e., familiarity to training exemplars) in their grammatical judgment. These results refute our hypothesis that children in the DLD group would show judgment based on familiarity.

The impact of military sexual trauma and warfare exposure on women veterans' perinatal outcomes.

OBJECTIVE: In the general population, history of trauma is associated with a range of adverse perinatal outcomes, which have long-term negative consequences for both mother and child. Research examining the impact of trauma, particularly trauma occurring during military service, on perinatal outcomes among women veterans is still in its nascence. The current study examined if warfare exposure and military sexual trauma (MST) contributed unique variance to the prediction of a broad range of adverse perinatal outcomes (i.e., preterm birth, full-term birth, infant birth weight, postpartum depression and/or anxiety). METHOD: Women veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey, and reported information about all pregnancies that occurred since enlistment in the military. They also reported on warfare exposure and MST using the Deployment Risk and Resilience Inventory. RESULTS: A total of 911 women reported on 1,752 unique pregnancies. Results revealed that MST, but not warfare exposure, was associated with having a lower infant birth weight (B = -17.30, SE = 5.41), a slight decrease in the likelihood of having a full-term birth (OR = .97, 95% CI [.93, 1.00]), and an increased likelihood of experiencing postpartum depression and/or anxiety (OR = 1.09, 95% CI [1.10, 1.14]) above and beyond age at pregnancy, racial/ethnic minority status, childhood violence exposure, and warfare exposure. CONCLUSIONS: Findings highlight the importance of screening for MST during pregnancy and trauma-informed obstetric care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Phonological working memory and central executive function differ in children with typical development and dyslexia.

The primary purpose of this study was to compare the working memory performance of monolingual English-speaking second- grade children with dyslexia (N = 82) to second-grade children with typical development (N = 167). Prior to making group comparisons, it is important to demonstrate invariance between working memory models in both groups or between-group comparisons would not be valid. Thus, we completed invariance testing using a model of working memory that had been validated for children with typical development (Gray et al., 2017) to see if it was valid for children with dyslexia. We tested three types of invariance: configural (does the model test the same constructs?), metric (are the factor loadings equivalent?), and scalar (are the item intercepts the same?). Group comparisons favoured the children with typical development across all three working memory factors. However, differences in the Focus-of-Attention/Visuospatial factor could be explained by group differences in non-verbal intelligence and language skills. In contrast, differences in the Phonological and Central Executive working memory factors remained, even after accounting for non-verbal intelligence and language. Results highlight the need for researchers and educators to attend not only to the phonological aspects of working memory in children with dyslexia, but also to central executive function.

Relationships Among Personality, Daily Speaking Voice Use, and Phonotrauma in Adult Female Singers.

PURPOSE: This study sought to determine whether personality traits related to extraversion and impulsivity are more strongly associated with singers with nodules compared to vocally healthy singers and to understand the relationship between personality and the types of daily speaking voice use. METHOD: Weeklong ambulatory voice recordings and personality inventories were obtained for 47 female singers with nodules and 47 vocally healthy female singers. Paired t tests investigated trait differences between groups. Relationships between traits and weeklong speaking voice measures (vocal dose, sound pressure level [SPL], neck surface acceleration magnitude [NSAM], fundamental frequency, cepstral peak prominence [CPP], and the ratio of the first two harmonic magnitudes [H 1 -H 2]) were examined using pairwise Pearson r coefficients. Multiple regressions were performed to estimate voice parameters that correlated with two or more traits. RESULTS: Singers with nodules scored higher on the Social Potency scale (reflecting a tendency toward social dominance) and lower on the Control scale (reflecting impulsivity) compared to the vocally healthy singers. In vocally healthy singers, vocal dose measures were positively correlated with a combination of Wellbeing (i.e., happiness) and Social Potency, mean SPL was positively correlated with Wellbeing, SPL variability was positively correlated with Social Potency and negatively with Harm Avoidance, and CPP mean was positively correlated with Wellbeing. Singers with nodules had a negative correlation between NSAM skewness and Social Potency. Both groups had negative correlations between H 1 -H 2 mean and Social Potency and Social Closeness. CONCLUSIONS: Singers with nodules are more socially dominant and impulsive than vocally healthy singers. Personality traits are related to daily speaking voice use, particularly in vocally healthy singers. Individuals with higher levels of traits related to happiness and social dominance and lower Harm Avoidance tended to speak more, with higher laryngeal forces, with more SPL variability, and with more pressed glottal closure, which could increase risk of phonotrauma.

Factors that influence non-word repetition performance in children with and without persistent speech sound disorders.

BACKGROUND: Nonword repetition (NWR) is a common phonological processing task that is reported to tap into many cognitive, perceptual, and motor processes. For this reason, NWR is often used in assessment batteries to aid in verifying the presence of a reading or language disorder. AIMS: To examine the extent to which child- and item-level factors predict the probability of a correct response on a non-word repetition (NWR) task in a sample of children with persistent speech sound disorders (P-SSDs) compared with their typically developing peers. METHODS & PROCEDURES: A total of 40 American-English-speaking children were tested on an NWR task for which the stimuli were manipulated for phonological neighbourhood density and list length. Additional measures of vocabulary and word reading were also administered. OUTCOMES & RESULTS: Children who were typically developing were 1.82 times more likely than children with P-SSD to respond correctly. The item-level factor of phonological neighbourhood density influenced performance, but only for the P-SSD group, and only at certain list lengths. Vocabulary and word-reading ability also influenced NWR task performance. CONCLUSIONS & IMPLICATIONS: Children with P-SSD present as a complex and heterogeneous group. Multiple factors contribute to their ability to perform phonological tasks such as NWR. As such, attention to the item-level factors in screenings and assessments is necessary to ensure that appropriate decisions are made regarding diagnosis and subsequent treatment. WHAT THIS PAPER ADDS: What is already known on the subject? Good expressive vocabulary is important for children with speech sound disorders; it can aid in their performance on phonological processing tasks like NWR. Nonword repetition may be a helpful test/ subtest to add to assessment batteries when evaluating children with speech sound disorders. What this paper adds to existing knowledge? Vocabulary and word reading abilities must also be measured for children with SSDs, to observe the bigger picture of their linguistic abilities. What are the potential or actual clinical implications of this work? The relation between word reading and speech sound production influences performance on phonological processing tasks.

Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females.

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = -0.25). The posttreatment patient group's DPI was still significantly higher than the control group (d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

Arm Motor Recovery After Ischemic Stroke: A Focus on Clinically Distinct Trajectory Groups.

BACKGROUND AND PURPOSE: Recovery of arm function poststroke is highly variable with some people experiencing rapid recovery but many experiencing slower or limited functional improvement. Current stroke prediction models provide some guidance for clinicians regarding expected motor outcomes poststroke but do not address recovery rates, complicating discharge planning. This study developed a novel approach to defining recovery groups based on arm motor recovery trajectories poststroke. In addition, between-group differences in baseline characteristics and therapy hours were explored. METHODS: A retrospective cohort analysis was conducted where 40 participants with arm weakness were assessed 1 week, 6 weeks, 3 months, and 6 months after an ischemic stroke. Arm recovery trajectory groups were defined on the basis of timing of changes in the Fugl-Meyer Assessment Upper Extremity (FMA-UE), at least the minimal clinically important difference (MCID), 1 week to 6 weeks or 6 weeks to 6 months. Three recovery trajectory groups were defined: Fast (n = 19), Extended (n = 12), and Limited (n = 9). Between-group differences in baseline characteristics and therapy hours were assessed. Associations between baseline characteristics and group membership were also determined. RESULTS: Three baseline characteristics were associated with trajectory group membership: FMA-UE, NIH Stroke Scale, and Barthel Index. The Fast Recovery group received the least therapy hours 6 weeks to 6 months. No differences in therapy hours were observed between Extended and Limited Recovery groups at any time points. DISCUSSION AND CONCLUSIONS: Three clinically relevant recovery trajectory groups were defined using the FMA-UE MCID. Baseline impairment, overall stroke severity, and dependence in activities of daily living were associated with group membership and therapy hours differed between groups. Stratifying individuals by recovery trajectory early poststroke could offer additional guidance to clinicians in discharge planning.(See Supplemental Digital Content 1 for Video Abstract, available at: http://links.lww.com/JNPT/A337.).

Electrophysiological Examination of Feedback-Based Learning in 8-11-Year-Old Children.

The study aimed at evaluating the extent to which the feedback related negativity (FRN), an ERP component associated with feedback processing, is related to learning in school-age children. Eighty typically developing children between the ages of 8 and 11 years completed a declarative learning task while their EEG was recorded. The study evaluated the predictive value of the FRN on learning retention as measured by accuracy on a follow-up test a day after the session. The FRN elicited by positive feedback was found to be predictive of learning retention in children. The relationship between the FRN and learning was moderated by age. The P3a was also found to be associated with learning, such that larger P3a to negative feedback was associated with better learning retention in children.

Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction.

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1-H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = -0.86) and voice therapy (d = -1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1-H2). Further validation of the DPI is needed to better understand its potential clinical use.