The impact of tinnitus on adult cochlear implant recipients: A mixed-method approach.

BACKGROUND: Tinnitus is a common problem in patients with a cochlear implant (CI). Between 4% and 25% of CI recipients experience a moderate to severe tinnitus handicap. However, apart from handicap scores, little is known about the real-life impact tinnitus has on those with CIs. We aimed to explore the impact of tinnitus on adult CI recipients, situations impacting tinnitus, tinnitus-related difficulties and their management strategies, using an exploratory sequential mixed-method approach. METHODS: A 2-week web-based forum was conducted using Cochlear Ltd.'s online platform, Cochlear Conversation. A thematic analysis was conducted on the data from the forum discussion to develop key themes and sub-themes. To quantify themes and sub-themes identified, a survey was developed in English with face validity using cognitive interviews, then translated into French, German and Dutch and disseminated on the Cochlear Conversation platform, in six countries (Australia, France, Germany, New Zealand, the Netherlands and United Kingdom). Participants were adult CI recipients experiencing tinnitus who received a Cochlear Ltd. CI after 18 years of age. RESULTS: Four key themes were identified using thematic analysis of the discussion forum: tinnitus experience, situations impacting tinnitus, difficulties associated with tinnitus and tinnitus management. Among the 414 participants of the survey, tinnitus burden on average was a moderate problem without their sound processor and not a problem with the sound processor on. Fatigue, stress, concentration, group conversation and hearing difficulties were the most frequently reported difficulties and was reported to intensify when not wearing the sound processor. For most CI recipients, tinnitus seemed to increase when performing a hearing test, during a CI programming session, or when tired, stressed, or sick. To manage their tinnitus, participants reported turning on their sound processor and avoiding noisy environments. CONCLUSION: The qualitative analysis showed that tinnitus can affect everyday life of CI recipients in various ways and highlighted the heterogeneity in their tinnitus experiences. The survey findings extended this to show that tinnitus impact, related difficulties, and management strategies often depend on sound processor use. This exploratory sequential mixed-method study provided a better understanding of the potential benefits of sound processor use, and thus of intracochlear electrical stimulation, on the impact of tinnitus.

Short- and Long-Term Effect of Cochlear Implantation on Disabling Tinnitus in Single-Sided Deafness Patients: A Systematic Review.

Patients with single-sided deafness can experience an ipsilateral disabling tinnitus that has a major impact on individuals' social communication and quality of life. Cochlear implants appear to be superior to conventional treatments to alleviate tinnitus in single-sided deafness. We conducted a systematic review to evaluate the effectiveness of cochlear implants in single-sided deafness with disabling tinnitus when conventional treatments fail to alleviate tinnitus (PROSPERO ID: CRD42022353292). All published studies in PubMed/MEDLINE and SCOPUS databases until December 2021 were included. A total of 474 records were retrieved, 31 studies were included and were divided into two categories according to whether tinnitus was assessed as a primary complaint or not. In all studies, cochlear implantation, evaluated using subjective validated tools, succeeded in reducing tinnitus significantly. Objective evaluation tools were less likely to be used but showed similar results. A short-(3 months) and long-(up to 72 months) term tinnitus suppression was reported. When the cochlear implant is disactivated, complete residual tinnitus inhibition was reported to persist up to 24 h. The results followed a similar pattern in studies where tinnitus was assesed as a primary complaint or not. In conclusion, the present review confirmed the effectiveness of cochlear implantation in sustainably reducing disabling tinnitus in single-sided deafness patients.

Analysis of a Cochlear Implant Database: Changes in Tinnitus Prevalence and Distress After Cochlear Implantation.

The aim of this study was to estimate the prevalence and distress of tinnitus pre- and post-cochlear implantation in patients with bilateral severe to profound hearing loss. In this retrospective study, we included patients from a cochlear implant clinic in Perth, Western Australia. Pre- and post-cochlear implantation data from 300 implant recipients were collected on self-reported presence of tinnitus, tinnitus distress using the Tinnitus Reaction Questionnaire (TRQ), hearing-related quality of life using the Abbreviated Profile of Hearing Aid Benefit (APHAB), and consonant-nucleus vowel-consonant (CNC) word recognition test scores. Retrospectively, patients were grouped into those with or without tinnitus, and the grade of tinnitus distress. The potential factors associated with post-implantation changes in the presence of tinnitus and its distress were evaluated. Tinnitus prevalence was 55.8% pre-operatively and 44.3% post-implantation with a median TRQ score respectively of 12.0 (IQR: 1.0-28.0) and 3.5 (IQR: 0.0-16.2) points. Among the 96 patients experiencing tinnitus pre-implantation, 14.6% patients experienced moderate to catastrophic tinnitus distress pre-implantation compared to 6.3% post-implantation. To conclude, the pre- and post-implantation median TRQ score for the cohort population showed that tinnitus was a "slight" handicap. Tinnitus prevalence and its associated tinnitus distress decreased post-implantation. Patients with tinnitus post-implantation were significantly younger and had less severe pre-implantation hearing loss in the non-implanted ear than patients without tinnitus. Further research is needed to understand the factors influencing changes in tinnitus.

Influence of tinnitus annoyance on hearing-related quality of life in cochlear implant recipients.

Tinnitus is a common symptom in cochlear implant (CI) recipients. There is no clear evidence of the influence of tinnitus on hearing-related quality of life (QoL) in this population. The aim of this study was to assess the relationship between hearing-related QoL measured by the Speech, Spatial and Qualities of Hearing scale (SSQ12) and tinnitus annoyance or perceived change in tinnitus annoyance after cochlear implantation. The study sample consisted of 2322 implanted adults across France, Germany, Ireland, Italy, the Netherlands, Sweden and the United Kingdom. Information relating to QoL measured using the SSQ12 and tinnitus annoyance and change in tinnitus annoyance, assessed using single-item questions, were collected one or more years post-implantation. The relationship between SSQ12 score and tinnitus annoyance or change in tinnitus annoyance was analysed using linear models adjusted for age and unilateral versus bilateral implants. Tukey pairwise tests were used to compare mean SSQ12 scores across levels of tinnitus annoyance and changes. Tinnitus prevalence was 33.9% post-implantation. Recipients with tinnitus had a significantly lower SSQ12 score than recipients without tinnitus. SSQ scores varied significantly with tinnitus annoyance, age and unilateral versus bilateral implants. Overall, CI recipients who experienced less bothersome tinnitus reported better hearing-related QoL. Healthcare professionals should be aware of the influence of tinnitus on CI recipients' hearing to manage patient expectations.

Systematic Review on Intra- and Extracochlear Electrical Stimulation for Tinnitus.

Several electrical stimulation patterns of the auditory nerve have been described for tinnitus relief, but there is no consensus on the most effective stimulation pattern. Therefore, we aim to systematically review the literature on the effect of intra- and extracochlear electrical stimulation patterns as a treatment option for patients with tinnitus. Only studies on intra- and extracochlear electrical stimulation for patients with tinnitus were included if the stimulation used did not concern standardized CI stimulation patterns to primarily rehabilitate hearing loss as intervention. A total of 34 studies met the inclusion criteria, with 10 studies (89 patients) on intracochlear electrical stimulation and 25 studies on extracochlear electrical stimulation (1109 patients). There was a high to medium risk of bias in 22 studies, especially due to lack of a non-exposed group and poor selection of the exposed group. All included studies showed subjective tinnitus improvement during or after electrical stimulation, using different stimulation patterns. Due to methodological limitations and low reporting quality of the included studies, the potential of intra- and extracochlear stimulation has not been fully explored. To draw conclusions on which stimulation patterns should be optimized for tinnitus relief, a deeper understanding of the mechanisms involved in tinnitus suppression is needed.

Cochlear implantation for patients with tinnitus - A systematic review.

BACKGROUND: Cochlear implantation (CI) is used in patients with severe-to-profound hearing loss when hearing aids provide limited or no benefit for speech perception. Studies on this topic reported tinnitus reduction as a common side effect of the electrical activation after cochlear implantation. So far, it is unclear what the effect is when patients do receive their implant primarily because of tinnitus complaints. OBJECTIVES: To assess the effectiveness of the electrical stimulation with a cochlear implant in patients with tinnitus as a primary complaint, by systematically reviewing the literature. METHODS: Two independent authors identified studies, extracted data and assessed risk of bias of included studies. Original studies reporting outcomes of electrical stimulation by cochlear implantation for primarily tinnitus (defined as severe or incapacitating distress levels) were included, if they reported a follow-up of at least three months. The pre- and post-implantation tinnitus distress scores on single and/or multi-item questionnaires of the included studies were extracted. RESULTS: In total, 4091 unique articles were retrieved. After screening titles, abstracts and full texts, we included seven prospective cohort studies (105 subjects in total, range: 10-26). All studies had considerable risks of bias. All tinnitus patients in the included studies had asymmetrical hearing loss or single-sided deafness. A statistically significant tinnitus distress improvement based on tinnitus questionnaire scores was found in every study. CONCLUSION: Our systematic review reveals that electrical stimulation by cochlear implants in patients with a primary complaint of tinnitus has a positive impact on tinnitus distress. Nevertheless, only small sample sizes were found and studies showed considerable risks of bias.a.

Fossil palm reading: using fruits to reveal the deep roots of palm diversity.

PREMISE: Fossils are essential for understanding evolutionary history because they provide direct evidence of past diversity and geographic distributions. However, resolving systematic relationships between fossils and extant taxa, an essential step for many macroevolutionary studies, requires extensive comparative work on morphology and anatomy. While palms (Arecaceae) have an excellent fossil record that includes numerous fossil fruits, many are difficult to identify due in part to limited comparative data on modern fruit structure. METHODS: We studied fruits of 207 palm species, representing nearly every modern genus, using X-ray microcomputed tomography. We then developed a morphological data set to test whether the fossil record of fruits can improve our understanding of palm diversity in the deep past. To evaluate the accuracy with which this data set recovers systematic relationships, we performed phylogenetic pseudofossilization analyses. We then used the data set to investigate the phylogenetic relationships of five previously published fossil palm fruits. RESULTS: Phylogenetic analyses of fossils and pseudofossilization of extant taxa show that fossils can be placed accurately to the tribe and subtribe level with this data set, but node support must be considered. The phylogenetic relationships of the fossils suggest origins of many modern lineages in the Cretaceous and early Paleogene. Three of these fossils are suitable as new node calibrations for palms. CONCLUSIONS: This work improves our knowledge of fruit structure in palms, lays a foundation for applying fossil fruits to macroevolutionary studies, and provides new insights into the evolutionary history and early diversification of Arecaceae.

Sound therapy for cochlear implant users with tinnitus.

OBJECTIVE: Despite the positive effect of a cochlear implant (CI) on tinnitus in many patients, tinnitus remains a problem for a significant proportion of CI users. We investigated the acceptability and effect of sound therapy (a combination of natural background sounds and one concise tinnitus counselling session) on tinnitus and speech perception in CI users who still experienced tinnitus during CI use. DESIGN AND STUDY SAMPLE: Thirty-two CI users (32-78 years) participated in phase 1: a test at the clinic to evaluate six background sounds provided by the sound processor. Eighteen out of the 32 CI users participated in phase 2: an optional take-home evaluation of 2 weeks without sound therapy, followed by 5 weeks with sound therapy, ending with an evaluation visit. RESULTS: Thirty subjects (93.8%) found at least one background sound acceptable. In phase 2, a small improvement with sound therapy was found for tinnitus loudness, annoyance, and intrusiveness. 50% of the subjects subjectively reported benefit of sound therapy. Especially the sense of control on their tinnitus was highly appreciated. No detrimental effect on speech perception was observed. CONCLUSION: The background sounds were acceptable and provided tinnitus relief in some CI users with tinnitus during CI use.

Correction: Reinvestigating an enigmatic Late Cretaceous monocot: morphology, taxonomy, and biogeography of Viracarpon.

[This corrects the article DOI: 10.7717/peerj.4580.].

Reinvestigating an enigmatic Late Cretaceous monocot: morphology, taxonomy, and biogeography of Viracarpon.

Angiosperm-dominated floras of the Late Cretaceous are essential for understanding the evolutionary, ecological, and geographic radiation of flowering plants. The Late Cretaceous-early Paleogene Deccan Intertrappean Beds of India contain angiosperm-dominated plant fossil assemblages known from multiple localities in central India. Numerous monocots have been documented from these assemblages, providing a window into an important but poorly understood time in their diversification. One component of the Deccan monocot diversity is the genus Viracarpon, known from anatomically preserved infructescences. Viracarpon was first collected over a century ago and has been the subject of numerous studies. However, resolution of its three-dimensional (3D) morphology and anatomy, as well as its taxonomic affinities, has remained elusive. In this study we investigated the morphology and taxonomy of genus Viracarpon, combining traditional paleobotanical techniques and X-ray micro-computed tomography (µCT). Re-examination of type and figured specimens, 3D reconstructions of fruits, and characterization of structures in multiple planes of section using µCT data allowed us to resolve conflicting interpretations of fruit morphology and identify additional characters useful in refining potential taxonomic affinities. Among the four Viracarpon species previously recognized, we consider two to be valid (Viracarponhexaspermum and Viracarponelongatum), and the other two to be synonyms of these. Furthermore, we found that permineralized infructescences of Coahuilocarpon phytolaccoides from the late Campanian of Mexico correspond closely in morphology to V. hexaspermum. We argue that Viracarpon and Coahuilocarpon are congeneric and provide the new combination, Viracarpon phytolaccoides (Cevallos-Ferriz, Estrada-Ruiz & Perez-Hernandez) Matsunaga, S.Y. Smith, & Manchester comb. nov. The significant geographic disjunction between these two occurrences indicates that the genus Viracarpon was widespread and may be present in other Late Cretaceous assemblages. Viracarpon exhibits character combinations not present in any extant taxa and its affinities remain unresolved, possibly representing an extinct member of Alismatales. The character mosaic observed in Viracarpon and the broad distribution of the genus provide new data relevant to understanding early monocot evolution and suggest that the (thus far) largely invisible Late Cretaceous monocot diversification was characterized by enigmatic and/or stem taxa.

An organismal concept for Sengelia radicans gen. et sp. nov. - morphology and natural history of an Early Devonian lycophyte.

Background and Aims: Fossil plants are found as fragmentary remains and understanding them as natural species requires assembly of whole-organism concepts that integrate different plant parts. Such concepts are essential for incorporating fossils in hypotheses of plant evolution and phylogeny. Plants of the Early Devonian are crucial to reconstructing the initial radiation of tracheophytes, yet few are understood as whole organisms. Methods: This study assembles a whole-plant concept for the Early Devonian lycophyte Sengelia radicans gen. et sp. nov., based on morphometric data and taphonomic observations from >1000 specimens collected in the Beartooth Butte Formation (Wyoming, USA). Key Results: Sengelia radicans occupies a key position between stem-group and derived lycophyte lineages. Sengelia had a rooting system of downward-growing root-bearing stems, formed dense monotypic mats of prostrate shoots in areas that experienced periodic flooding, and was characterized by a life-history strategy adapted for survival after floods, dominated by clonality, and featuring infrequent sexual reproduction. Conclusions: Sengelia radicans is the oldest among the very few early tracheophytes for which a detailed, rigorous whole-plant concept integrates morphology, growth habit, life history and growth environment. This plant adds to the diversity of body plans documented among lycophytes and may help elucidate patterns of morphological evolution in the clade.

Vascularization of the Selaginella rhizophore: anatomical fingerprints of polar auxin transport with implications for the deep fossil record.

The Selaginella rhizophore is a unique and enigmatic organ whose homology with roots, shoots, or neither of the two remains unresolved. Nevertheless, rhizophore-like organs have been documented in several fossil lycophytes. Here we test the homology of these organs through comparisons with the architecture of rhizophore vascularization in Selaginella. We document rhizophore vascularization in nine Selaginella species using cleared whole-mounts and histological sectioning combined with three-dimensional reconstruction. Three patterns of rhizophore vascularization are present in Selaginella and each is comparable to those observed in rhizophore-like organs of fossil lycophytes. More compellingly, we found that all Selaginella species sampled exhibit tracheids that arc backward from the stem and side branch into the rhizophore base. This tracheid curvature is consistent with acropetal auxin transport previously documented in the rhizophore and is indicative of the redirection of basipetal auxin from the shoot into the rhizophore during development. The tracheid curvature observed in Selaginella rhizophores provides an anatomical fingerprint for the patterns of auxin flow that underpin rhizophore development. Similar tracheid geometry may be present and should be searched for in fossils to address rhizophore homology and the conservation of auxin-related developmental mechanisms from early stages of lycophyte evolution.

Root evolution at the base of the lycophyte clade: insights from an Early Devonian lycophyte.

BACKGROUND AND AIMS: The evolution of complex rooting systems during the Devonian had significant impacts on global terrestrial ecosystems and the evolution of plant body plans. However, detailed understanding of the pathways of root evolution and the architecture of early rooting systems is currently lacking. We describe the architecture and resolve the structural homology of the rooting system of an Early Devonian basal lycophyte. Insights gained from these fossils are used to address lycophyte root evolution and homology. METHODS: Plant fossils are preserved as carbonaceous compressions at Cottonwood Canyon (Wyoming), in the Lochkovian-Pragian (∼411 Ma; Early Devonian) Beartooth Butte Formation. We analysed 177 rock specimens and documented morphology, cuticular anatomy and structural relationships, as well as stratigraphic position and taphonomic conditions. KEY RESULTS: The rooting system of the Cottonwood Canyon lycophyte is composed of modified stems that bear fine, dichotomously branching lateral roots. These modified stems, referred to as root-bearing axes, are produced at branching points of the above-ground shoot system. Root-bearing axes preserved in growth position exhibit evidence of positive gravitropism, whereas the lateral roots extend horizontally. Consistent recurrence of these features in successive populations of the plant preserved in situ demonstrates that they represent constitutive structural traits and not opportunistic responses of a flexible developmental programme. CONCLUSIONS: This is the oldest direct evidence for a rooting system preserved in growth position. These rooting systems, which can be traced to a parent plant, include some of the earliest roots known to date and demonstrate that substantial plant-substrate interactions were under way by Early Devonian time. The morphological relationships between stems, root-bearing axes and roots corroborate evidence that positive gravitropism and root identity were evolutionarily uncoupled in lycophytes, and challenge the hypothesis that roots evolved from branches of the above-ground axial system, suggesting instead that lycophyte roots arose as a novel organ.

Honeggeriella complexa gen. et sp. nov., a heteromerous lichen from the Lower Cretaceous of Vancouver Island (British Columbia, Canada).

PREMISE OF THE STUDY: Colonists of even the most inhospitable environments, lichens are present in all terrestrial ecosystems. Because of their ecological versatility and ubiquity, they have been considered excellent candidates for early colonizers of terrestrial environments. Despite such predictions, good preservation potential, and the extant diversity of lichenized fungi, the fossil record of lichen associations is sparse. Unequivocal lichen fossils are rare due, in part, to difficulties in ascertaining the presence of both symbionts and in characterizing their interactions. This study describes an exceptionally well-preserved heteromerous lichen from the Lower Cretaceous of Vancouver Island. METHODS: The fossil occurs in a marine carbonate concretion collected from the Apple Bay locality on Vancouver Island, British Columbia, and was prepared for light microscopy and SEM using the cellulose acetate peel technique. KEY RESULTS: The lichen, Honeggeriella complexa gen. et sp. nov., is formed by an ascomycete mycobiont and a chlorophyte photobiont, and exhibits heteromerous thallus organization. This is paired with a mycobiont-photobiont interface characterized by intracellular haustoria, previously not documented in the fossil record. CONCLUSIONS: Honeggeriella adds a lichen component to one of the richest and best characterized Early Cretaceous floras and provides a significant addition to the sparse fossil record of lichens. As a heteromerous chlorolichen, it bridges the >350 million-year gap between previously documented Early Devonian and Eocene occurrences.

Gains in fluid ability performance and their relationship to cortisol.

The present analyses examined the relationship between cortisol and performance gains in crystallized (Gc) and fluid (Gf) ability, as well as the relationship to measures of everyday cognitive functioning in a sample of 73 older adults. The analyses were part of a larger study examining the impact of anxiety-reduction training on everyday tasks. Cortisol was assessed via urine sampling. Results indicated that there was a significant negative correlation between cortisol and performance gains for Gf, replicating earlier findings reported by our laboratory. These findings also extend the relationship to cortisol measured in urine; previous analyses were conducted using serum-based cortisol. Cortisol was also significantly related to performance gains in some measures of everyday cognitive functioning.

Comparisons of urinary versus serum cortisol in older persons.

The present analysis compared urine- versus serum-based amounts of the stress hormone cortisol in two older adult samples, given that urine as a sample medium is a less expensive and less invasive method of determining cortisol amounts relative to serum. Seventy-three older adults provided urine samples as part of an ongoing study to assess levels of cortisol as a function of intellectual efficacy/performance; these data were compared to serum cortisol levels obtained from 96 older adults in a separate study examining health beliefs and cortisol levels. Analyses indicated that the cortisol levels did not differ across samples, i.e., cortisol amounts measured in serum or urine yielded similar, typical (within normal ranges) results. The data, though preliminary, indicate that urine may provide an alternative to serum when assessing cortisol in older persons.

Oral contraceptive use: implications for cognitive and emotional functioning.

This study investigated the role of oral contraception use versus nonuse as a moderator variable differentially influencing cognitive-emotional processes. Seventy-six healthy women (29 users and 47 nonusers; 18 to 48 years old), completed the State-Trait Anger Expression Inventory, the Clinical Analysis Questionnaire, the Rotter Scale of locus of control, the Daily Hassles Scale, and a Repertory Grid. A subsample (N = 33) also volunteered for a blood draw. Hormonal levels of progesterone and estrogen mostly were unrelated to cognitive and emotional measures, and contraindicated the "chemical suppression" proposition. Alternatively, when cognitive-emotional functioning was examined separately for users and nonusers, cognitive factors including the appraisal of stress, loci of control, and self-integration were implicated with specific patterns of negative affect and much more so for users than for nonusers. For the most part, oral contraceptive use versus nonuse seemed to influence the saliency rather than the nature of cognitive-emotional patterns. Discussion focused on oral contraceptive use as a moderator variable and the need for longitudinal research to clarify the evolving, biopsychosocial influence of hormonal regulatory treatment.

Social support and chronic fatigue syndrome.

The role of social support was examined in Chronic Fatigue Syndrome (CFS). Social support has been shown to affect illness outcome in medical disorders, likely due in part to communication between patient and support giver on illness-related concerns. Forty-one participants, 25 of whom had a primary support giver, completed the Beck Depression Inventory, the Perceived Stress Scale, the Profile of Mood States, and the Inventory of Socially Supportive Behaviors (ISSB); the primary support giver completed a modified version of the ISSB indicating the level of support he or she provided and a questionnaire assessing beliefs about CFS. Results indicated that there were no differences among individuals with CFS with or without support on measures of mood and perceived stress. Individuals with CFS and their support givers agreed on the amount of support offered, and extent of support was independent of beliefs concerning etiology. Exploratory analyses revealed that verbal emotional-cognitive support generally was more predictive of mental health than was tangible, less communicative support. The lack of positive effect of social support is discussed in relation to the degree of support offered, and implications for future research are discussed.

Depot medroxyprogesterone acetate (Depo-Provera) and levonorgestrel (Norplant) use in adolescents among clinicians in Northern Europe and the United States.

PURPOSE: To compare attitudes and practices related to clinicians' use of depot medroxyprogesterone acetate [Depo-Provera (DMPA)] and levonorgestrel implants in adolescents in three northern European countries and the United States. METHODS: Between the fall of 1993 and the winter of 1995, surveys eliciting clinician attitudes and practices with the two contraceptive methods were collected from practitioners who provide contraceptive care to teens in Sweden (n = 282), The Netherlands (n = 197), Great Britain (n = 108), and the United States (n = 548). RESULTS: Clinicians in Great Britain and the United States reported prescribing of DMPA, selected DMPA in their top three choices for contraception in teens, and had patients ask about DMPA more frequently than clinicians in Sweden or The Netherlands (p < 0.0001). U.S. clinicians were more likely to report prescribing of the implants, list them as a top choice, and have patients ask for it more frequently than were providers in the other three countries (p < 0.0001). Noncompliance with previous contraceptives was the most common indication for use of either method in this age group. "Worst fears" with DMPA use included infertility, particularly among Swedish clinicians (p < 0.0001), as was pregnancy and loss to follow-up, particularly among British clinicians (p < 0.0001). Condom nonuse was a concern associated with both methods. Breakthrough uterine bleeding was a concern related to implant use, particularly among Swedish practitioners (p < 0.0001). CONCLUSION: Clinicians in the United States and Great Britain display more enthusiasm toward the use of the long-term progestins in adolescents than do clinicians in Sweden or The Netherlands. Continuing education programs could be designed to educate clinicians to allay their concerns about these contraceptives in countries where teen pregnancy is considered a problem.

The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism.

The effects of two levels of exercise (walking versus jogging) in suppressing the self-stimulatory behavior of a five-year-old boy with autism were examined. The exercise conditions were applied immediately before periods of academic programming. Maladaptive self-stimulatory behaviors were separately tracked, enabling identification of behaviors that were more susceptible to change (e.g., physical self-stimulation and "out of seat" behavior) versus those that were more resistant (e.g., visual self-stimulation). Examination of temporal effects indicated a decrease in physical self-stimulation and "out of seat" behavior, but only for the jogging condition. In addition, sharp reductions in these behaviors were observed immediately following the jogging intervention and gradually increased but did not return to baseline levels over a 40 min period. Implications for further research and clinical intervention are discussed.