Psychological interventions for chronic pain following spinal cord injury.

Currently, no literature is available regarding the clinical efficacy and treatment outcome of psychological interventions for chronic pain among spinal cord injured (SCI) persons. The present article provides a framework for cognitive-behavioral interventions used with other pain populations and suggested application for the SCI population with chronic pain. Primary focus is upon a biopsychosocial model with patient self-management as the treatment goal. SCI rehabilitation has traditionally relied upon self-management strategies, as have recent psychological treatment approaches for chronic pain. In addition, recommendations for treatment outcome research are provided with the emphasis on using existing standardized assessment and measurement protocols.

The Rehabilitation Situations Inventory: staff perception of difficult behavioral situations in rehabilitation.

Development of an instrument to assess staff perception of the difficulty of typical rehabilitation situations involving patients, their families, and other staff is described. Use of the Rehabilitation Situations Inventory (RSI) with 177 staff in three facilities showed an instrument with high internal reliability and consistency across facilities. A decrease in perception of difficulty of situations with experience in rehabilitation was found. Preliminary evidence supports its usefulness as an instrument to assess which situations should be emphasized in staff training as well as an outcome measure for such training.

Bad drivers: identification of a target group for alcohol-related prevention and early intervention.

Individuals arrested for driving while intoxicated (DWI) have been targeted for preventive intervention of alcohol-related problems. However, high rates of diagnosed alcoholism among DWI arrestees suggest a need to identify individuals at risk earlier in the developmental process. The present study investigates one such group, namely male "bad drivers" with a history of multiple nonalcohol-related driving convictions. Over 11% of a sample of 254 men identified as bad drivers during an index year received an initial DWI arrest over a subsequent 3-year follow-up period. This was over five times greater than the rate of initial DWI arrest among a representative sample of men from the general driving population over the same time period. The same high rate of subsequent DWI arrest among drivers having four or more driving offenses within the index year was replicated in a 1% probability sample of over 39,000 drivers from the general driving population. Those individuals from the original group of 254 bad drivers who received an initial DWI had significantly higher levels of drinking at the time of their original identification as bad drivers than did those who did not receive a DWI. The results were discussed in terms of early identification and preventive interventions within the population of bad drivers.

Lower extremity manifestations of spasticity in chronic spinal cord injury.

The prevalence of various manifestations of spasticity from questionnaire responses and from clinical examination of chronic spinal cord injured patients is reported. Extensor spasms, flexor withdrawal spasms, and clonus were reported by most subjects. Those with incomplete lesions reported more interference with activities, more pain, and less functional usefulness, than did those with complete lesions. Extensor spasms were reported to interfere more with transfers, whereas flexor withdrawal spasms were reported to be more frequent at night and to interfere more with sleep. Increased muscle tone was observed more often in extensor than in flexor muscles. Those with incomplete lesions had more hypertonus and more limited passive joint movements than did those with complete lesions. Flexor withdrawal reactions and extensor spasms were also more pronounced in those with incomplete lesions, particularly those with Frankel grade C lesions.

Hypnosis and behavioral treatment in a worksite smoking cessation program.

In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home.

Multidimensional health locus of control in a rehabilitation setting.

In an attempt to replicate a recent report of the factorial structure of the Multidimensional Health Locus of Control Scale, a sample of rehabilitation patients (N = 107) were studied. Analyses in the present study failed to validate the previously reported three-dimensional structure, which indicates a need for careful interpretation of this scale when used with certain populations. An alternative factor structure and possible future directions are proposed.

Intoxicated and bad drivers: subgroups within the same population of high-risk men drivers.

Three groups of men drivers in the state of Washington were compared: those who had been arrested for driving while intoxicated (DWI group, N = 172), those who had received multiple nonalcohol-related violations or who had been involved in traffic accidents (high-risk drivers, or HRD group, N = 193) and a representative random sample of the general driving population of men in the state (GDP group, N = 154). Subjects completed a questionnaire assessing demographic, drinking, driving attitude, personality and hostility measures. The HRD and DWI groups were generally more deviant than the GDP subjects. The latter individuals were demographically more stable, had lower levels of drinking behavior and were more emotionally stable, with lower levels of depression, sensation seeking, external perception of control, and both overt and covert hostility. The GDP group also had lower levels of driving-related hostility. The HRD and DWI groups did not suffer significantly from each other on any of the measures of personality function or hostility. These two groups did differ on aspects of drinking behavior, driving-related attitudes and demographic characteristics. The noted similarities between the DWI and HRD groups are consistent with the contention that these two groups may represent subtypes within a larger population of high-risk drivers.

Social supports and stress as predictors of illness.

The incidence and pattern of self-reported illness were studied over a six-month period in panels of 292 women and 188 men categorized by their experience of stressful life changes and their perceived supportive relationships. Men and women with more than average stressful changes had a risk of illness 1.6 and 1.8 times that reported by those with below-average changes. Analysis of the interaction of stressful changes with social supports showed that women with a combination of high changes and low supports experienced 2.5 times the rate of illness as those with low changes and high supports. This interaction was not found for men. A monthly rating of perceived life stress was correlated with subsequently recalled life changes for both men and women. The findings for women are consistent with the hypothesis that the interaction of stress with degree of social support is an important predictor of illness experience.

Derivation and validation of neuropsychological clusters among men alcoholics.

Scores from 13 cognitive-neuropsychological tests administered to 245 men alcoholics were subjected to an average linkage cluster analysis. Six subtypes were derived but three were eliminated from further analyses because they had samples of less than 10. The remaining clusters appeared to reflect differing levels and patterns of neuropsychological functioning. Subsequent analyses indicated that the clusters were related to age but were independent of most other demographic and pretreatment alcohol-related variables. Significant associations were found between cluster membership and the likelihood of abstinence, completion of aftercare therapy and employment status over a 9-month follow-up period. Although this relationship to outcome is encouraging, neuropsychological status accounted for only a limited amount of the variance. The findings suggest the need to broaden the base of assessment, using multiple domains, in future attempts to derive meaningful subtypes within an alcoholic population.

Psychological response to amputation as a function of age and time since amputation.

Much of what is known about the psychological response to amputation is derived from studies of veterans. Most recent amputees come from a different group; they are typically older and have experienced medical problems prior to their amputation. In order to investigate the effects of age and time since amputation on psychological response, 66 amputees were assessed by the Symptom Checklist-90, Beck Depression Inventory and interviewed. When classified by time since amputation and by age, the results indicate that older amputees exhibited less depression and fewer psychological symptoms: in contrast, younger amputees evidenced increased depression and psychological symptomatology the longer the time since their amputation.