Timothy J. Wolf

Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia.

BACKGROUND Individuals with schizophrenia use psychoactive substances more frequently than the general population. The genetic vulnerability to develop schizophrenia may also increase risk for the development of substance use disorders. We examine this hypothesis by assessing the rates of substance use disorders and nicotine use in non-psychotic siblings of individuals with schizophrenia. METHODS Participants included 59 individuals with DSM-IV schizophrenia, 53 of their siblings, 80 community controls, and 75 of their siblings. Statistical regression was used to assess the rates of substance use disorders and nicotine use in study participants while controlling for age, gender, lifetime diagnosis of a mood or anxiety disorder, and a family history of substance use disorder. RESULTS Individuals with schizophrenia and their non-psychotic siblings reported higher rates of alcohol and cannabis use disorders and nicotine use when compared to siblings of comparison subjects. CONCLUSIONS The vulnerability to develop schizophrenia may also extend to substance use disorders. Future research is needed to investigate the neurobiological basis of increased substance use in non-psychotic siblings and the psychosocial mechanisms that may contribute to increased substance use in non-psychotic siblings.

Determining work outcomes in mild to moderate stroke survivors.

OBJECTIVE To assess the work outcomes of individuals who have a mild to moderate stroke. PARTICIPANTS Individuals who (1) experienced a mild to moderate stroke as determined by the National Institutes of Health Stroke Scale (NIHSS) scores (range 0-16); (2) were working full time prior to their stroke; and (3) were between the ages of 30-65. METHODS Participants were contacted and provided verbal consent to complete the Occupational Outcome Questionnaire (OOQ) over the telephone at 6 months post-stroke to determine their work outcomes. RESULTS Of the 98 participants recruited for this study, 37% (n = 36) never returned to work following stroke. Of the 63% (n = 62) who did return to work, 90% (n = 56) returned immediately to their previous jobs at their previous level. Of those returning to work, 56% (n = 35) of individuals reported performing at 75% of their ability or less. Further, the majority of all participants reported chronic symptoms from their strokes. CONCLUSIONS The current assumption in the literature is that individuals experiencing mild to moderate strokes are returning to work even in the absence of work rehabilitation services. The assumptions of previous literature can be disputed with the results of the current study.

Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial.

Purpose. The purpose of this study was to estimate the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach compared with usual outpatient rehabilitation on activity and participation in people <3 months poststroke. Methods. An exploratory, single-blind, randomized controlled trial, with a usual-care control arm, was conducted. Participants referred to 2 stroke rehabilitation outpatient programs were randomized to receive either usual care or CO-OP. The primary outcome was actual performance of trained and untrained self-selected activities, measured using the Performance Quality Rating Scale (PQRS). Additional outcomes included the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale Participation Domain, the Community Participation Index, and the Self-Efficacy Gauge. Results. A total of 35 eligible participants were randomized; 26 completed the intervention. Post intervention, PQRS change scores demonstrated that CO-OP had a medium effect over usual care on trained self-selected activities (d = 0.5) and a large effect on untrained activities (d = 1.2). At a 3-month follow-up, PQRS change scores indicated a large effect of CO-OP on both trained (d = 1.6) and untrained activities (d = 1.1). CO-OP had a small effect on COPM and a medium effect on the Community Participation Index perceived control and on the Self-Efficacy Gauge. Conclusion. CO-OP was associated with a large treatment effect on follow-up performances of self-selected activities and demonstrated transfer to untrained activities. A larger trial is warranted.

The performance quality rating scale (PQRS): reliability, convergent validity, and internal responsiveness for two scoring systems

Abstract Purpose: The performance quality rating scale (PQRS) is an observational measure of performance quality of client-selected, personally meaningful activities. It has been used inconsistently with different scoring systems, and there have been no formal publications on its psychometric properties. The purpose of this study was to test and compare the psychometric properties of two PQRS scoring systems in two populations. Methods: A secondary analysis of video recorded participant-selected activities from previous studies involving either adults living with stroke or children diagnosed with developmental coordination disorder (DCD) was conducted. Three pairs of raters scored the video recorded performances with PQRS operational definitions (PQRS-OD) and a generic rating system (PQRS-G). Results: For inter-rater reliability, PQRS-OD ICCs were substantial, ranging from 0.83 to 0.93; while the PQRS-G ICCs were moderate, ranging from 0.71 to 0.77. Test–retest reliability was substantial, >0.80 (ICC), for both rating systems across all rater pairs. Internal responsiveness was high for both rating systems. Convergent validity with the Canadian Occupational Performance Measure (COPM) was inconsistent, with scores ranging from low to moderate. Conclusion: Both scoring systems have demonstrated they are reliable and have good internal responsiveness. The PQRS-OD demonstrated greater consistency across raters and is more sensitive to clinically important change than the PQRS-G and should be used when greater accuracy is required. Further exploration of validity with actual rather than perceived performance measures is required. Implications for Rehabilitation The PQRS provides clinicians and researchers with a means of measuring actual performance of self-selected activities. Rehabilitation scientists are encouraged to improve our understanding of the relationship between perceived and actual performance as a means to improve interventions and outcomes.

Executive dysfunction immediately after mild stroke.

The purpose of this study was to determine the presence of executive function deficits immediately after mild stroke that are known to impact participation in home, work, and community life. Individuals with mild stroke who were discharged from the acute setting to the home with few or no rehabilitation services were assessed within 1 week after discharge using a cognitive battery. Using rigorous criteria to identify a specific deficit in executive function, results showed that 66% of the population (N = 35) scored in the deficit range on at least one of the four measures of executive function; 27% of the population (N = 14) scored in the deficit range on two or more measures. Although deficits post-stroke are sometimes known to spontaneously recover, cognitive dysfunction of this nature often becomes chronic. This group is typically discharged with little or no rehabilitation; by detecting these deficits in the acute stage of stroke care, occupational therapists can make appropriate rehabilitation and follow-up recommendations.

Perceived recovery as a predictor of physical activity participation after mild stroke

Purpose: The purpose of this study was to identify what acute care variables and/or perceived recovery factors could predict decreased participation in physical activities post-mild stroke. Methods: Secondary analysis of persons with mild stroke. Participants were split into two groups based on the percentage of high-demand leisure (HDL) activities retained on the Activity Card Sort (ACS) at 6 months post-stroke. Demographic variables, measures from the acute care setting (National Institutes of Health Stroke Scale (NIHSS), premorbid Barthel Index, and Modified Rankin Scale), and a perceived recovery measure collected at 6 months post-stroke (Stroke Impact Scale (SIS)) were analyzed between groups using independent samples t-tests and logistic regression. Results: There were no significant differences between groups on any of the demographic or acute care setting measures. Logistic regression indicated that only the overall perceived recovery (p = 0.05) and strength domain scores (p = 0.01) of the SIS were statistically significant factors for determining the percent of retained HDL activities following mild stroke. Conclusions: Clinicians must consider the clients’ own perceived recovery level and other more subjective factors in determining what barriers are limiting their physical activity participation after stroke. Implications for Rehabilitation Persons with mild stroke are significantly decreasing their participation in physical activities post-stroke. Common stroke measures from the acute care setting that are currently used in practice are not sensitive enough to predict the changes in physical activity after mild stroke. Perceived level of recovery/limitations should be considered by clinicians in determining what barriers are affecting clients’ physical activity participation after stroke.

Changes in cognition following mild stroke

The objective of the study was to determine how performance on cognitive assessments administered in the subacute phase of mild stroke change or remain stable over time. A prospective longitudinal cohort pilot study was used to assess the cognitive status of participants with mild stroke (n = 20) at two time points: (1) within 3 weeks post-discharge from the acute care setting following mild stroke, and (2) approximately 6 months post-mild stroke. Participants were given a battery of cognitive assessments at both time points that included the following measures: (1) Short Blessed Test, (2) California Verbal Learning Test (CVLT), (3) Connors Continuous Performance Task (CPT), and (4) The Delis-Kaplan Executive Function System (DKEFS) Trail Making subtest. The only significant differences between the test administrations was on the CVLT Short Delay Free Recall (p = .027) and Long Delay Free Recall (p = .002) which was likely due to practice effects associated with this measure. The results of the study show that performance on standardised cognitive testing in the early phases of mild stroke remained stable over a 6 month period. These results help justify the necessity and ability to assess cognition immediately post-mild stroke in order to make accurate and appropriate rehabilitation recommendations.

Participation Changes in Sexual Functioning after Mild Stroke

The purpose of this study was to explore the extent to which people with mild stroke experience changes in participation in sexual activity post stroke. A cross-sectional study was completed with adults 6 to 18 months post mild stroke (N = 13); a brief case study was also done with one of the participants. Participants completed an assessment battery over the telephone that included the modified Quality of Sexual Function scale, the Stroke Impact Scale (SIS), and the Patient Health Questionnaire-9. The sample reported mild problems with sexual dysfunction (mean = 10.77, SD = 4.09). Sexual dysfunction post stroke was highly correlated (r = −0.372 to −0.875) with all of the domains on the SIS. Several participants in this study reported that they would have liked more information about sexual functioning post stroke. These findings suggest that individuals with mild stroke are experiencing decreased participation in sexual activities post stroke and would like more information from the health care community on the potential for sexual changes.

Perceived participation after stroke: the influence of activity retention, reintegration, and perceived recovery.

OBJECTIVE We sought to determine the extent to which perceptions of participation in everyday occupations were affected in a sample of people with predominantly mild stroke. Demographic variables, stroke severity, community integration, participation in everyday occupations, and perceptions of recovery were examined as potential contributors to their perceptions of participation. METHOD We conducted a cross-sectional study with 116 people with mild to moderate first stroke assessed approximately 6 mo after stroke. RESULTS Perceptions of participation assessed using the Stroke Impact Scale varied (range = 19-100), with a mean score of 82. Regression analyses revealed three factors that contributed to perceptions of participation: retention of previous activities, reintegration in home and community, and perception of stroke recovery. CONCLUSION Although the majority of participants reported a high level of perceived participation, more than a third failed to report successful participation.

Feasibility of using the EFPT to detect executive function deficits at the acute stage of stroke

OBJECTIVE The goal of this study was to test the feasibility of administering subtests of the EFPT to stroke survivors in the acute phase of stroke to detect executive function deficits. PARTICIPANTS A population of adults with mild to moderate stroke (N=20). METHODS This study employed a cross-sectional design using the EFPT and a neuropsychological battery immediately post-stroke. RESULTS Overall EFPT performance significantly correlated with 3 of the 13 DKEFS scaled scores: Sorting (r = -0.511, p = 0.030), Verbal Fluency (r = -0.474, p = 0.035) and Color-Word Interference (r = -0.566, p = 0.011) and the Short Blessed Test (r = 0.548, p = 0.012). Multiple significant correlations were also found between EFPT-bill paying and cooking subtests and DKEFS subtests. CONCLUSIONS Performance on the EFPT one-week post stroke was very similar to what was found in a prior study validating the EFPT in stroke survivors at 6-months post-onset. The results of this study provide evidence to the support conducting a follow-up study in the acute care setting using the bill paying subtest of the EFPT along with a neuropsychological battery, to augment discharge planning.