Biomedical subjects

Corwin Boake

Publications and source records attributed to Corwin Boake.

17 recordsLinked to original sources

PubMed2006

Confirmatory factor structure of the Center for Epidemiologic Studies-Depression scale (CES-D) in mild-to-moderate traumatic brain injury.

PRIMARY OBJECTIVE: The Center for Epidemiologic Studies Depression scale (CES-D) is a frequently-used self-report measure of depressive symptom severity. Brief depression screening measures can be important in the identification and prediction of depression following traumatic brain injury. The objective of this study was to investigate the validity of the CES-D in measuring depressive symptoms in patients with mild-to-moderate TBI as it has been rarely used in neurologically compromised populations. RESEARCH DESIGN: Inception cohort. METHODS AND PROCEDURES: The CES-D was administered to 340 participants with mild-to-moderate TBI at 3-months post-injury. MAIN OUTCOMES AND RESULTS: Confirmatory factor analysis of the CES-D indicated that the data are a reasonable fit similar to that of Radloff 's original 4-factor model. CONCLUSIONS: These findings suggest that the CES-D may be appropriate for use in patients with mild-to-moderate TBI.

Adult↗

PubMed2006

Functional reorganization and recovery after constraint-induced movement therapy in subacute stroke: case reports.

Preliminary assessments of the feasibility, safety, and effects on neuronal reorganization measured with transcranial magnetic stimulation (TMS) from Constraint-Induced Movement Therapy (CIMT) of the upper extremity were made in eight cases of subacute stroke. Within fourteen days of their stroke, patients were randomly assigned to two weeks of CIMT or traditional therapy. Baseline motor performance and cortical/subcortical representation for movement with TMS were assessed before treatment. Post-treatment assessments were made at the end of treatment and at three months after the stroke. The TMS mapping showed a larger motor representation in the lesioned hemisphere of the CIMT patients as compared to the controls at the three-month follow-up assessment. The enlarged motor representation in the lesioned hemisphere for hand movement correlated with improved motor function of the affected hand, suggesting a link between movement representation size as measured with TMS and functionality. These results suggest that TMS can be safely and effectively used to assess brain function in subacute stroke and further suggest that CIMT may enhance cortical/subcortical motor reorganization and accelerate motor recovery when started within the first two weeks after stroke.

Aged↗

PubMed2006

A discordant twin study of premorbid cognitive ability in schizophrenia.

Twin studies are advantageous because sources of genetic and environmental variation are equated in ways that are not possible in standard case-control designs. We examined premorbid cognitive ability by comparing Armed Forces Qualification Test scores administered at the time of military enlistment in 21 schizophrenia-discordant twin pairs and 860 matched control twins. Scores were significantly lower in schizophrenia probands than in their nonpsychotic co-twins; co-twins were midway between probands and control twins. Effects were reduced when the discordant pairs were extended to include 33 psychosis-discordant pairs. Compared with controls, education at enlistment was significantly lower in psychosis probands and in co-twins from both schizophrenia- and psychosis-disordant pairs. Co-twins from psychosis-discordant pairs had significantly lower education at midlife than controls. Results suggest that cognitive ability is influenced by familial vulnerability for schizophrenia or psychosis, and that premorbid cognitive ability is lower in schizophrenia versus psychosis in general. Educational advancement may be slightly slowed by this familial vulnerability, but results were equivocal with regard to attenuation of one's ultimate educational attainment.

Adult↗

PubMed2005

Predicting depression following mild traumatic brain injury.

CONTEXT: Minimizing negative consequences of major depression following traumatic brain injury is an important public health objective. Identifying high-risk patients and referring them for treatment could reduce morbidity and loss of productivity. OBJECTIVE: To develop a model for early screening of patients at risk for major depressive episode at 3 months after traumatic brain injury. DESIGN: Prediction model using receiver operating characteristic curve. SETTING: Level I trauma center in a major metropolitan area. PARTICIPANTS: Prospective cohort of 129 adults with mild traumatic brain injury. MAIN OUTCOME MEASURES: Center for Epidemiologic Studies Depression Scale score and current major depressive episode module of the Structured Clinical Interview for the DSM-IV. RESULTS: A prediction model including higher 1-week Center for Epidemiologic Studies Depression Scale score, older age, and computed tomographic scans of intracranial lesions yielded 93% sensitivity and 62% specificity. CONCLUSION: This study supports the feasibility of identifying patients with mild traumatic brain injury who are at high risk for developing major depressive episode by 3 months' postinjury, which could facilitate selective referral for potential treatment and reduction of negative outcomes.

Adult↗

PubMed2005

Postconcussional disorder: Are the DSM-IV criteria an improvement over the ICD-10?

Little is known about the characteristics and outcomes of patients diagnosed with postconcussional disorder (PCD) under the provisionally proposed criteria in the DSM-IV and how they differ from patients diagnosed with postconcussional syndrome (PCS) under the International Classification of Diseases, 10th edition clinical (ICD-10) criteria. This study investigated differences in outcome based on a diagnosis of PCD (DSM-IV) versus PCS (ICD-10 clinical criteria) as to which criteria set might be preferred for clinical practice. A consecutive series of adult patients with mild (N = 319) to moderate (N = 21) traumatic brain injury was assessed at 3 months postinjury with a brief neuropsychological battery and measures of specific outcome domains. In two separate series of analyses, patients with PCD were compared with those without PCD, and those with PCS were compared with those without PCS. Although the two criteria sets resulted in markedly different incidence rates, there was no substantial pattern of differences between the DSM-IV and ICD-10 in the outcome domains of psychiatric symptoms and disorders, social and community integration, health-related quality of life, or global outcome as measured by the Glasgow Outcome Scale-Extended. In spite of significant differences between the two diagnostic criteria sets and different incidence rates for PCD/PCS, outcome in all measured domains was very similar at 3 months postinjury. There is no compelling evidence, based on these outcome domains, to suggest which of the two diagnostic criteria sets should be clinically preferred.

Adult↗

PubMed2005

Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.

This study evaluated the prevalence and specificity of diagnostic criteria for postconcussional syndrome (PCS) in 178 adults with mild to moderate traumatic brain injury (TBI) and 104 with extracranial trauma. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) criteria for PCS were evaluated 3 months after injury. The results showed that prevalence of PCS was higher using ICD-10 (64%) than DSM-IV criteria (11%). Specificity to TBI was limited because PCS criteria were often fulfilled by patients with extracranial trauma. The authors conclude that further refinement of the DSM-IV and ICD-10 criteria for PCS is needed before these criteria are routinely employed.

Adult↗

PubMed2005

Lost productive work time after mild to moderate traumatic brain injury with and without hospitalization.

OBJECTIVE: Lost productivity after mild traumatic brain injury (TBI) is a large component of the economic costs of brain trauma in the United States. This is the first prospective study of employment after mild TBI to include patients not admitted to a hospital. METHODS: Concurrent inception cohorts of 210 working-age adults with mild to moderate TBI and 122 patients who sustained general trauma not involving the brain were recruited at a trauma center and followed up to 6 months later. Outcomes were time from injury until first day worked and problems reported after resuming work. RESULTS: Most patients who worked after their injury remained employed 6 months later in a similar capacity as before the injury. No consistent differences were demonstrated between employment outcomes of patients with mild TBI and those with general trauma. The majority of nonhospitalized patients with mild TBI did not work for at least 1 month and did not begin working until 1 to 3 months after injury. Most patients with moderate TBI remained unemployed at 6 months postinjury. Patients with lower preinjury occupational status tended to have longer work absences. CONCLUSION: Lost productive work time after nonhospitalized TBI may cause significant economic costs because these injuries are frequent. Contrary to the theory that brain injury is more disabling to patients in cognitively demanding occupations, patients with higher job status tended to begin work earlier. A technique is needed to screen patients with mild TBI for risk of employment problems. Rehabilitation after moderate TBI may help to minimize lost productivity.

Adult↗

PubMed2004

Constraint-induced movement therapy.

Constraint-induced movement therapy improves outcome after chronic stroke, conforms experimental observations of neuronal plasticity, and proves the efficacy of intensive occupational therapy. More acutely instituted constraint-induced movement therapy has both practical and theoretic risks and benefits that deserve further careful evaluation.

Animals↗

PubMed2004

Spatiotemporal patterns of language-specific brain activity in patients with chronic aphasia after stroke using magnetoencephalography.

Six participants with chronic aphasia secondary to first-ever ischemic stroke within the middle cerebral artery (MCA) distribution of the left hemisphere and six neurologically intact controls of similar age were given a running recognition memory task for words while the magnetic flux normal to the scalp surface was measured with a whole-head neuromagnetometer. This task had been previously shown to be valid for the localization and lateralization of brain activity specific to receptive language function. As expected, patients exhibited relatively decreased activation in areas known to be involved in receptive language function, including superior temporal gyrus (STG) in the left hemisphere, as well as increased activation of areas outside of the left STG that might potentially support language function. Decreased activation within left STG was associated with a reduction in receptive language in patients, as was increased activation outside of left STG. Results support hypotheses suggesting that peri-lesional areas outside premorbid language areas may assume receptive language function after aphasia secondary to stroke, but that better recovery occurs when putative premorbid language areas are able to normalize.

Aged↗

PubMed2004

Limited agreement between criteria-based diagnoses of postconcussional syndrome.

The objectives of this study were to compare diagnoses of postconcussional syndrome between the International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The patient sample was comprised of 178 adults with mild-moderate traumatic brain injury (TBI). The study design was inception cohort, and the main outcome measure was a structured interview 3 months after injury. The results were that, despite concordance of DSM-IV and ICD-10 symptom criteria (kappa=0.73), agreement between overall DSM-IV and ICD-10 diagnoses was slight (kappa=0.13) because fewer patients met the DSM-IV cognitive deficit and clinical significance criteria. Agreement between DSM-IV postconcussional disorder and ICD-10 postconcussional syndrome appears limited by different prevalences and thresholds.

Adult↗

PubMed2004

Perception of health and quality of life in minorities after mild-to-moderate traumatic brain injury.

Much has been reported of the influence of age, affective symptoms, and satisfaction on self-ratings of health functioning, but little is known about the extent that race-based perceptions may have on influencing behavior or adjustment after a mild-to-moderate traumatic brain injury (MTBI). We investigated differences in perception of health functioning by race for mental and physical functioning using a global measure of health functioning. MTBI (n = 135) and general trauma (GT, n = 83) patients recruited from an area Level-1 trauma center at 3 months after injury were administered the Medical Outcomes Study: Short Form (SF-36), Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), Community Integration Questionnaire, Social Support Questionnaire (SSQ), Center for Epidemiological Studies-Depression, and the Visual Analogue Scale of Depression. A significant interaction for Race Group (p < .01) was found on the Physical Component Scale (PCS) of the SF-36. In the MTBI group, African Americans reported worse functioning (p < .04) on the PCS scale; they perceived functioning on subscales General Health Perception (p < .02) and Physical Functioning (p < .04) to be more limited. On the SSQ, Hispanic MTBI patients reported having fewer social supports available to them (p < .05), although the race groups were comparable for satisfaction with their support. Rate of depression across groups was comparable, although subjective reporting by minority MTBI patients indicated greater depressed feelings. Differences in perception of health functioning may be related to the unique interaction created between sustaining an MTBI and variations in cultural expression of disability. Manifestations of physical difficulties may be better accepted for some cultures than having mental illness.

Activities of Daily Living↗

PubMed2003

Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study.

OBJECTIVE: To explore whether intrathecal baclofen (ITB) therapy improves ambulation in stroke survivors. DESIGN: Case series. SETTING: Tertiary care center. PARTICIPANTS: Ten adults with poststroke hemiparesis who were ambulatory at the time of pump implantation. INTERVENTIONS: Implantation of ITB pump after inadequate control of spasticity with other interventions. Time from stroke onset to implantation averaged 28.6 months (range, 9-55mo). MAIN OUTCOME MEASURES: Customary walking speed was measured from the time required to walk 50ft (15m) at a self-selected pace. Evaluators rated spastic hypertonia and functional mobility. RESULTS: Statistically significant improvements occurred in walking speed, functional mobility ratings, and spasticity (P<.05) at a follow-up interval that averaged 8.9 months. Mean walking speed over 50ft improved from 36.6 to 52cm/s. Mean Modified Ashworth Scale scores in the muscles of the affected lower limb improved from 2.0 to 0.4. Normal muscle strength (5/5) was preserved in the unaffected limbs. CONCLUSIONS: This preliminary study suggests that ITB therapy, in combination with physical therapy, may improve walking speed and functional mobility in ambulatory individuals with poststroke spastic hemiplegia.

Adult↗

PubMed2002

Association of postdoctoral programs in clinical neuropsychology: update and new directions.

This paper provides an update on the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), which was formed in 1992. The paper summarizes the historical background of APPCN, reports on contemporary influences on APPCN and its role in postdoctoral education and training in neuropsychology, and provides an update on APPCN's most recent initiatives. The paper includes a list of current members in APPCN and explains how other postdoctoral residency programs in clinical neuropsychology may apply for membership.

Education↗

PubMed2002

National survey of clinical neuropsychology postdoctoral fellows.

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.

Data Collection↗

PubMed2002

From the Binet-Simon to the Wechsler-Bellevue: tracing the history of intelligence testing.

The history of David Wechsler's intelligence scales is reviewed by tracing the origins of the subtests in the 1939 Wechsler-Bellevue Intelligence Scale. The subtests originated from tests developed between 1880 and World War I, and was based on approaches to mental testing including anthropometrics, association psychology, the Binet-Simon scales, language-free performance testing of immigrants and school children, and group testing of military recruits. Wechsler's subtest selection can be understood partly from his clinical experiences during World War I. The structure of the Wechsler-Bellevue Scale, which introduced major innovations in intelligence testing, has remained almost unchanged through later revisions.

Adult↗

PubMed2002

Botulinum toxin in upper limb spasticity after acquired brain injury: a randomized trial comparing dilution techniques.

OBJECTIVE: To compare the efficacy of two different volume preparations of the same dose of botulinum toxin-A in relieving spasticity in wrist and finger flexors secondary to acquired brain injury. DESIGN: Thirteen adult patients who had modified Ashworth scale scores of 3 for both wrist and finger flexors were included in this randomized, controlled trial. Wrist and finger flexors were each injected. Blinded modified Ashworth scale ratings of wrist and finger flexor spasticity were measured. RESULTS: Spasticity in both muscles decreased significantly in both treatment groups. However, the high-volume and low-volume groups did not differ significantly in spasticity reduction. CONCLUSIONS: Because this preliminary study found no difference in spasticity reduction between high- and low-volume preparations of a 60-unit dose of botulinum toxin-A, a larger-sample study seems warranted to compare the efficacy of high-volume and low-volume preparations.

Adult↗

PubMedDate not supplied

Constraint-induced movement therapy during early stroke rehabilitation.

BACKGROUND: Limited data are available about the effectiveness of early rehabilitation after stroke. OBJECTIVE: This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome. METHODS: Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand. RESULTS: Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS. CONCLUSIONS: Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.

Adult↗