Recent Faculty Publications
Goverover, Y., Genova, H. M., Hillary, G. M., & DeLuca, J. (In-press). The Relationship between Neuropsychological Measures and the Timed Instrumental Activities of Daily Living Task in Multiple Sclerosis. Multiple Sclerosis.
Multiple sclerosis (MS) can result in cognitive deficits and a loss of functional independence. To date, little research has linked the observed cognitive and behavioral deficits in MS, especially those in the processing speed domain, to performance on tasks of everyday functioning. This study study examined the relationship between neuropsychological test performance and performance on the Timed Instrumental Activities of Daily Living task (TIADL) in individuals with MS and in healthy controls (HCs). The TIADL is a functional measure that assesses both accuracy and speed in one’s performance of everyday activities. The MS group performed significantly worse on the TIADL relative to the HC group. Additionally, TIADL scores of individuals with MS were significantly correlated with neuropsychological measures of processing speed. TIADL scores were not, however, correlated with neuropsychological measures of verbal episodic memory or working memory. These results indicate that the impairments in processing speed may hinder performance in activities of daily living in persons with MS.
Bear-Lehman J., Albert, S., & Burkhardt, A. (2006). Disparities between ambient, standard lighting and retinal acuities in community-dwelling older people: Implications for disability. Journal of the American Geriatrics Society, 922, 1-7.
This study examined three types of visual ability and their relationship with self-reported disability in community-dwelling older people. The extent to which lighting and correctable ocular conditions may contribute to vision loss was the focus of the research. Vision testing was conducted in the homes of community-dwelling older people, and the three visual abilities studied were ambient acuity, standard lighting acuity, and retinal acuity. Results were assessed using a near reading card and a Retinal Acuity Meter. Self-reports were used to gather responses to questions regarding difficulties in activities of daily living. In the study of 299 participants, 45% were found to have the potential for better vision by three of more lines of letters. If the sample is representative, then 4.5 million elderly Americans living independently have the capacity to see better with improved lighting and ophthalmologic care. This study examined three types of visual ability and their relationship with self-reported disability in community-dwelling older people. The extent to which lighting and correctable ocular conditions may contribute to vision loss was the focus of the research. Vision testing was conducted in the homes of community-dwelling older people, and the three visual abilities studied were ambient acuity, standard lighting acuity, and retinal acuity.Results were assessed using a near reading card and a Retinal Acuity Meter. Self-reports were used to gather responses to questions regarding difficulties in activities of daily living. In the study of 299 participants, 45% were found to have the potential for better vision by three of more lines of letters. If the sample is representative, then 4.5 million elderly Americans living independently have the capacity to see better with improved lighting and ophthalmologic care.
Bear-Lehman, J., Albert, S., Burkhardt, A., Merete-Roa, B., Noboa-Lemonier, R., & Teresi, J. (2006). Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability. Journal of Gerontology: Medical Sciences, 61A:8, 826-831.
This study assessed clinician-rated instrumental activities of daily living (IADL) performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). The relative role of physical, cognitive, and environmental factors in self-reports of difficulty with the IADL remains unclear, and this research aimed to clarify those relationships. Self-reported IADL disability is associated with increased risks of mortality, hospitalization, development of more extensive disability, and need for long-term care. AMPS and self-rated IADL disability were compared in two groups in the homes of elderly persons without ADL limitation. In this sample, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical defects appeared to be more salient in self-ratings than is cognitive ability, because cognitive ability (particularly verbal fluency) was associated only with clinician-rated IADL performance.
Bear-Lehman, J. (2006). Occupational therapy. The Merck Manual of Geriatrics, 3rd edition (pp. 287-295, 437). Retrieved from http://www.merck.com/mrkshared/mmg/home.jsp
This section within the manual describes occupational therapy’s role in the field of geriatrics. Topics discussed include assessments, interventions, and settings for practice, as well as occupational therapy work in the treatment of Parkinson’s disease. The Merck Manual of Geriatrics provides specific information related to the care of elderly persons. It has been in publication since 2000, and this e-book edition is the first one available for free access on the internet.
Bear-Lehman, J. (2006). Functional evaluation of the wrist and hand. In M. Nordin, G. Andersson, & M. Pope (Eds.), Musculoskeletal disorders in the workplace: Prevention of disability. Philadelphia: Elsevier.
Success in the rehabilitation of the wrist and hand is measured by the patient's ability to spontaneously use the injured part in ordinary activities. It is therefore important to use measurement instruments that produce reliable and valid data to improve the accountability of both the clinician and the patient. Dr. Bear-Lehman, Ph.D., OTR, FAOTA, reviewed the various performance-based tools used to measure hand and wrist function. The tools were divided into three broad categories:
1. clinical assessment measurements (range of motion, edema, muscle performance testing and sensation);
2. functional assessment measurements (information processing); and
3. daily life task performance measurements (dexterity, physical capacity evaluation).
Goverover Y., Chiaravalloti, N., & DeLuca, J. (2005). The relationship between self-awareness of neurobehavioral symptoms, cognitive functions and emotional symptoms in multiple sclerosis. Multiple Sclerosis, 11, 203-212.
The objective of this study was to examine self-awareness of neurobehavioral symptoms in multiple sclerosis (MS) across three domains of function (apathy, disinhibition, and executive control) and to examine the relationship between self-awareness and cognitive functioning. Twenty-six individuals with MS completed neuropsychological testing, measures of emotional functioning, and self-ratings of neurobehavioral symptoms using the Frontal Systems Behavior Scale (FrSBe), a 46-item questionnaire with subscales assessing frequency of symptoms in executive dysfunction, disinhibition, and apathy. Informants’ ratings of the FrSBe were also obtained. Decreasing differences between patient and informant reports on each subscale of the FrSBe (concordance) indicate higher levels of self-awareness. Results showed significant positive correlations between cognitive abilities and self-awareness of executive dysfunction and disinhibition. In contrast, affect symptomatology (measures of anxiety and depression) were negatively correlated with self-awareness of executive dysfunction. The level of self-awareness of neurobehavioral symptoms in MS is related to the level of cognitive impairment. In addition, symptoms of depression and anxiety reduced the accuracy of self-reporting. Thus, a clinician who relies on self-reports in creating an evaluation and treatment plan should consider the patient’s cognitive and emotional states.
Goverover, Y., Kalmar, J., Gaudino-Goering, E., Shawaryn, M., Moore, N. B., Halper, J., DeLuca, J. (2005). The relationship between subjective and objective measures of everyday life activities in persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 86, 2303-2308.
The lack of association between objective performance-based measures and subjective self-report measures of functional activities is a challenge to outcomes measurement and has implications for assessment of functional performance. This study investigated the relationship between subjective and objective performance-based measures of functional status in persons with multiple sclerosis (MS). It also compared their performances to healthy controls (HCs). In an outpatient rehabilitation research institution, 74 individuals with MS and 35 individuals as HCs participated. A between-groups design was used, with a correlational approach in examining the relationship between objective and subjective measures of functional capacity. Outcomes were measured using the Executive Function Performance Test (EFPT), the Functional Assessment of Multiple Sclerosis (FAMS), and the Functional Behavior Profile (FBP). There were no interventions. MS participants reported more difficulties on functional tasks relative to the HCs. MS participants also performed significantly worse on the EFPT than healthy individuals. However, all correlations between subjective and objective functional measures were non-significant. After controlling for depressive symptomatology, EFPT performance was significantly associated with FBP scores but not with FAMS scores. Results are discussed in terms of the different dimensions these tools are measuring and their respective strengths and limitations.
Johnston, M. V., Goverover, Y., & Dijkers, M. (2005). Community activities and individuals' satisfaction about them: Quality of life in the first year after traumatic brain injury. Archives of Physical Medicine & Rehabilitation, 86, 735-745.
This study investigates the relationships between community activities and personal and global life satisfaction with these activities, as well as desires to change them. Interviews were conducted with 162 individuals who were hospitalized with mostly moderate to severe traumatic brain injury (TBI). Follow-ups were performed one month after rehabilitation discharge and 12 months post-injury. 90.1% were reached (mostly by phone) one month after rehabilitation discharge, with 84.6% being reached at 12 months post-injury. The Community Integration Questionnaire-2 (CIQ-2), augmented by individuals’ ratings of satisfaction/dissatisfaction with and desire to change each activity, was used for measurement. The Satisfaction with Life Scale was also utilized. While significant correlations were found for some items, most correlations between activities and ratings of global quality of life were low and non-significant. Individuals reported that they were satisfied with most of their community activities, but there were exceptions (e.g., paid work). Correlations between activity-specific satisfaction and general life satisfaction were generally weak and non-significant. Dissatisfaction with an activity correlated strongly with desire to change the activity, but general life satisfaction did not correlate with desire to change activities. The lack of association between frequency of activities and subjective appraisals of them is a challenge to outcomes measurement and has implications for the targeting of rehabilitative interventions and evaluation of their worth. More research is needed to understand how individualizing functional objectives might maximize the effects of rehabilitation on the quality of life of persons served.