James H. Baños

UFOV performance and driving ability following traumatic brain injury

Primary objective: To investigate the relationship between performance on the Useful Field of View Test (UFOV) and driving performance following traumatic brain injury (TBI). Participants: Sixty people with TBI referred for driving evaluation. Measures: Useful Field of View Test, Global Rating Scale and Driver Assessment Scale. Results: Subject performance diminished as the complexity of the UFOV sub-tests increased. There was a significant relationship between UFOV performance, particularly on the second sub-test, and on-road driving performance. Subject age and Trail Making Test, Part B were also predictive of driving performance. Conclusions: The UFOV can be used as a screening measure to determine readiness to participate in an on-road driving assessment.

Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

ABSTRACT Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one’s acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self‐reports of depressive symptoms. Sixty‐seven individuals with chronic back pain completed self‐report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self‐reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

Self-report of cognitive abilities in temporal lobe epilepsy: cognitive, psychosocial, and emotional factors

Self-report of cognitive functioning using the Multiple Abilities Self-Report Questionnaire (MASQ) was examined in 57 left (LTLE) and 36 right (RTLE) temporal lobe epilepsy patients. The MASQ is a 38-item self-report measure assessing five domains of self-perceived cognitive functioning: Language, Visual-Perceptual Abilities, Verbal Memory, Visual-Spatial Memory, and Attention/Concentration. Overall, LTLE patients self-reported more cognitive difficulties across all domains. Language was the only domain to emerge as a robust indicator of seizure lateralization (LTLE patients reporting more problems). Neuropsychological test performance did not emerge as a significant predictor for any domain, whereas measures of psychosocial and emotional functioning accounted for a significant but modest amount of variance in all of them. The results suggest caution in using such self-report measures as an ecological extension of objective testing, but suggest a role in assessing self-appraisal of deficits.

Catastrophizing, acceptance, and interference: laboratory findings, subjective report, and pain willingness as a moderator.

OBJECTIVE The present study investigated the effects of both catastrophizing and the pain willingness component of acceptance on interference in daily activities and task performance during experimentally induced ischemic pain. In addition, the potential moderating role of pain willingness on the relationship between catastrophizing and degree of pain interference was also examined. DESIGN Sixty-seven persons with chronic low back pain completed measures of catastrophizing, acceptance, and daily pain interference. Participants underwent an ischemic pain induction procedure during which a Stroop-like task was administered. MAIN OUTCOME MEASURES Self-reported pain interference and observed performance on a Stroop-like task during induced pain. RESULTS The pain willingness component of acceptance and catastrophizing both contributed significantly to self-reports of pain interference. However, levels of pain willingness had an effect much stronger than the negative effects associated with catastrophizing with respect to observed pain interference during induced pain. Results also indicated that pain willingness serves as a moderator in the relationship between catastrophizing and task performance during induced pain. CONCLUSION The pain willingness factor of acceptance and catastrophizing both appear to be strong predictors for self-reported pain interference. During an objective assessment of pain interference, however, pain willingness shows a stronger effect and attenuates the negative impact of catastrophizing on task functioning.

Impact of Early Administration of Sertraline on Depressive Symptoms in the First Year after Traumatic Brain Injury

The potential for sertraline administered in the first 3 months after moderate to severe traumatic brain injury (TBI) to decrease the incidence of depression in the first year after injury was assessed in a double-blinded randomized control trial. Subjects were enrolled an average of 21 days after injury (none >8 weeks) followed by oral administration of placebo (50 subjects) or sertraline 50 mg (49 subjects) for 3 months. Subjects were not depressed at the time of study initiation. Outcome was assessed using the Hamilton Depression Rating Scale (HDRS) and the Depression Scale of the Neurobehavioral Functioning Inventory (NFI). Based on intent-to-treat and efficacy subset analyses, those receiving placebo exhibited significantly greater depressive symptoms than those receiving sertraline during the first 3 months after injury while receiving placebo/drug (10% of placebo group achieving a score of 6 or greater on the HDRS, 0% of the sertraline group; p < 0.023.). There was no significant difference in depressive symptoms during the remainder of the year between the two groups. Sertraline is effective in diminishing depressive symptoms even among those not clinically depressed while the medication is being taken. However, the results do not support the idea that administration early in recovery diminishes the expression of depressive symptoms after the drug is stopped. There is no basis from this study to assume that sertraline administered early in recovery after TBI, when neurotransmitter functioning is often altered, has ongoing effects on the serotonin system after sertraline is discontinued.

Impact of early administration of sertraline on cognitive and behavioral recovery in the first year after moderate to severe traumatic brain injury.

Objective:To assess the efficacy of sertraline administered in the first 3 months after moderate to severe traumatic brain injury (TBI) in improving cognitive and behavioral outcomes. Design:Double-blind, randomized controlled trial. Setting:Academic medical center. Participants:Ninety-nine individuals randomized to placebo (n = 50) or sertraline 50 mg (n = 49) conditions. There were no group differences in age, gender, education, or severity of injury. Interventions:Participants were enrolled an average of 21 days after injury (none > 8 weeks), followed by oral administration of placebo or sertraline 50 mg for 3 months. Main Outcome Measures:Wechsler Memory Scale—Third Edition Logical Memory, Trail Making Test, Wechsler Adult Intelligence Scale—Third Edition Working Memory Index, Symbol-Digit Modalities Test, Wisconsin Card Sorting Test (64-item), Neurobehavioral Functioning Inventory administered 3, 6, and 12 months after the onset of injury. Results:Early administration of sertraline did not result in improved cognitive functioning during the year after injury compared with placebo administration. Those receiving placebo performed marginally better than the treatment group on a measure of executive function, but this appeared to be inauthentic. The treatment group followed expected recovery patterns based on existing literature. The placebo group performed better than expected on some measures, primarily due to differential dropout. Conclusions:Sertraline does not appear to prevent development of cognitive and behavioral problems following TBI, although this does not negate evidence for the treatment (as opposed to prophylactic) role of sertraline to address emotional and neurobehavioral problems in individuals with TBI.

Cardiorespiratory fitness in survivors of pediatric posterior fossa tumor.

Advances in medical therapies have greatly improved survivorship rates in children diagnosed with brain tumor; as a result, morbidities associated with survivorship have become increasingly important to identify and address. In general, pediatric posterior fossa tumor survivors tend to be less physically active than peers. This may be related to late effects of diagnosis and treatment, including cardiovascular, endocrine, psychological, and neurocognitive difficulties. Exercise has been shown to be effective in improving physical functioning, mood, and even cognitive functioning. Consequently, the benefits of physical exercise need to be explored and incorporated into the daily lives of pediatric posterior fossa tumor survivors. The primary aim of the present study was to establish the feasibility and safety of cardiorespiratory fitness testing in pediatric posterior fossa tumor survivors who had received cranial radiation therapy. In addition, comparing our cohort with previously published data, we found that pediatric posterior fossa tumor survivors tended to be less fit than children with pulmonary disease and healthy controls and approximately as fit as children with chronic heart disease and survivors of other types of childhood cancer. The importance of cardiorespiratory fitness in pediatric posterior fossa tumor survivors is discussed along with implications for future directions.

An fMRI investigation of working memory and its relationship with cardiorespiratory fitness in pediatric posterior fossa tumor survivors who received cranial radiation therapy

The present study investigated the relationship between cardiorespiratory fitness and executive functioning in pediatric brain tumor survivors who received cranial radiation. This population is known to show executive dysfunction and lower rates of aerobic exercise compared to peers.

Visceral pain and life quality in persons with spinal cord Injury: a brief report.

Abstract Background/Objective: Few studies have examined the prevalence of visceral pain in persons with spinalcord injury (SCI), and virtually no studies have looked at the relationship between visceral pain and selfreportedquality of life. We examined the frequency of reported visceral pain at 5, 10, and 15 years afterinjury to determine whether the presence of visceral pain is related to quality of life, and to determine towhat extent visceral pain should be of concern to clinicians treating patients with SCI. Methods: Visceral pain and quality of life in persons with SCI were compared from a combined CraigHospital and National Model SCI Systems database at 5 (N=33), 10 (N=132), and 15 (N=96) years afterinjury. Results: The rates of visceral pain increased at each measurement (10% at year 5, 22% at year 10, and 32%at year 15); although these numbers reflect cross-sectional data, they do show a clear statistical change.Only a limited true longitudinal sample was available, but at 10 years after injury, individuals who hadreported visceral pain at any time reported a significantly lower quality of life than those never experiencingvisceral pain, F1,188 = 3.95, P <0.05. Conclusions: Although visceral pain may not be as prevalent as the more researched neuropathic andmusculoskeletal subtypes of pain, it may account for a higher percentage of people with SCI who report painthan previously recognized. More quantitative and longitudinal research is needed to examine therelationship of visceral pain with overall quality of life and to pursue interventions.

Confirmatory factor analysis of the california verbal learning test in patients with epilepsy: relationship to clinical and neuropathological markers of temporal lobe epilepsy.

Latent constructs involved in California Verbal Learning Test (D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1987) performance were examined using confirmatory factor analysis in 388 epilepsy surgery candidates. Eight factor models were compared. A single-factor model was examined, along with 7 models accommodating constructs of auditory attention, inaccurate recall, and delayed recall in different combinations. The retained model consisted of 3 correlated factors: Auditory Attention. Verbal Learning, and Inaccurate Recall. Validity of this factor structure was examined in a subsample of patients with left and right temporal lobe epilepsy. All 3 factors were related to seizure focus and magnetic resonance imaging hippocampal volume. Only Verbal Learning was related to hippocampal neuropathology, supporting the distinction between learning and attention in the factor structure.