Yvonne Tran

Psychological morbidity and spinal cord injury: a systematic review

Study Design:A systematic review of the literature concerning the nature of the psychological morbidity in people with spinal cord injury (SCI).Objectives:SCI is believed to place the individual at a high risk of psychological morbidity. The objective of this paper was to examine systematically the prevalence of negative psychological states in people with SCI, as well as to explore mediating and contextual factors.Methods:Search engines such as Medline and PsycInfo were systematically searched using specific key words, such as SCI, depression, anxiety and so on. Only studies that fulfilled certain criteria such as the use of valid measures in assessing psychological morbidity were used in the review process.Results:The systematic review revealed that clarification is still needed concerning the psychological consequences of people with SCI. However, findings suggest that approximately 30% of people with SCI are at risk of having a depressive disorder although in rehabilitation, and approximately 27% are at risk of having raised depressive symptoms when living in the community. The review also established that people with SCI have higher comparative risks of anxiety disorder, elevated levels of anxiety, feelings of helplessness and poor quality of life (QOL).Conclusion:People with SCI have an increased risk of suffering debilitating levels of psychological morbidity. Future research needs to clarify the extent and nature of psychological morbidity following SCI by conducting prospective and comprehensive research in large heterogeneous samples of people with SCI during the rehabilitation phase and following reintegration into the community.

The impact of stuttering on the quality of life in adults who stutter.

UNLABELLED Stuttering is an involuntary fluency disorder that is not uncommon in society. However, the impact of stuttering on a composite measure such as quality of life has rarely been estimated. Quality of life (QOL) assesses the well-being of a person from a multidimensional perspective, and valid and reliable general QOL measures are available that can be used to estimate the impact of stuttering on QOL. This study involved the use of a general measure of QOL called the Medical Outcomes Study Short Form-36 (SF-36) in order to assess the impact of stuttering in 200 adults who stutter (AWS). Comparisons to 200 adults of similar age and sex ratio who do not stutter were made so that the unique contribution of stuttering on QOL could be estimated. Findings indicated that stuttering does negatively impact QOL in the vitality, social functioning, emotional functioning and mental health status domains. Results also tentatively suggest that people who stutter with increased levels of severity may have a higher risk of poor emotional functioning. These findings have implications for treatment such as the necessity to address the emotional and psychological aspects of QOL in AWS and the need for additional clinical resources to be invested in stuttering treatment. EDUCATIONAL OBJECTIVES The reader will be able to: (a) summarize the method used in quality of life assessment using the SF-36; (b) describe the impact of stuttering on the quality of life of adults who stutter; (c) compare the impact of stuttering to the quality of life of adults who do not stutter; (d) describe the relationship between frequency of stuttering and quality of life.

SOCIAL ANXIETY DISORDER IN ADULTS WHO STUTTER

Background: The nature and prevalence of social anxiety disorder (social phobia (SP)) in people who stutter is uncertain, and DSM‐IV differential diagnosis guidelines make it difficult to classify an adult who stutters (AWS) with SP as it is assumed any social anxiety symptoms will be a consequence of their stuttering. The aim of this study was to determine the spot prevalence of SP in AWS and to investigate differences in social anxiety between AWS and controls who do not stutter. Methods: The study involved a comprehensive assessment of 200 AWS and 200 adults who do not stutter similar in age and sex ratio. Measures included stuttering severity, health status, self‐report measures of social anxiety as well as a structured diagnostic interview for SP for randomly selected sub‐group of 50 from each group. Results: The AWS were found to have significantly raised trait and social anxiety, as well as significantly increased risk of SP in comparison to the controls. Findings indicated a SP spot prevalence of at least 40% in AWS, and for them to be at high risk of having Generalized SP. Conclusions: It is concluded that the DSM‐IV diagnostic guidelines for diagnosing SP in AWS could result in professional confusion and have possible negative mental health ramifications. Implications for the psychological and medical treatment of AWS are discussed. Depression and Anxiety, 2010.

Regional brain wave activity changes associated with fatigue

Assessing brain wave activity is a viable strategy for monitoring fatigue when performing tasks such as driving, and numerous studies have been conducted in this area. However, results of a systematic review on changes in brain wave activity associated with fatigue have revealed equivocal findings. This study investigated brain wave activity associated with fatigue in 48 nonprofessional healthy drivers as they participated in a simulated driving task until they fatigued. The results showed that as a person fatigues, slow wave activity increased over the entire cortex, in theta and in alpha 1 and 2 bands, while no significant changes were found in delta wave activity. Substantial increases also occurred in fast wave activity, though mostly in frontal sites. The results suggest that as a person fatigues, the brain loses capacity and slows its activity, and that attempts to maintain vigilance levels lead to increased beta activity.

Electroencephalographic slowing and reduced reactivity in neuropathic pain following spinal cord injury.

Study Design:Brain wave activity in people with paraplegia, with and without neuropathic pain, was compared to brain wave activity in matched able-bodied controls.Objectives:To investigate whether spinal cord injury with neuropathic pain is associated with a slowing of brain wave activity.Setting:Australia.Methods:Electroencephalographic (EEG) data were collected in the eyes open (EO) and eyes closed (EC) states from 16 participants with paraplegia (eight with neuropathic pain and eight without pain) and matched able-bodied controls. Common EEG artefacts were removed using independent component analysis (ICA). Peak frequency in the θ–α band and EEG power in the δ, θ, α and β frequency bands were compared between groups.Results:The results show significant slowing of the EEG in people with neuropathic pain, consistent with the presence of thalamocortical dysrhythmia (TCD). Furthermore, people with neuropathic spinal cord injury (SCI) pain had significantly reduced EEG spectral reactivity in response to increased or decreased sensory input flowing into the thalamocortical network, as modulated by the eyes open and eyes closed states.Conclusion:The results provide further evidence for alterations in brain electric activity that may underlie the development of neuropathic pain following SCI.

Developing a model of associations between chronic pain, depressive mood, chronic fatigue, and self-efficacy in people with spinal cord injury.

UNLABELLED Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed. PERSPECTIVE The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI.

Subjective distress associated with chronic stuttering

UNLABELLED Stuttering is a chronic condition involving involuntary disruption to speech fluency. While elevated social anxiety has been found to be a risk factor for adults who have stuttered all their lives, it is unclear how stuttering influences other negative mood states such as interpersonal sensitivity and depressive mood. Consequently, controlled research was conducted that investigated negative affectivity across a number of domains in adults who stutter. Participants included 200 adults who have stuttered since childhood, with comparisons made to 200 non-stuttering controls of similar age and sex. The adults who stuttered were found to have significantly elevated levels of distress and negative mood states compared to the controls. As expected, significant differences were found for anxiety, however, significant and substantial differences were also found across a broad range of negative affect, including dimensions such as somatization, interpersonal sensitivity, depressive mood, hostility and paranoia. The implications of these findings for the better management of stuttering are discussed. EDUCATIONAL OBJECTIVES The reader will be able to describe: (a) the negative impact of a chronic disorder like stuttering on people who have stuttered all their life; (b) the factor structure of the SCL-90-R; (c) the negative affectivity construct, and (d) the difference between psychogenic theories of stuttering and neurological theories of stuttering.

A controlled investigation into the psychological determinants of fatigue.

Driver fatigue is associated with risks of road accidents that result in injury and death. Research has been limited by several issues such as confusion over definitions, how best to measure fatigue, and the contribution of psychological factors to fatigue. This study addressed these limitations by investigating the relationship between psychological factors and fatigue. Participants were assessed and were required to perform a monotonous task till they tired. Results found few psychological factors to be related to physiological and performance decrement fatigue outcome measures. However, psychological factors were found to correlate consistently with self-reported fatigue. The results suggest that fatigue is associated with a predisposition to be anxious, depressive, less self-assured, more conscientious (rule bound), less socially bold, less adaptable and low vigour. The results indicate that future research should employ a range of fatigue outcome measures in order to best understand what factors contribute to fatigue.

Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis

PURPOSE The relationship between chronic stuttering and anxiety has been a matter of some debate over the past two decades, with a major emphasis of research focused on examining whether people who stutter have abnormally elevated levels of trait or social anxiety. The major goal of this paper was to perform a systematic literature review and perform meta-analyses on research that has assessed (i) trait anxiety and (ii) social anxiety, in adults who stutter. METHOD Only studies that met strict inclusion criteria were selected for the meta-analyses. Two meta-analyses were conducted, the first for trait anxiety, and the second for social anxiety. Meta-analysis combines statistically the results of selected studies that meet strict design criteria, thereby clarifying the size of differences in trait and social anxiety between adults who stutter and adults who do not stutter. RESULTS Meta-analytic results confirmed that adults with chronic stuttering do have substantially elevated trait and social anxiety. The overall effect size for trait and social anxiety was calculated to be .57 and .82, respectively. CONCLUSIONS Trait and social anxiety are definite problems for many adults who stutter. Clinical implications of these findings for the diagnosis and treatment of adult who stutter are discussed. EDUCATIONAL OBJECTIVES The reader will be able to: (a) describe the process of conducting a systematic review and meta-analysis; (b) describe the possible impact of publication bias on meta-analysis results; (c) explain the impact of a chronic disorder like stuttering on levels of trait anxiety; (d) explain the impact of stuttering on levels of social anxiety; (e) interpret the results of meta-analysis when applied to differences in anxiety between adult people who stutter and those who do not stutter; and (f) describe implications for fluency enhancing treatments.

Levels of brain wave activity (8–13 Hz) in persons with spinal cord injury

Study design: Brain wave activity in people with spinal cord injury (SCI) was compared to brain wave activity in able-bodied controls.Objectives: To investigate whether a spinal injury results in changes in levels of brain wave activity in the 8–13 Hz spectrum of the electroencephalography (EEG).Setting: Sydney, Australia.Methods: Monopolar, multichannel EEG assessment was completed for 20 persons with SCI and 20 able-bodied, sex- and age-matched controls. A total of 14 channels of EEG were measured across the entire scalp for all participants. Comparisons between the able-bodied and SCI participants were made across the frontal, central, parietal, occipital and temporal regions. Comparisons were also made for impairment level, that is, between participants with tetraplegia and paraplegia.Results: Compared to the able-bodied controls, consistently reduced brain wave activity (measured by magnitude and peak amplitude) in the 8–13 Hz component of the EEG occurred in persons with SCI across all regions and sites, and differences were larger in the central, parietal and occipital sites. The SCI group also had consistently lower frequencies than the able-bodied controls. Furthermore, the subgroup of SCI participants with tetraplegia generally had significantly reduced brain activity (magnitude and peak amplitude) compared with the paraplegic subgroup and able-bodied controls.Conclusions: The findings of this research enhance our understanding of changes in brain wave activity that could be associated with deafferentation that occurs following SCI, as well as provide essential data on the potential of SCI persons to use a ‘hands free’ environmental control system that is based upon 8–13 Hz brain activity.