Malachy Bishop

The impact of epilepsy on quality of life: a qualitative analysis.

The assessment and understanding of epilepsys impact on an individuals quality of life (QOL) is increasingly being recognized as an important component of clinical care. Because the impact of epilepsy can span a range of clinically important functional and psychosocial domains, QOL as a model for understanding epilepsys impact should be inclusive of the many life domains that are important to the individual. In this study a community-based sample of 46 adults with epilepsy were surveyed to identify the QOL domains that are important to persons with epilepsy, the factors that contribute to and detract from QOL, and the ways that epilepsy is perceived to impact QOL. A multidomain structure of quality of life emerged from the qualitative data analysis. Epilepsy was seen as having both a direct and an indirect impact on QOL, by directly affecting QOL domains and by affecting those factors that contribute to QOL.

Quality of Life and Psychosocial Adaptation to Chronic Illness and Disability Preliminary Analysis of a Conceptual and Theoretical Synthesis

This article describes and presents an initial analysis of a quality-of-life—based model of psychosocial adaptation to chronic illness and disability. This model, termed disability centrality, represents a conceptual and theoretical synthesis of several existing theories and models, drawn from the quality-of-life, rehabilitation counseling, and rehabilitation psychology literature. The model was analyzed in a cross-sectional analysis using survey-based research among 72 college students with disabilities. The results supported the relationships hypothesized in the proposed model. The implications for clinical practice and further research concerning the psychosocial adaptation process are presented.

Employment Concerns of People with Epilepsy and the Question of Disclosure: Report of a Survey of the Epilepsy Foundation.

This article presents the results of a survey of the Epilepsy Foundation affiliates in the United States and Puerto Rico, regarding the employment-related questions and concerns of people with epilepsy. The survey also explored how Epilepsy Foundation affiliates advise people with epilepsy about disclosing epilepsy status in the employment-seeking process. Some of the major employment-related questions and concerns reported by the affiliates included identifying resources to help in finding a job, questions about disclosure of epilepsy status in job applications, questions about job-related discrimination or Americans with Disabilities Act (ADA) violations, questions about the ADA, and questions about how to deal with co-workers or supervisors. Implications and design limitations are discussed.

Ipsilateral Reorganization of Language in Early-Onset Left Temporal Lobe Epilepsy.

Purpose. Decline in confrontation naming ability occurs in a subset of temporal lobe epilepsy (TLE) patients following left (dominant) anterior temporal lobectomy (ATL). Patients with late age of onset of seizures are most vulnerable to such decline. In addition, object names typically acquired later in language development are the words most likely to be inaccessible after ATL. Early-onset left TLE patients may be at lower risk for post-ATL dysnomia either because they have a limited preoperative lexicon that does not include most late-age-of-acquistion names or they undergo early ipsilateral language reorganization, which results in a lexicon similar to that of late-onset TLE patients but offers protection from post-ATL naming decline.Methods. Sixty-five left hemisphere speech dominant left TLE patients who had undergone ATL were assessed pre- and postoperatively on the Boston Naming Test (BNT).Results. The early- and late-onset groups performed similarly across three BNT age-of-acquisition categories at the preoperative assessment. Words acquired relatively later in life were most likely to become inaccessible postoperatively for both groups, but the early-onset patients showed significantly less overall postoperative decline in naming ability compared with the late-onset group.Conclusions. The more stable pre- to postoperative naming performance exhibited by early-onset patients cannot be attributed to lack of acquisition of the words shown to be most vulnerable to postoperative decline (i.e., late-age-of-acquisition words). Their object naming stability suggests that early-onset left TLE patients undergo intrahemispheric reorganization of language early in life that provides protective benefits.

State vocational rehabilitation services and employment in multiple sclerosis

Background: Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS). Objective: The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits. Methods: We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression. Results: A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes. Conclusion: VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.

Research implications of the Institute of Medicine Report, Epilepsy Across the Spectrum: Promoting Health and Understanding

In March 2012 the Institute of Medicine (IOM) released the report, Epilepsy Across The Spectrum: Promoting Health and Understanding. This report examined the public health dimensions of the epilepsies with a focus on the following four areas: public health surveillance and data collection and integration; population and public health research; health policy, health care, and human services; and education for providers, people with epilepsy and their families, and the public. The report provided recommendations and research priorities for future work in the field of epilepsy that relate to increasing the power of data on epilepsy; prevention of epilepsy; improving health care for people with epilepsy; improving health professional education about epilepsy; improving quality of life for people with epilepsy; improving education about epilepsy for people with epilepsy and families; and raising public awareness about epilepsy. For this article, the authors selected one research priority from each of the major chapter themes in the IOM report: expanding and improving the quality of epidemiologic surveillance in epilepsy; developing improved interventions for people with epilepsy and depression; expanding early identification/screening for learning impairments in children with epilepsy; evaluating and promoting effective innovative teaching strategies; accelerating research on the identification of risk factors and interventions that increase employment and improve quality of life for people with epilepsy and their families; assessing the information needs of people with epilepsy and their families associated with epilepsy‐related risks, specifically sudden unexpected death in epilepsy; and developing and conducting surveys to capture trends in knowledge, awareness, attitudes, and beliefs about epilepsy over time and in specific population subgroups. For each research priority selected, examples of research are provided that will advance the field of epilepsy and improve the lives of people with epilepsy. The IOM report has many other research priorities for researchers to consider developing to advance the field of epilepsy and better the lives of people with epilepsy.

Self-Management, Perceived Control, and Subjective Quality of Life in Multiple Sclerosis: An Exploratory Study

Self-management has been shown to increase perceived control over both illness and nonillness aspects of life among people with chronic conditions but has not received significant research attention among persons with multiple sclerosis (MS). Based on relationships proposed in the illness intrusiveness and disability centrality models, this study explored the relationships between subjective and objective measures of MS impact, self-management, perceived control, and subjective quality of life (SQOL). A sample of 157 adults with MS participated in this research. The results suggest that self-management is strongly associated with perceived control and that both perceived control and self-management mediate the relationship between MS impact and SQOL. The rehabilitation counseling implications of these findings are discussed.

The Effects of Psychosocial Factors on Quality of Life among Individuals with Chronic Pain.

This study investigated the psychosocial factors affecting the quality of life (QOL) of 171 individuals with chronic pain. Participants completed a battery of self-rated inventories measuring three sets of predictor variables—demographic (age, gender, income, marital status), pain-specific (chronicity, severity, duration, frequency, pain impairment), and psychosocial (interference, social support, depression, coping)—and one criterion variable with five models (physical, psychological, social, environmental, total). Hierarchical multiple regression indicates that income predicts the psychological and environmental domains of QOL. Across all five models, 56% to 76% of the variance was accounted for with the three sets of variables. Demographics remained minimally predictive of all models. Pain impairment was predictive of all five models. Depression was predictive of all but physical QOL, and coping was predictive of all but physical and environmental QOL. The pain impairment variable and the two psychosocial variables (depression and coping) remained imperative in predicting QOL of individuals with chronic pain.

Quality of Life Among Adults with Epilepsy An Exploratory Model

The last 20 years has seen an increased interest in identifying the factors that affect quality of life for individuals with epilepsy. The great majority of this research has focused on the impact of medical interventions on quality of life. At the same time, increased understanding has developed regarding the significant impact that physical, social, and psychological factors make on the quality of life and life satisfaction of people with epilepsy. In an effort to better understand the relationships of the physical and psychosocial factors to each other and to quality of life among people with epilepsy, the authors developed and evaluated an exploratory model. The results have implications for rehabilitation professionals who work with people with epilepsy.

Determinants of Employment Status among a Community-Based Sample of People with Epilepsy: Implications for Rehabilitation Interventions.

People with epilepsy may face a number of complex and interacting problems and barriers related to employment. Understanding these barriers is an important step toward implementing effective rehabilitation interventions. This article explores the factors that predicted employment status among a community-based sample of adults with epilepsy. Data for the analysis were collected from 146 adults with epilepsy through Epilepsy Foundation chapters in Wisconsin, Kentucky, and Ohio. Several demographic and epilepsy-related variables were analyzed to explore the determinants of employment status. Results of a binary logistic regression analysis suggest that gender, number of antiepilepsy medications used, seizure frequency, and reported interference in daily functioning created by seizures were the best predictors of employment. Additional analyses suggested that the possession of a drivers license was also associated with employment status. The results are discussed in terms of their implications for rehabilitation-based intervention.