Subhadra Evans

Young people's experiences using electric powered indoor – outdoor wheelchairs (EPIOCs): Potential for enhancing users' development?

Purpose. To examine the experiences of severely physically disabled young people who use electric powered indoor – outdoor chairs (EPIOCs). Methods. A priori interview questions examined young peoples functioning with EPIOCs, pain and discomfort with EPIOC use and accidents or injuries resulting from EPIOC use. Eighteen young people (13 males and five females) aged 10 – 18 (mean 15) years were interviewed by telephone using a qualitative framework approach. Participants were interviewed 10 – 19 (mean 14.5) months after delivery of the chair. Diagnoses included muscular dystrophy (n = 10), cerebral palsy (n = 5), and ‘other’ (n = 3). Results. Many children reported positive functioning following EPIOC use, including increased independence and social activities like wheelchair football. However, EPIOC use was also associated with pain and discomfort, as well as perceived lack of safety, and minor accidents. Most young people and their families were fairly satisfied with the service and provision of their wheelchairs. Conclusions. The findings suggest that the development of disabled young people may benefit from the use of electric powered indoor/outdoor wheelchairs, although the advantages may come at certain costs to young peoples perceived and real safety. Recommendations to powered wheelchair providers include the demonstrated need for additional driving training as these young people mature.

Using the biopsychosocial model to understand the health benefits of yoga

Yoga is widely practiced as a means to promote physical, psychological and spiritual well-being. While a number of studies have documented the efficacy of yoga for functioning in healthy individuals and those experiencing illness or pain, biopsychosocial effects have not been detailed. We propose an analogue between the physical, psychological and spiritual effects of practice as espoused in yoga traditions, and the biopsychosocial model of health. To this end, we present a review and conceptual model of the potential biopsychosocial benefits of yoga, which may provide clues regarding the possible mechanisms of action of yoga upon well-being. Physical systems activated through yoga practice include musculoskeletal, cardiopulmonary, autonomic nervous system and endocrine functioning. Psychological benefits include enhanced coping, self-efficacy and positive mood. Spiritual mechanisms that can be understood within a Western medical model include acceptance and mindful awareness. We present empirical evidence that supports the involvement of these domains. However, additional well-conducted research is required to further establish the efficacy of yoga for health states, and to understand how posture, breath and meditative activity affect the body, mind and spirit.

Psychosocial adjustment and physical health of children living with maternal chronic pain

Aim:  There is limited research examining the functioning of children living with parental chronic pain and illness. The aim of this study was to examine the psychosocial adjustment and physical health of children living with a mother experiencing chronic pain.

Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis

Objective:Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health-related quality of life (HRQoL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga program on HRQoL of young adults with RA compared with a usual-care waitlist control group. Methods:The program was designed to improve the primary outcome of HRQoL including pain and disability and psychological functioning in patients. Assessments were collected pretreatment, posttreatment, and at 2 months after treatment. Weekly ratings of anxiety, depression, pain, and sleep were also recorded. A total of 26 participants completed the intervention (yoga=11; usual-care waitlist=15). All participants were female (mean age=28 y). Results:Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQoL, pain disability, general health, mood, fatigue, acceptance of chronic pain, and self-efficacy regarding pain at posttreatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQoL general health, pain disability, and weekly ratings of pain, anxiety, and depression were maintained at follow-up. Conclusions:The findings suggest that a brief Iyengar yoga intervention is a feasible and safe adjunctive treatment for young people with RA, leading to HRQoL, pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.

Iyengar Yoga for Young Adults with Rheumatoid Arthritis: Results From a Mixed-Methods Pilot Study

CONTEXT Rheumatoid arthritis (RA) is a chronic disease that often impacts patients quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning. OBJECTIVES This pilot study investigated the feasibility of a single-arm, group-administered, six-week, biweekly Iyengar yoga (IY) program for eight young adults with RA. METHODS IY is known for its use of props, therapeutic sequences designed for patient populations, emphasis on alignment, and a rigorous teacher training. Treatment outcomes were evaluated using a mixed-methods approach that combined quantitative results from standardized questionnaires and qualitative interviews with participants. RESULTS Initial attrition was 37% (n=3) after the first week because of scheduling conflicts and a prior non-RA related injury. However, the remaining participants (n=5) completed between 75% and 100% of treatment sessions (mean=95%). No adverse events were reported. The quantitative results indicated significant improvements in pain, pain disability, depression, mental health, vitality, and self-efficacy. Interviews demonstrated improvement in RA symptoms and functioning but uncertainty about whether the intervention affected pain. CONCLUSION These preliminary findings indicate that IY is a feasible complementary approach for young people with RA, although larger clinical trials are needed to demonstrate safety and efficacy.

Anxiety sensitivity and catastrophizing: associations with pain and somatization in non-clinical children.

This study examined the relationships among anxiety sensitivity (AS), catastrophizing, somatization and pain in 240 non-clinical children (121 girls; mean age = 12.7 years). Children with pain problems (n = 81; 33.8%) reported greater AS and catastrophizing (ps < .01) relative to children without pain problems. AS but not catastrophizing was significantly associated with current pain. However, both AS and catastrophizing were significantly associated with somatization. AS and catastrophizing represent related but partially distinct cognitive constructs that may be targeted by interventions aimed at alleviating pain and somatization in children.

Iyengar yoga for adolescents and young adults with irritable bowel syndrome.

Objectives:Irritable bowel syndrome (IBS) is a chronic, disabling condition that greatly compromises patient functioning. The aim of this study was to assess the impact of a 6-week twice per week Iyengar yoga (IY) program on IBS symptoms in adolescents and young adults (YA) with IBS compared with a usual-care waitlist control group. Methods:Assessments of symptoms, global improvement, pain, health-related quality of life, psychological distress, functional disability, fatigue, and sleep were collected pre- and posttreatment. Weekly ratings of pain, IBS symptoms, and global improvement were also recorded until 2-month follow-up. A total of 51 participants completed the intervention (yoga = 29; usual-care waitlist = 22). Results:Baseline attrition was 24%. On average, the yoga group attended 75% of classes. Analyses were divided by age group. Relative to controls, adolescents (14–17 years) assigned to yoga reported significantly improved physical functioning, whereas YA (18–26 years) assigned to yoga reported significantly improved IBS symptoms, global improvement, disability, psychological distress, sleep quality, and fatigue. Although abdominal pain intensity was statistically unchanged, 44% of adolescents and 46% of YA reported a minimally clinically significant reduction in pain following yoga, and one-third of YA reported clinically significant levels of global symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects for adolescents revealed global improvement immediately post-yoga that was not maintained at follow-up. For YA, global improvement, worst pain, constipation, and nausea were significantly improved postyoga, but only global improvement, worst pain, and nausea maintained at the 2-month follow-up. Conclusions:The findings suggest that a brief IY intervention is a feasible and safe adjunctive treatment for young people with IBS, leading to benefits in a number of IBS-specific and general functioning domains for YA. The age-specific results suggest that yoga interventions may be most fruitful when developmentally tailored.

Dealing With Chronic Pain: Giving Voice to the Experiences of Mothers With Chronic Pain and Their Children

Despite the substantial monetary, personal, and social cost of chronic pain, research into the family life of sufferers is wanting. Parents dealing with chronic pain, as well as their children, have been particularly neglected. Using qualitative interview data from 16 mothers suffering from a variety of chronic pain conditions, and their 21 children, aged 6 to 12 years, we explored the impact of maternal chronic pain on mothers and children. Consistent with a gains-and-loss theory and the strengths perspective, the findings revealed both positive and challenging aspects of pain. Despite the presence of risks—including maternal stress, parenting difficulties, and childrens distress—maternal chronic pain also provided opportunities for growth in many families. The findings suggest that maternal chronic pain can catalyze enhanced development as well as adversity. Researchers and clinicians should be aware of the pitfalls facing families dealing with chronic pain, while remaining open to the possibility that some families might flourish.

Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children

Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children’s well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to healthy control children and, further, to examine children’s HRV following a series of acute experimental pain tasks in both groups. Participants included 104 healthy control children and 48 children with chronic pain aged 8–17 years. The laboratory session involved a 5-minute baseline electrocardiogram followed by four pain induction tasks: evoked pressure, cold pressor, focal pressure, and a conditioned pain modulation task. After the tasks were complete, a 5-minute post-task electrocardiogram recording was taken. Spectral analysis was used to capture high-frequency normalized power and the ratio of low-to-high frequency band power, signifying cardiac vagal tone and sympathetic balance, respectively. Results revealed that children with chronic pain had significantly lower resting HRV (signified by low high-frequency normalized power and high ratio of low-to-high frequency band power) compared to healthy children; moreover, a significant interaction between groups and time revealed that children with chronic pain displayed a static HRV response to the pain session compared to healthy children, whose HRV was reduced concomitant with the pain session. These findings suggest that children with chronic pain may have a sustained stress response with minimal variability in response to new acute pain stressors.

Parents with chronic pain: are children equally affected by fathers as mothers in pain? A pilot study

This study compared the psychological and physical functioning of 12 children in each of three groups: mothers with chronic pain, fathers with chronic pain and a control, pain-free parents. Parents completed a number of questionnaires including the RAND-36 Health Status Inventory, a child health scale and the Child Behavior Checklist. Children completed the Revised Child Manifest Anxiety Scale and a scale measuring pain and sickness behaviour. Children of mothers with chronic pain reported the most physical and psychological problems, followed by children of fathers with chronic pain and children from the control group. Pain reports between children and parents with chronic pain were significantly correlated, suggesting support for a familial pain model. Social learning may explain the concordance between parent and child health in families experiencing parental chronic pain.