Amanda E. Smith

Hybrid functional electrical stimulation orthosis system for the upper limb : Effects on spasticity in chronic stable hemiplegia

A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.

Social support, depression, and physical disability: Age and diagnostic group effects

BACKGROUND Social support is an important resource that may benefit individuals aging with physical disabilities, although its effects may vary depending on age, sex, and type of disability. OBJECTIVES To (1) examine differences in social support--and how support might vary as a function of age and sex--in samples of individuals with multiple sclerosis (MS), spinal cord injury (SCI), and muscular dystrophy (MD) and (2) understand the extent that associations between different support domains and depression might be moderated by disability diagnosis, sex and age. METHODS A convenience sample (N = 1416) of individuals with MS, SCI, and MD completed surveys that included measures of perceived social support and depressive symptoms. RESULTS No significant support differences were found between diagnostic groups. There was a gradual decrease in social support with chronological age, and women reported more support than men, particularly friend support. Levels of perceived friend support were negatively associated with depression, and the associations between social support and depression did not differ as a function of age, sex, or diagnosis. CONCLUSIONS Social support is similarly associated with lower levels of depression for men and women, across disability diagnoses and all ages. Being a man and being older may be associated with lower levels of perceived support. Research is needed to determine if interventions that improve support will decrease depression and improve quality of life in persons with disabilities, particularly for men and individuals who are aging.

Resilience, age, and perceived symptoms in persons with long-term physical disabilities

Resilience may mitigate impact of secondary symptoms such as pain and fatigue on quality of life in persons aging with disability. This study examined resilience in a large sample of individuals with disabling medical conditions by validating the Connor–Davidson Resilience Scale, obtaining descriptive information about resilience and evaluating resilience as a mediator among key secondary symptoms and quality of life using structural equation modeling. Results indicated that the measure’s psychometric properties were adequate in this sample. Resilience was lowest among participants who were middle-aged or younger, and participants with depression. Resilience mediated associations between secondary symptoms and quality of life.

Efficacy of a Telephone-Delivered Self-Management Intervention for Persons With Multiple Sclerosis: A Randomized Controlled Trial With a One-Year Follow-Up

OBJECTIVE To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS). DESIGN Single-center, randomized (1:1), single-blind (outcome assessors), parallel-group trial with a primary endpoint of posttreatment (9-11 wk postrandomization) and long-term follow-up at 6 and 12 months. SETTING Telephone-delivered across the United States. PARTICIPANTS Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range, 25-76 y). INTERVENTIONS Eight-week individual telephone-delivered self-management intervention (T-SM) (n=75) versus an 8-week individual telephone-delivered MS education intervention (T-ED) (n=88). MAIN OUTCOME MEASURES The primary outcome was the proportion who achieved a ≥50% decrease in 1 or more symptoms-fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect. RESULTS For our primary outcome, 58% of those in the T-SM group and 46% of those in the T-ED group had a ≥50% reduction in 1 or more symptoms; this difference was not statistically significant (odds ratio, 1.50; 95% confidence interval, .77-2.93; P=.238). Participants in both groups significantly improved from baseline to posttreatment in primary and secondary outcome measures (P<.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6 and 12 months. CONCLUSIONS Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in care and extending the reach of rehabilitation for individuals with MS.

Modeling Secondary Health Conditions in Adults Aging With Physical Disability

Objectives: To test a conceptual model of secondary health conditions, age, and function in persons aging with long-term physical disabilities. Methods: Surveys were collected from 1,862 adults with spinal cord injury, neuromuscular disease, multiple sclerosis, or post-polio syndrome. Structural equation modeling was used to build a model describing relationships among physical and psychosocial secondary health conditions, pain, functional impairments, chronic medical conditions, and age. Results: In total, 12 individual symptom or function domains (latent factors) were identified, grouped into 5 broader factors. Increasing age was associated with greater rates of physical and health problems and poorer function, and showed curvilinear relationships with pain and psychosocial difficulties. Discussion: These data support a biopsychosocial model of secondary health conditions in adults aging with physical disability and suggest a five-factor approach for conceptualizing secondary conditions and their impact. Results also emphasize the importance of age in symptom severity and impact.

Prevalence and impact of pain in adults aging with a physical disability: Comparison to a US general population sample:

Objectives:To describe rates of pain and pain interference in a large sample of adults aging with long-standing physical disabilities, relative to a normative US population sample. Methods:Self-report survey data was collected for a sample of 1877 individuals with spinal cord injury, neuromuscular disease, postpolio syndrome, or multiple sclerosis. Rates of pain severity and pain interference in these samples were then compared with those taken from a large normative sample (>20,000) collected through the NIH Patient Reported Outcomes Measurement Information System (PROMIS). Results:Individuals with long-standing physical disabilities reported higher levels of pain and pain interference across the lifespan as compared with individuals in the normative sample. In general, individuals with disability did not experience an age-related decrease in pain and pain impact in contrast to those in the normative sample. For 3 disability groups (neuromuscular disease, postpolio syndrome, and multiple sclerosis), pain interference remained elevated and significantly higher than national norms in the “postretirement” period (ie, age 65 to 74). Discussion:Results from this study provide a large scale data on prevalence rates of pain and pain interference in this population. Findings underscore the prevalence and impact of pain in persons with disabilities and suggest that individuals with disability may not experience the same degree of decrease in pain interference in later life that is typical of the US population. Those aging with disability may be especially at risk for pain-related impairment in later life.

Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy.

BACKGROUND Pain and fatigue are common symptoms experienced by persons with muscular dystrophy (MD). However, it is unclear from previous studies whether pain and fatigue have independent effects on physical functioning and depression, and whether age moderates the relationship of pain and fatigue with physical functioning and depression. OBJECTIVE This cross-sectional study aimed to describe the relationship of pain and fatigue to physical functioning and depression in persons 20-89 years old with MD. METHOD A convenience sample of 332 individuals with MD completed a questionnaire that included measures of physical functioning (PROMIS item bank items), depression (PHQ-9), pain intensity (0-10 NRS), and fatigue (0-10 NRS). RESULTS Pain and fatigue were each independently associated with physical functioning and depression. Depressive symptoms were most severe among middle-aged participants (45-64 years old) relative to older and younger participants. Physical functioning had a negative relationship with chronological age. CONCLUSIONS Symptoms of pain and fatigue are significantly and independently related to physical functioning and depression in persons with MD. Research is needed to determine if treatments that target both pain and fatigue in patients with MD have more beneficial effects than treatments that target only one of these symptoms.

The association of age, pain, and fatigue with physical functioning and depressive symptoms in persons with spinal cord injury

Abstract Context/objective To describe the relationship of pain and fatigue with physical and psychological functioning in adults with spinal cord injury (SCI). Design Cross-sectional survey. Setting Community-based survey. Participants Convenience sample of individuals with SCI. Intervention Not applicable. Outcome measures Physical functioning (Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Functioning item bank items), depression (Patient Health Questionnaire-9 (PHQ-9)), pain severity (0–10 Numerical Rating Scale (NRS)), and fatigue (0–10 NRS). Results Pain and fatigue were independently associated with depression, but only pain was associated with physical functioning. Additionally, depression was more severe among middle-aged participants relative to younger or older participants. Physical functioning declined with increasing age, as well as with higher level of injury. Conclusions The findings support the need for continued development of effective treatments for both pain and fatigue in order to prevent and mitigate the negative effects these symptoms can have on functioning.

Symptom burden in persons with myotonic and facioscapulohumeral muscular dystrophy

ObjectiveThis study examines the prevalence of pain, fatigue, imbalance, memory impairment, and vision loss in persons with myotonic and facioscapulohumeral dystrophy and their association with functioning. DesignA survey (N = 170) included measures of severity (0–10 scales) and course of these symptoms as well as measures of social integration, home competency, mental health, and productive activity. Descriptive and regression analyses examined the associations between symptoms and functioning. ResultsFatigue (91%), imbalance (82%), and pain (77%) were the most commonly reported. The most severe symptom was fatigue (mean ± SD severity, 5.14 ± 2.81), followed by imbalance (4.95 ± 3.25). Symptoms were most likely to stay the same or worsen since onset. Controlling for potential medical and demographic confounds, symptoms were associated with 17% of the mental health variance, 10% of home competency, 10% of social integration, 16% of productive activity for myotonic dystrophy type 1, and 12% of productive activity for facioscapulohumeral muscular dystrophy. ConclusionsPain, fatigue, and imbalance are common in persons with muscular dystrophy. Interventions may be useful to mitigate their impact on functioning. Further research should examine these relationships to guide clinical practices.

The role of pain acceptance on function in individuals with disabilities: a longitudinal study.

Abstract Having higher levels of pain acceptance has been shown to be associated positively with quality of life in patients with chronic pain, but its role in adjustment to chronic pain among individuals with physical disabilities living in the community is not known. Moreover, issues related to item overlap between measures of pain acceptance and measures of patient function have limited the conclusions that can be drawn from previous research in this area. To better understand the role that pain acceptance plays in patient function, we administered measures of pain acceptance, pain intensity, depressive symptoms, and function to 392 individuals with physical disabilities, and the pain, symptom, and function measures were readministered 3.5 years later. Analyses evaluated the main and interaction effects of initial pain acceptance on subsequent changes in pain and function. Having higher levels of pain acceptance—in particular as reflected by a willingness to engage in activities despite pain—resulted in less increase in pain intensity and more improvements in pain interference, physical function, depressive symptoms, and sleep quality. The findings indicate that previous research supporting the importance of pain acceptance to function in patients from health care settings extends to individuals with chronic pain living in the community. Moreover, they indicate that pain acceptance may have long-lasting (up to 3.5 years) beneficial effects on subsequent pain and function and on the association between change in pain and depression. Research to examine the potential benefits of community-based treatments that increase pain acceptance is warranted.