Rehabilitation Psychology

Testing two types of self-help CBT-I for insomnia in older adults with arthritis or coronary artery disease.
Objective: The present study tested two methods of self-help cognitive–behavioral therapy for insomnia (CBT-I) for 106 older adults (mean age = 68) with osteoarthritis (n = 33) or coronary artery disease (n = 33) or no significant medical condition (n = 40). The latter was employed as a comparison group to test the differential efficacy between primary and comorbid insomnia. Method: Self-help CBT-I has demonstrated efficacy in previous studies, so two treatments were compared rather than employing a no treatment control group. Participants were randomly assigned to a book version or an enhanced multimedia version of CBT-I. Results: Both versions of CBT-I demonstrated efficacy in improving all measures of sleep at posttreatment, using intent-to-treat analyses. These sleep improvements were maintained among 86 treatment completers who participated in 1-year follow-up assessment. There were no significant differences in treatment response between primary (no medical condition) and comorbid insomnia participants and no significant differences between the two types of self-help according to sleep log measure. However, multimedia participants compared to book participants showed more improvement on three global sleep measures administered at posttreatment only. Conclusions: Although outcomes were attenuated relative to those obtained in therapist led intervention studies, the results suggest that self-help CBT-I has good potential to serve as a first-line, cost-effective treatment for both primary and comorbid insomnia in older adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Analyzing longitudinal data with missing values.
Missing data methodology has improved dramatically in recent years, and popular computer programs now offer a variety of sophisticated options. Despite the widespread availability of theoretically justified methods, researchers in many disciplines still rely on subpar strategies that either eliminate incomplete cases or impute the missing scores with a single set of replacement values. This article provides readers with a nontechnical overview of some key issues from the missing data literature and demonstrates several of the techniques that methodologists currently recommend. This article begins by describing Rubin's missing data mechanisms. After a brief discussion of popular ad hoc approaches, the article provides a more detailed description of five analytic approaches that have received considerable attention in the missing data literature: maximum likelihood estimation, multiple imputation, the selection model, the shared parameter model, and the pattern mixture model. Finally, a series of data analysis examples illustrate the application of these methods. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists.
Objective: The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. Conclusions: Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Prevalence of interpersonal violence against community-living adults with disabilities: A literature review.
Objective: To review the empirical literature on the prevalence of interpersonal violence (IPV) against people with disabilities. Method: The authors searched for, obtained, and reviewed 6,000 abstracts published between January, 2000 and August, 2010 via searches in PsycINFO and PubMed. Subsequently, 177 potentially applicable full-text articles were independently assessed for inclusion; 22 articles describing 21 individual studies were included in this review. Results: The prevalence of IPV varied depending on the time frame, the definition and type of violence, perpetrator, and disability. Prevalence of any type of IPV among women with disabilities ranged from 26.0%–90.0% for lifetime; 4.9%–29.1% for the past 5 years; and 2.0%−70.0% for the past year. In some studies, when compared to women without disabilities, women with disabilities experienced more lifetime, 5 year, and past year physical and sexual IPV. Prevalence of any IPV in men with disabilities ranged from 28.7%–86.7% for lifetime; 24.9% for the past 5 years; and 36.7% for the past year. Conclusions/Implications: IPV occurs at elevated and disproportionate rates among women and men with disabilities, especially when assessed over the course of their lives. Future research that relies on standard definitions of disability and violence, uses accessible measurement, and examines IPV in diverse populations of people with disabilities will strengthen future reviews and better inform research and policy priorities on disability and violence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Clinical applications of problem-solving research in neuropsychological rehabilitation: Addressing the subjective experience of cognitive deficits in outpatients with acquired brain injury.
Objective: The goal of this paper is to illustrate how the lessons learned in over 20 years of randomized clinical trials have advanced cognitive rehabilitation beyond traditional approaches to problem solving by more explicitly integrating subjective self-appraisal factors in routine clinical practice. Results: The concept of problem orientation , as proposed by cognitive–behavioral psychologists, provides a much-needed framework for conceptualizing interventions to address the impact of subjective experience on cognitive functioning, within the context of cognitive remediation. By explicitly focusing on the beliefs, assumptions, and expectations that individuals with acquired brain injury have about their own cognitive functioning, the concept of problem orientation allows rehabilitation psychologists to add an element to interventions, not systematically addressed in standard approaches to cognitive remediation. Targeting objective deficits in cognitive remediation is necessary, but not sufficient: For optimal benefit, remedial interventions must address objective cognitive deficits and the patient's subjective experience of such deficits in tandem. Conclusion: Contemporary evidence-based treatment recommendations now typically include incorporating interventions to address motivational, attitudinal, and affective factors in cognitive remediation. Further research is needed to directly compare the effectiveness of cognitive rehabilitative interventions that systematically address subjective factors with those that do not. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
When is differential treatment discriminatory? Legal, ethical, and professional considerations for psychology trainees with disabilities.
Purpose: A supervisor may tell graduate trainees with obvious disabilities to disclose the disability to potential clients. Legal and ethical guidelines only partially address whether this requirement is permissible. Here we examine such disclosures from several vantage points. Background: Professional judgments guide supervisors in deciding whether to request that a trainee disclose a disability. The law provides little guidance to supervisors in making this decision. Instead, professional ethics and beliefs about disability drive decisions, and these beliefs may be prejudicial. Method: In this article, we examine whether it is good practice for a supervisor in a practicum or internship to require a trainee with an obvious disability to disclose the disability to potential clients before the first meeting so that the client has freedom to request a different therapist. We use this situation to examine the pertinent legal standards; ethical guidelines; and clinical, professional, and social justice issues. Conclusion: The requirement of disclosure may not be in the best interests of the client and has deleterious repercussions for trainees with disabilities, their peers, and the profession. Unless addressed without prejudice, differential treatment becomes discriminatory and is an obstacle to successful completion of professional education by trainees with obvious disabilities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.
Objective: A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans. Method: 213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression. Results: Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs. Conclusions: These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Parenting style is related to executive dysfunction after brain injury in children.
Objective: The goal of this study was to examine how parenting style (authoritarian, authoritative, permissive) and family functioning are related to behavioral aspects of executive function following traumatic brain injury (TBI) in young children. Method: Participants included 75 children with TBI and 97 children with orthopedic injuries (OI), ages 3–7 years at injury. Pre-injury parenting behavior and family functioning were assessed shortly after injury, and postinjury executive functions were assessed using the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia & Isquith, 2004) at 6, 12, and 18 months postinjury. Mixed model analyses, using pre-injury executive functioning (assessed by the BRIEF at baseline) as a covariate, examined the relationship of parenting style and family characteristics to executive functioning in children with moderate and severe TBI compared to OI. Results: Among children with moderate TBI, higher levels of authoritarian parenting were associated with greater executive difficulties at 12 and 18 months following injury. Permissive and authoritative parenting styles were not significantly associated with postinjury executive skills. Finally, fewer family resources predicted more executive deficits across all of the groups, regardless of injury type. Conclusion: These findings provide additional evidence regarding the role of the social and familial environment in emerging behavior problems following childhood TBI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Ecological validity of the screening module and the Daily Living tests of the Neuropsychological Assessment Battery using the Mayo-Portland Adaptability Inventory-4 in postacute brain injury rehabilitation.
Purpose: The assessment of ecological validity of neuropsychological measures is an area of growing interest, particularly in the postacute brain injury rehabilitation (PABIR) setting, as there is an increasing demand for clinicians to address functional and real-world outcomes. In the current study, we assessed the predictive value of the Screening module and the Daily Living tests of the Neuropsychological Assessment Battery (NAB) using clinician ratings from the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in patients with moderate to severe traumatic brain injury. Method: Forty-seven individuals were each administered the NAB Screening module (NAB-SM) and the NAB Daily Living (NAB-DL) tests following admission to a residential PABIR program. MPAI-4 ratings were also obtained at admission. Linear regression analysis was used to examine the association between these functional and neuropsychological assessment measures. Results: We replicated prior work (Temple at al., 2009) and expanded evidence for the ecological validity of the NAB-SM. Furthermore, our findings support the ecological validity of the NAB-DL Bill Payment, Judgment, and Map Reading tests with regards to functional skills and real-world activities. Conclusions: The current study supports prior work from our lab assessing the predictive value of the NAB-SM, as well as provides evidence for the ecological validity for select NAB-DL tests in patients with moderate to severe traumatic brain injury admitted to a residential PABIR program. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Factor structure of posttraumatic stress disorder symptoms in OEF/OIF veterans presenting to a polytrauma clinic.
Objective: A significant number of Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) veterans are returning from deployment and presenting to Veterans Health Administration (VHA) polytrauma clinics with elevated rates of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Inherent to the accurate assessment and treatment of this diagnostically complex group of veterans is the assumption that the construct of PTSD is the same in this population as in other trauma groups. To our knowledge, no previous study has examined the structure of PTSD in this relevant and fast-growing population of treatment-seeking OEF/OIF veterans. Evidence suggests that the latent structure of PTSD symptoms is best represented by a four-factor model, rather than the three-factor model found in the current DSM–IV–TR. Thus, we examined the three and four-factor models using the PTSD Check List-Civilian (PCL-C) in a sample of treatment-seeking OEF/OIF veterans seen through a VHA polytrauma clinic. Method: A chart review was conducted for OEF/OIF veterans (N = 361) seen through a VHA outpatient polytrauma clinic from September 2007 through August 2008. Participants completed the PCL-C as part of a comprehensive polytrauma evaluation. Results: Confirmatory factor analyses showed that the DSM–IV–TR three-factor model did not fit the data well. A direct comparison showed that the four-factor model provided a superior fit relative to the three-factor model. Conclusion: Results extend the generalizability of the four-factor model to OEF/OIF veterans presenting to Veterans Health Administration (VHA) polytrauma clinics. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Mothers report more child-rearing disagreements following early brain injury than do fathers.
Objective: To investigate differences between mother's and father's perceptions of marital relationship quality, child rearing disagreements, and family functioning over the initial 18 months following traumatic brain injury (TBI) in early childhood relative to an orthopedic-injury comparison group. Methods: Participants included 147 parent-dyads of children with TBI (n = 53) and orthopedic injuries (OI; n = 94) who were between the ages of 3 and 7 years at injury. Family functioning, marital quality, and child-rearing disagreements were assessed shortly after injury and at 6, 12, and 18-month follow-ups, with ratings at the initial assessment completed to reflect preinjury functioning. Mixed model analyses were used to examine mother and father's reports of family functioning, marital quality, and child-rearing disagreements over time as a function of injury severity and parent gender. Results: We found a significant Group x Gender interaction for ratings of love and parenting disagreements. As hypothesized, mothers of children with severe TBI rated the relationship as significantly less loving than did their partners, and mothers of children with both moderate and severe TBI endorsed more parenting disagreements than did their partners. However, fathers reported higher levels of family dysfunction than their partners, regardless of injury type or severity. Conclusions: Implications for treatment based on differences in mothers' and fathers' perceptions of family and marital functioning, and future directions for research, are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Severity of children's intellectual disabilities and Medicaid personal care services.
Objectives: This research investigated the relationship between a child's reported intellectual disability (ID) level and caregivers' reports of the child's health status to predict Medicaid Personal Care Services (PCS) hours authorized for that child. We also investigated how activity limitations in the home varied with the level of ID. Design: The sample included 1,108 community-residing children with a reported level of ID in the Texas Medicaid system and who were assessed for the PCS program. All data were collected with the Personal Care Assessment Form (PCAF), an instrument developed by the authors for evaluating children's PCS needs. Case managers completed the PCAF in the child's home with the child and primary caregivers present. Structural equation modeling (SEM) was used to test a model reflecting the role of ID and other characteristics of the child in determining the number of PCS hours authorized. Additional analyses revealed the degree to which variation among the case managers affected the number of hours authorized. Results: ID level and other individual characteristics had a significant effect on reports of a child's activity limitations (R2 = .67), which in turn affected the hours of PCS authorized (R2 = .27). We found no significant direct relationship between ID level and PCS hours: ID level had an indirect relationship on PCS hours through activity limitations. When the variance in hours authorized was decomposed, individual characteristics accounted for 20% of the variance and case managers accounted for 14%. Conclusions: Assessments of caregiver and child strengths and limitations in the home are critical in the allocation of Medicaid home-based services, above and beyond the information conveyed by demographic and diagnostic data. Implications for home-based assessments of functional limitations and needs for family caregivers and their children with ID are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)

Rehabilitation Psychology - Vol 56, Iss 4