Machiko Tomita

Meta-Analysis of Facial Affect Recognition Difficulties After Traumatic Brain Injury

OBJECTIVE Difficulties in communication and social relationships present a formidable challenge for many people after traumatic brain injury (TBI). These difficulties are likely to be partially attributable to problems with emotion perception. Mounting evidence shows facial affect recognition to be particularly difficult after TBI. However, no attempt has been made to systematically estimate the magnitude of this problem or the frequency with which it occurs. METHOD A meta-analysis is presented examining the magnitude of facial affect recognition difficulties after TBI. From this, the frequency of these impairments in the TBI population is estimated. Effect sizes were calculated from 13 studies that compared adults with moderate to severe TBI to matched healthy controls on static measures of facial affect recognition. RESULTS The studies collectively presented data from 296 adults with TBI and 296 matched controls. The overall weighted mean effect size for the 13 studies was -1.11, indicating people with TBI on average perform about 1.1 SD below healthy peers on measures of facial affect recognition. Based on estimation of the TBI population standard deviation and modeling of likely distribution shape, it is estimated that between 13% and 39% of people with moderate to severe TBI may have significant difficulties with facial affect recognition, depending on the cut-off criterion used. CONCLUSION This is clearly an area that warrants attention, particularly examining techniques for the rehabilitation of these deficits.

Use of Currently Available Smart Home Technology by Frail Elders: Process and Outcomes

A 2-year randomized controlled trial conducted to test the feasibility and effectiveness of currently available smart home technology compared 46 treatment and 67 control home-based frail elders who lived alone. Treatment group participants were provided with a computer with Internet access and X10-based smart home technology. Problems in the use of the technology were categorized into 4 areas: person, computer, X10 products, and home. For each area, solutions were identified. Participants benefited from the smart home technology, and 91% recommended its use by others. The treatment group maintained physical and cognitive status, whereas the control group declined significantly in both.

Use of Personal Emergency Response Systems by Older Individuals With Disabilities

This article describes how older persons perceive and use personal emergency response systems (PERSs), including issues related to device design, and report reasons for nonuse of PERSs. Data for this study were collected through a semistructured questionnaire that included fixed and open-ended response questions. Six hundred six participants 60 years and older were surveyed. Descriptive statistics were used to report sample characteristics. The most often-stated reason for using a PERS was related to concerns with falling (40% of responses). Asked how a PERS has been helpful, 75.6% of participants expressed an enhanced feeling of security with their PERS. Lack of perceived need (57.0% of responses), cost (37.0%), and lack of knowledge of the device (23.7%) were the most frequently stated reasons for not using a PERS. This study found that, while PERSs provide benefits for many elders, there appear to be many older persons who could benefit who do not have one. Only 16% of participants in this study, all of whom had disabilities, used a PERS.

Use of cell phones by elders with impairments: Overall appraisal, satisfaction, and suggestions

Continuity theory provides a rationalization for understanding older adult friendships. Older adults do not have to anticipate disengagement but can exercise their choice to actively participate in establishing and maintaining friendship structures. The role of friend is one a person can choose to maintain. Friendships are dynamic and progress on a continuum with beginnings, periods of endurance and change, and endings. Continuity theory provides ways to understand why particular people have developed and adapted distinct friendship and social support networks. This insight provides social service professionals, gerontologists, and family members ways to enable older adults to remain in their communities longer and maintain support stability.Continuity theory provides a rationalization for understanding older adult friendships. Older adults do not have to anticipate disengagement but can exercise their choice to actively participate in establishing and maintaining friendship structures. The role of friend is one a person can choose to maintain. Friendships are dynamic and progress on a continuum with beginnings, periods of endurance and change, and endings. Continuity theory provides ways to understand why particular people have developed and adapted distinct friendship and social support networks. This insight provides social service professionals, gerontologists, and family members ways to enable older adults to remain in their communities longer and maintain support stability.

Grip strength in the frail elderly

Shechtman O, Mann WC, Justiss MD, Tomita M: Grip strength in the frail elderly. Am J Phys Med Rehabil 2004;83:819–826. Objective:To explore the relationship of impairment types to grip strength in the live-at-home frail elderly. Design:All data in this cross-sectional study were collected in face-to-face interviews in subjects’ homes by a nurse or occupational therapist. A total of 832 elders with activity limitations, as determined by the FIM™ instrument, participated in the study. Subjects were divided into three age groups (60–69, 70–79, and 80+ yrs) and four impairment groups: (1) minimally impaired, (2) visually impaired, (3) motor impaired, and (4) cognitively impaired. The outcome measures included the average (in kilograms) of three grip-strength trials per hand measured with the Jamar dynamometer at the second handle setting. Results:There were significant differences in grip strength scores among all age groups, indicating that grip strength decreased with age. Among impairment groups, the minimally impaired and visually impaired groups had significantly greater grip strength scores than the motor-impaired and the cognitively impaired groups. There were no significant differences between the minimally impaired and visually impaired groups or between the motor-impaired and the cognitively impaired groups. Conclusions:Age and sex are not the only determining factors of grip strength in the frail elderly. The type of impairment affects grip strength as well. Thus, age-based norms may not be the only basis for interpreting evaluation data and establishing treatment goals with this population.

Caregiver Involvement in the Use of Assistive Devices by Frail Older Persons

The population of persons over age 65 years is increasing, and with this trend there is an increase in number of older persons with disabilities, or frail elders. The importance of supportive environments for home-based frail elders has been recognized. Supportive environments include the presence of family caregivers and appropriate assistive devices. Assistive devices (AD) offer the potential to decrease frail elders need for personal assistance, and could reduce some of the burden expressed by caregivers. The inclusion of family caregivers in treatment planning and its implementation is a component of occupational therapy practice. Occupational therapists are also recognized as the lead professional in the provision of most assistive devices. However, there has been little research on the involvement of family caregivers in the use of assistive devices. The purpose of this study was to examine the relationship between caregiver involvement and the use of, and satisfaction with, assistive devices by frail elders. Interviews regarding assistive devices were conducted with 20 frail, cognitively intact elders who had a primary caregiver in their homes. Results indicate that elders regard assistive devices as very useful in saving time, conserving energy, reducing frustration, and providing a feeling of security. Caregivers were involved in the use of assistive devices when the device was first acquired (early caregiver involvement) and made suggestions for using the devices. They also encouraged, instructed, and assisted with the use of devices later, as necessary. There was a relationship between early caregiver involvement and involvement at the time of the interview (later caregiver involvement). Verbal encouragement and caregivers use of assistive devices to help perform tasks were strongly associated with both device use and satisfaction. The results reinforce the importance of caregiver involvement with assistive devices used by frail older persons.

Predictors of the Use of Assistive Devices that Address Physical Impairments Among Community-Based Frail Elders

Use of assistive devices is a type of health behavior utilized to maintain independence and enable living at home. The purpose of this study is to identify predictors of the use of assistive devices that address physical impairments among community-based frail elders. A convenience sample of 694 cognitively intact, physically frail elders older than 60, living at home, was used. Interviewers who visited their homes identified devices in use (M = 9.5). Predictors were determined by hierarchical multiple regression analyses. Among 15 independent variables, physical disability level (higher severity) was the strongest overall predictor. Medication intake (more) was the only predictor among health indicators. Race (White) was the strongest predictor among demographic variables, followed by region (south) and living arrangements (living alone). Among the psychosocial variables, depression was an important predictor to hinder assistive-device use. Further studies are encouraged to create a model of maintaining health behavior that includes assistive-device use.

The Relationship of Functional Independence to Assistive Device Use of Elderly Persons Living at Home

This study explored the relationship between use of assistive devices and functional independence for noninstitutionalized elderly. Predictors of functional independence (including age, sex, education, mental status, physical disability, and visual impairment) were determined through correlation analysis on a sample of 364 subjects. From this sample, 117 pairs of subjects were matched on these predictors and compared for levels of functional independence relative to assistive device use. For 60 pairs, the subject who used more assistive devices was more functionally independent than the subject who used fewer devices. For 36 pairs, the opposite was found. For 21 pairs, the results were mixed: Within most pairs, the subject with more devices was more independent in ADL but less independent in IADL. Results suggest that increased use of assistive devices relates to increased functional independence.

Dissatisfaction and Nonuse of Assistive Devices Among Frail Elders

This article is based on the Rehabilitation Engineering Research Center on Aging Consumer Assessments Study. The sample included 1,056 subjects who reported use or nonuse of assistive devices. Of these subjects, 873 identified reasons for not using or being dissatisfied with certain assistive devices. Study participants owned a mean of 14.2 assistive devices, used 84.8% of the devices they owned, and were satisfied with 84.2% of the devices they owned. Devices were grouped into categories based on the type of impairment they addressed (hearing, vision, cognitive, and musculoskeletal/neuromotor). Study participants owned the largest number of devices in the musculoskeletal/neuromotor category (mean of 10.6 devices). Devices in the hearing impairment category were rated lowest by participants in terms of satisfaction. Almost half of all reasons listed for not using certain assistive devices related to perceived lack of need.

Affect Recognition, Empathy, and Dysosmia After Traumatic Brain Injury

OBJECTIVE To investigate if olfaction is associated with affect recognition and empathy deficits after traumatic brain injury (TBI). Prior research has shown that TBI often leads to loss of smell. We hypothesized a relationship with emotion perception, because the neural substrates of the olfactory system overlap with the ventral circuitry of the orbital frontal cortex, which play a critical role in affective responses, such as empathy. DESIGN Comparative study investigating differences between participants with TBI who had impaired olfaction (dysosmia) with those with normal olfaction (normosmia). SETTING Postacute rehabilitation facilities in the United States, Canada, and New Zealand. PARTICIPANTS Participants (N=106) in the current study were a convenience sample of adults with moderate to severe TBI who were tested for olfactory function as part of a larger, related study on affect recognition. On average, participants were 11.5 years postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Olfaction (Brief Smell Identification Test), facial affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Faces [DANVA2-AF]), vocal affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Paralanguage [DANVA2-AP]), emotional inference (Emotional Inference from Stories Test [EIST]), and empathy (Interpersonal Reactivity Index [IRI]). RESULTS Fifty-six percent of participants were dysosmic and only 36% of these participants were aware of their deficit. Participants with dysosmia performed significantly poorer on the DANVA2-AF (P=.003), DANVA2-AP (P=.007), EIST (P=.016), and IRI (P=.013). Medium effect sizes were found for all measures. Dysosmia had a sensitivity value of 86.4% for detecting facial affect recognition impairments and 67.8% for vocal affect recognition impairments. CONCLUSIONS This study shows that olfactory deficits may be indicative of affect recognition impairments and reduced empathy. Early knowledge of affect recognition and empathy deficits would be valuable so that treatment could be implemented predischarge.