Jeffrey E. Cassisi

Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls

The purpose of this study was to describe trunk strength and lumbar paraspinal muscle activity across five angles of flexion during isometric exercise and rest in chronic low-back pain patients and control subjects. High muscle tension as measured by surface integrated electromyography is predicted by a muscle spasm model, and low muscle tension is predicted by a muscle deficiency model. Prior lumbar surgery had no affect on peak torque or maximum surface integrated electromyography data. Both groups produced greater torque and less surface integrated electromyography in more flexed positions. Chranic low-back pain patients exhibited lower peak torque and lower maximum surface integrated electromyography bilaterally during isometric extension effort across all angles. A muscle deficiency model of chronic low back pain was supported by these data and a muscle spasm model was not supported. Discriminant analyses indicated that monitoring maximum surface integrated electromyography of lumbar muscles during isometric effort facilitates classification of chronic low-back pain patients. Future directions are discussed in terms of applying psychophysiologic methods to pain rehabilitation.

Emotion Recognition in Schizophrenia : Further Investigation of Generalized Versus Specific Deficit Models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

Independent evaluation of a multidisciplinary rehabilitation program for chronic low back pain

Severe chronic low back pain was diagnosed in 236 patients by one physician and they were referred to the University of Miami Comprehensive Pain and Rehabilitation Center (UMCPRC) over a 5-year period for an intensive 4-week inpatient treatment program. Of these 143 (61%) were able to be contacted by telephone and given a structured interview designed for the study. The average time elapsed at follow-up from referral for all patients was 22.5 months. Outcome was measured in the following terms: current levels of pain, percent decrease in pain, subsequent health care utilization, activities of daily living, and attitudes toward treatment. After completion of the interview, the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Questionnaire were sent to the patients. The patients fell into five groupings: Group 1--participants in the UMCPRC program (n = 39); Group 2--those whose participation was not approved by insurance (n = 30); Group 3--those who declined participation (n = 46); Group 4--participants in other programs (n = 14); Group 5--dropouts (n = 14). The five groups were not meaningfully different with regard to prereferral demographics. Interestingly, Group 1 patients exhibited significantly greater prereferral pain and unemployment levels. Despite this, at follow-up significantly more Group 1 members were employed and they exhibited a greater percent decrease in pain as compared to the nonparticipant groups. Returned McGill and Oswestry Questionnaires mirrored these findings. Group 1 members also demonstrated significantly lower rates of subsequent health care utilization, i.e., physician visits, hospitalizations, and surgery than the nonparticipant groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between confabulation and measures of memory and executive function

Confabulation has traditionally been attributed to a combination of memory impairment and executive dysfunction, but recent models propose that confabulation can result from executive dysfunction alone. One hundred and ten patients with diverse neurologic and psychiatric diagnoses were subdivided into high-, low-, and non-confabulator groups based upon the ratio of confabulations to total responses produced during story recall. Consistent with the combined deficit model, high-confabulators performed significantly worse than the low- and non-confabulators on measures of memory and measures of executive function that assess sustained attention, mental tracking, and set-shifting ability. However, there were no differences between groups on measures of problem-solving, concept formation, and verbal fluency, suggesting a dissociation in executive functions that contribute to confabulation.

Lumbar iEMG during isotonic exercise: chronic low back pain patients versus controls.

Two studies investigated the use of lumbar integrated electromyography (iEMG) during flexion-extension exercises of the lumbar spine. The first study compared the iEMG fatigue slopes of 12 pain-free controls during a standardized isotonic workout with a heavy weight and a light weight. Results indicated that the slopes of the iEMG across flexion-extension repetition was negative in both conditions, with the heavy weight producing significantly steeper fatigue slopes. In the second study, iEMG was compared from 16 chronic low back pain (CLBP) patients and 12 asymptomatic controls during isotonic exercise. Integrated EMG was recorded during 18 lumbar extension-flexion cycles (3 min) at a standard pace. Each subject exercised at a weight equal to 60% of his maximum isometric torque produced at the most extended position. Results indicated significantly less iEMG was produced by the CLBP group during both concentric and eccentric exertion. For both groups, eccentric exertion produced significantly less iEMG than concentric exertion. The groups showed significantly different iEMG fatigue slopes, with the control group showing declining iEMG by repetition, while the CLBP group showed flatter, slightly increasing iEMG. This occurred for both eccentric and concentric comparisons. A muscle deficiency model of CLBP is supported and results suggest the importance of endurance factors in addition to strength in rehabilitation efforts. Results also suggest the possibility of using this methodology for detecting insincere efforts in lumbar spine assessment.

The Relationship Between Self-Efficacy and Disability in Chronic Low Back Pain Patients

This study examined the reliability of an adapted version of the Arthritis Self-Efficacy Scale in a sample of 59 chronic low back pain patients. The present study also investigated the relationship between self-efficacy and measures of disability. Regression analyses indicated a significant negative relationship between self-efficacy and low back pain disability. That is, patients who report higher levels of self-efficacy have higher activity levels (R2=0.34,P<0.01), work more hours (R2=0.25,P<0.01), and have lower levels of psychological distress (R2=0.29,P<0.01), pain severity (R2=0.46,P<0.01), and pain behavior (R2=0.27,P<0.01) after controlling for the demographic variables of gender, duration of back pain, and having a lawyer on retainer. The results support the use of the Back Pain Self-Efficacy Scale (BPSES) as a general measure of self-efficacy in the chronic low back pain population.

Psychophysiological evaluation of stigma towards schizophrenia

Stigma is a potentially destructive phenomenon that may result in negative consequences for individuals diagnosed or labeled as having a mental illness. Several recent studies suggest that contact with various stigmatized out-group members result in psychophysiological reactions indicative of negative affect. It is unclear whether such reactions extend to encounters with individuals with mental illness. Participants imagined interacting with individuals labeled or unlabeled as having schizophrenia, while corrugator supercilii (brow) EMG, palmer skin conductance, and heart rate activity were monitored. Participants were 15 males and 20 females mainly African American students between the ages of 18 and 28 who attended a historically black university in the Southeastern region of the United States. Participants reported higher SUDS ratings and exhibited higher brow muscle tension during imagery with labeled than non-labeled individuals. Psychophysiological reactivity predicted global self-reported attitudes of stigma towards labeled individuals. The findings suggest that one reason why individuals avoid individuals with mental illness is physiological arousal, which is likely experienced as negative.

Relationships between coping style and PAI profiles in a community sample

Relationships between coping style and psychological functioning were examined in a heterogeneous community sample (N = 168). Psychological functioning was categorized with the Personality Assessment Inventory (PAI; Morey, 1991). Subjects were assigned to PAI configural profile clusters, using T-scores from PAI clinical scales. Three PAI clusters were prominent in this sample: normal, anxious, and eccentric. Multivariate analysis of covariance revealed that these clusters differed significantly in coping style, as measured by the dispositional format of the COPE Inventory (Carver, Scheier, & Weintraub, 1989). Normals coped through avoidance significantly less than anxious or eccentric subjects. Also, normals engaged in seeking social support and venting more than eccentric but less than anxious subjects. Gender differences also were noted, with women more likely to cope by seeking social support and men more likely to cope through hedonistic escapism.

The detection of malingering and deception with a short form of the MMPI-2 based on the L, F, and K scales.

This project examined the use of a short inventory based on the validity subscales from the MMPI-2. In Study 1, 69 subjects responded to the extracted L, F, and K items and to those items when embedded in the complete MMPI-2. Correlations between administrations were equivalent to the original test-retest reliabilities for these scales. In Study 2, 60 subjects responded to the short-form with instructions to be honest, fake good, or fake bad. The correct classification rate was 77% using the standard MMPI-2 rules of L greater than 7OT for faking good and F greater than 7OT for faking bad. Taken together, these findings suggest that the short-form may be useful alone or when combined with other questionnaires to identify potential problems in self-report.

Neurofeedback Training for a Patient With Thalamic and Cortical Infarctions

One year after a left posterior and thalamic stroke, a 52-year-old male participant was treated with 14 weeks of theta reduction neurofeedback training. Imaging studies revealed left temporal, parietal, occipital, and bilateral thalamic infarctions along the distribution of the posterior cerebral artery. Neuropsychological testing demonstrated severe verbal memory, naming, visual tracking, and fine motor deficits. Additionally, alexia without agraphia was present. A pretraining quantitative electroencephalograph (QEEG) found alpha attenuation, lack of alpha reactivity to eye opening, and excessive theta activity from the left posterior head region. Neurofeedback training to inhibit 4–8 Hz theta activity was conducted for 42 sessions from left hemisphere sites. Over the course of the training, significant reductions in theta amplitude occurred from the training sites as assessed from the postsession baseline periods. Posttraining, a relative normalization of the QEEG was observed from the left posterior head region.