Erin Hastings

Young Children's Video/Computer Game Use: Relations with School Performance and Behavior

This study examined the amount and content of childrens video game playing in relation with behavioral and academic outcomes. Relationships among playing context, child gender, and parental monitoring were explored. Data were obtained through parent report of childs game play, behavior, and school performance. Results revealed that time spent playing games was related positively to aggression and negatively to school competence. Violent content was correlated positively and educational content negatively with attention problems. Educational games were related to good academic achievement. Results suggest violent games, and a large amount of game play, are related to troublesome behavioral and academic outcomes, but educational games may be related to positive outcomes. Neither gender nor parental monitoring emerged as significant moderators of these effects.

Management of Deep Brain Stimulator Battery Failure: Battery Estimators, Charge Density, and Importance of Clinical Symptoms

Objective We aimed in this investigation to study deep brain stimulation (DBS) battery drain with special attention directed toward patient symptoms prior to and following battery replacement. Background Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator). Methods A cohort of 320 patients undergoing DBS battery replacement from 2002–2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY). Results The mean charge density for treatment of Parkinson’s disease was 7.2 µC/cm2/phase (SD = 3.82), for dystonia was 17.5 µC/cm2/phase (SD = 8.53), for essential tremor was 8.3 µC/cm2/phase (SD = 4.85), and for OCD was 18.0 µC/cm2/phase (SD = 4.35). There was a significant relationship between charge density and battery life (r = −.59, p<.001), as well as total power and battery life (r = −.64, p<.001). The UF estimator (r = .67, p<.001) and the Medtronic helpline (r = .74, p<.001) predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001). Conclusions Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.

The relative success of a self-help and a group-based memory training program for older adults.

This study evaluates self-help and group-based memory training programs to test for their differential impact on memory beliefs and performance. Self-help participants used a manual that presented strategies for name, story, and list recall and practice exercises. Matched content from that same manual was presented by the trainer in 2-hr weekly group sessions for the group-based trainees. Relative to a wait-list control group, most memory measures showed significant gains for both self-help and group-based training, with no significant training condition differences, and these gains were maintained at follow-up. Belief measures showed that locus of control was significantly higher for the self-help and group-based training than the control group; memory self-efficacy significantly declined for controls, increased for group-trained participants, and remained constant in the self-help group. Self-efficacy change in a self-help group may require more opportunities for interacting with peers and/or an instructor emphasizing ones potential for memory change.

Self-regulation and recall: growth curve modeling of intervention outcomes for older adults.

Memory training has often been supported as a potential means to improve performance for older adults. Less often studied are the characteristics of trainees that benefit most from training. Using a self-regulatory perspective, the current project examined a latent growth curve model to predict training-related gains for middle-aged and older adult trainees from individual differences (e.g., education), information processing skills (strategy use) and self-regulatory factors such as self-efficacy, control, and active engagement in training. For name recall, a model including strategy usage and strategy change as predictors of memory gain, along with self-efficacy and self-efficacy change, showed comparable fit to a more parsimonious model including only self-efficacy variables as predictors. The best fit to the text recall data was a model focusing on self-efficacy change as the main predictor of memory change, and that model showed significantly better fit than a model also including strategy usage variables as predictors. In these models, overall performance was significantly predicted by age and memory self-efficacy, and subsequent training-related gains in performance were best predicted directly by change in self-efficacy (text recall), or indirectly through the impact of active engagement and self-efficacy on gains (name recall). These results underscore the benefits of targeting self-regulatory factors in intervention programs designed to improve memory skills.

Goal orientation and self-efficacy in relation to memory in adulthood

ABSTRACT The achievement goal framework (Dweck, 1986, American Psychologist, 41, 1040) has been well-established in children and college-students, but has rarely been examined empirically with older adults. The current study, including younger and older adults, examined the effects of memory self-efficacy, learning goals (focusing on skill mastery over time) and performance goals (focusing on performance outcome evaluations) on memory performance. Questionnaires measured memory self-efficacy and general orientation toward learning and performance goals; free and cued recall was assessed in a subsequent telephone interview. As expected, age was negatively related and education was positively related to memory self-efficacy, and memory self-efficacy was positively related to memory, in a structural equation model. Age was also negatively related to memory performance. Results supported the positive impact of learning goals and the negative impact of performance goals on memory self-efficacy. There was no significant direct effect of learning or performance goals on memory performance; their impact occurred via their effect on memory self-efficacy. The present study supports past research suggesting that learning goals are beneficial, and performance goals are maladaptive, for self-efficacy and learning, and validates the achievement goal framework in a sample including older adults.

Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients.

Objective To investigate the relationship of our interdisciplinary screening process on post-operative unintended hospitalizations and quality of life. Background There are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method. Methods An Essential Tremor cohort was selected from our institutional Deep Brain Stimulation database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential Deep Brain Stimulation candidates. Concerns for surgery raised by each specialty were documented and classified as none, minor, or major. Charts were reviewed to identify unintended hospitalizations and quality of life measurements at 1 year post-surgery. Results Eighty-six percent (44/51) of the potential screened candidates were approved for Deep Brain Stimulation. Eight (18%) patients had an unintended hospitalization during the follow-up period. Patients with minor or major concerns raised by any specialty service had significantly more unintended hospitalizations when compared to patients without concerns (75% vs. 25%, p < 0.005). The rate of hospitalization revealed a direct relationship to the “level of concern”; ranging from 100% if major concerns, 42% if minor concerns, and 7% if no concerns raised, p = 0.001. Quality of life scores significantly worsened in patients with unintended hospitalizations at 6 (p = 0.046) and 12 months (p = 0.027) when compared to baseline scores. No significant differences in tremor scores between unintended and non-unintended hospitalizations were observed. Conclusions The number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life. The interdisciplinary evaluation may help to stratify risk for these complications. However, data should be interpreted with caution due to the limitations of our study. Further prospective comparative and larger studies are required to confirm our results.

Interdisciplinary Parkinson’s Disease Deep Brain Stimulation Screening and the Relationship to Unintended Hospitalizations and Quality of Life

Objective To investigate the impact of pre-operative deep brain stimulation (DBS) interdisciplinary assessments on post-operative hospitalizations and quality of life (QoL). Background DBS has been utilized successfully in Parkinson’s disease (PD) for the treatment of tremor, rigidity, bradykinesia, off time, and motor fluctuations. Although DBS is becoming a more common management approach there are no standardized criteria for selection of DBS candidates, and sparse data exist to guide the use of interdisciplinary evaluations for DBS screening. We reviewed the outcomes of the use of an interdisciplinary model which utilized seven specialties to pre-operatively evaluate potential DBS candidates. Methods The University of Florida (UF) INFORM database was queried for PD patients who had DBS implantations performed at UF between January 2011 and February 2013. Records were reviewed to identify unintended hospitalizations, falls, and infections. Minor and major concerns or reservations from each specialty were previously documented and quantified. Clinical outcomes were assessed through the use of the Parkinson disease quality of life questionnaire (PDQ-39), and the Unified Parkinson’s Disease Rating Score (UPDRS) Part III. Results A total of 164 cases were evaluated for possible DBS candidacy. There were 133 subjects who were approved for DBS surgery (81%) following interdisciplinary screening. There were 28 cases (21%) who experienced an unintended hospitalization within the first 12 months following the DBS operation. The patients identified during interdisciplinary evaluation with major or minor concerns from any specialty service had more unintended hospitalizations (93%) when compared to those without concerns (7%). When the preoperative “concern” shifted from “major” to “minor” to “no concerns,” the rate of hospitalization decreased from 89% to 33% to 3%. A strong relationship was uncovered between worsened PDQ-39 at 12 months and increased hospitalization. Conclusions Unintended hospitalizations and worsened QOL scores correlated with the number and severity of concerns raised by interdisciplinary DBS evaluations. The data suggest that detailed screenings by interdisciplinary teams may be useful for more than just patient selection. These evaluations may help to stratify risk for post-operative hospitalization and QoL outcomes.

Comparable Botulinum Toxin Outcomes between Primary and Secondary Blepharospasm: A Retrospective Analysis

Background Blepharospasm is a focal cranial dystonia, which could be idiopathic in origin or secondary to an underlying disorder that commonly impairs quality of life. Botulinum toxin (BoNT) injections have become the treatment of choice; however, a less favorable response to BoNT is expected in secondary blepharospasm. No studies have been conducted comparing outcomes between blepharospasm cohorts. We therefore aim to compare BoNT outcomes in primary and secondary blepharospasm subjects. Methods A retrospective review of 64 blepharospasm subjects receiving BoNT therapy was conducted. Demographics, BoNT treatment schedules, duration of BoNT therapy, and side effects were recorded. Outcome measures were duration of benefit, peak-dose benefit recorded with the Clinical Global Impressions Scale (CGIS), and related side effects. Results No difference was found between the two cohorts regarding duration of benefit from treatment (primary 9.47 weeks vs. secondary 9.63 weeks, p = 0.88). Perceived peak-dose benefit was more commonly reported as “very much improved” in secondary patients, but this was not significant (p = 0.13). Higher BoNT dosages were required in both groups over time, with a mean increase of 20.5% in primary and 26.5% in secondary blepharospasm. Ptosis (8%) and diplopia (6%) were the most common reported side effects. Mean follow-up in years was similar between groups, 3.6 years for primary vs. 2.4 years for secondary blepharospasm (p = 0.17). Discussion BoNT injections were effective with comparable benefits seen in both primary and secondary blepharospasm populations. Clinicians should be aware of the similar benefit from BoNT reported in secondary blepharospasm patients. The average duration of benefit in this cohort was comparable with previous reports.