Age-related smartphone use patterns among individuals with moderate-to-severe traumatic brain injury.

OBJECTIVE: With mobile health technologies serving as an alternative means of providing healthcare, evaluating patients' abilities to navigate digital infrastructures is becoming increasingly relevant. The goal of this study is to investigate smartphone use patterns among individuals with history of moderate-to-severe traumatic brain injury (TBI). METHODS: An anonymous survey was delivered via e-mail or text message to eligible participants who had a history of moderate-to-severe TBI and were prospectively followed at one of the eight participating Traumatic Brain Injury Model Systems centers for at least 1-year post-injury. The survey captured demographic data and included a questionnaire to evaluate smartphone use (calling, texting, web browsing, etc.). RESULTS: A total of 2665 eligible individuals were contacted to complete the survey, 472 of which responded. 441 of them reported smartphone use. Individuals ages 45 and older were significantly less likely to use their phones for functions other than calling and texting when compared to individuals ages 18-44 (p < 0.05). CONCLUSIONS: Most individuals with moderate-to-severe TBI in this cohort demonstrated intentional smartphone use, suggesting that mobile health technologies may be feasible as a cost-effective healthcare alternative. However, doing so will require additional interventions to provide further technological education especially in older individuals with TBI.

Breastmilk pumping experiences of physician mothers: quantitative and qualitative findings from a nationwide survey study.

BACKGROUND: Nearly half of graduating medical students today are women, with many having children early in their careers, necessitating thoughtful consideration of practices and policies. The short duration of maternity leave for physician mothers often means that most who choose to breastfeed must return to work while still breastfeeding their infants. OBJECTIVE: To characterize the experience of physician mothers and identify facilitators and barriers related to breastmilk pumping upon return to work. DESIGN: Cross-sectional nationwide survey study administered to physician mothers electronically via REDCap™ to broadly characterize their personal experiences with family leave and return to work. PARTICIPANTS: Physician mothers in the USA (n=724). APPROACH/MAIN MEASURE: Demographic data and survey responses related to experiences during family leave and return to work, including free-text response options when participants indicated "other" experiences not captured by the survey response options and one open-ended question asking, "What do you think are the most important factors contributing to a positive maternity/family leave experience?" For this study, we searched free-text responses across the entire survey for keywords related to breastfeeding and pumping and thematically analyzed them to summarize key features of physician mothers' experiences. KEY RESULTS: Lack of time, flexibility, dedicated and hygienic locations for pumping breast milk, disrespect and lack of support from others, and concerns about financial consequences of productivity changes were the most common barriers to pumping breastmilk reported by physician mothers. CONCLUSIONS: Flexibility in scheduling, adjusted productivity targets, and clean, private, and well-equipped pumping rooms would likely provide the greatest support to help physician mothers thrive in their careers while simultaneously allowing them to provide the nourishment needed for their developing infants.

Usability of a two-way personalized mobile trainer system in a community-based exercise program for adults with chronic traumatic brain injury.

OBJECTIVE: To examine the usability of an Apple Watch-based, two-way Personalized Mobile Trainer (PMT) in community-based exercise programs for individuals with chronic traumatic brain injury (cTBI). METHODS: This is a prospective pilot study. Twenty participants with cTBI aged 46-73 were enrolled in a 3-month individualized exercise program. After one in-person training session on PMT and exercise program, participants were prescribed either aerobic exercise training (AET) or stretching and toning (SAT) performed at home. The PMT was used to remotely deliver updated exercise prescription, track exercise progress, and communicate with the participants. The primary outcome was compliance with the exercise programs. RESULTS: All the participants completed the assigned exercise program with an average compliance of 76%. Nineteen (95%) participants were able to use the PMT properly during exercise sessions. After 3 months of training, the AET trended toward maintaining exercise endurance when compared with the SAT group (0.3% vs -4%, p = 0.14) with a medium effect size of 0.43. CONCLUSION: Using the PMT system to support and track exercise in community-based exercise programs is feasible. The PMT may promote compliance with the training program but testing its effectiveness with larger trials is warranted.

Community-based exercise program, self-reported health-related symptoms, and quality of life in persons with traumatic brain injury 45 + years old.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise. OBJECTIVE: To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI. METHODS: Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45-80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality. RESULTS: AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms. CONCLUSIONS: This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI.

Physical activity and perceived barriers in individuals with moderate-to-severe traumatic brain injury.

INTRODUCTION: Regular physical activity (PA), especially aerobic exercise, may benefit cognitive function in middle-aged and older adults, but promoting regular PA in individuals with traumatic brain injury (TBI) remains a challenge. OBJECTIVE: To characterize PA and perceived barriers to PA in younger (<45 years) and middle age and older (≥45 years) individuals ≥1 year after moderate-to-severe TBI. DESIGN: Multicenter survey study. SETTING: Community. PARTICIPANTS: Persons who met the following criteria were included in the study: (1) 18 years and older; (2) English speaking; (3) History of moderate-to-severe TBI; (4) Followed in a TBI Model Systems Center for at least 1 year; and (5) Able to complete the survey independently. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): PA level measured by Rapid Assessment of Physical Activity questionnaire (RAPA) and self-reported barriers to PA. RESULTS: A total of 472 participants completed the survey (response rate of 21%). More individuals in the younger group (<45 years old) met Centers for Disease Control and Prevention (CDC) recommended aerobic PA guidelines compared to the middle-aged and older group (≥ 45 years old) (62% vs 36%, p < .001). Lack of motivation, lack of time, and fatigue were the most reported barriers. Perceived barriers to PA varied by age and PA level: the middle-aged and older individuals (≥ 45 years old) were more likely to report no barriers and inactive individuals (RAPA ≤5) more likely to report lack of motivation and money, pain, and lack of resources. CONCLUSION: Participants ≥45 years of age were less likely to meet the CDC PA guidelines than younger individuals after moderate-to-severe TBI. Because perceived barriers to PA varied between age groups and PA levels, individualized approaches may be needed to promote PA in this population.

Assessment of impaired self-awareness by cognitive domain after traumatic brain injury.

PURPOSE: To examine self-awareness in chronic traumatic brain injury (TBI) by cognitive domain, compare domain-specific self-awareness to global impaired self-awareness, and evaluate change in self-appraisal of cognitive ability from before to after neuropsychological testing. METHOD: Secondary analysis of a cross-sectional cohort of 59 participants with chronic TBI. We grouped participants as underestimators, fair estimators, and overestimators of their memory and executive functioning. We then compared these groups by global self-awareness measures, other clinical measures, and pre- to-posttest change in self-appraisal of cognitive performance. RESULTS: Analyses revealed no significant differences in global self-awareness measures or depression between fair or underestimators and overestimators in Memory or Executive Function Domains. Only 12.50% of participants in the Memory Composite Domain and 6.89% of participants in the Executive Function Composite Domain changed their pre- to postneuropsychological test self-appraisal of cognitive ability. CONCLUSION: This study revealed most participants did not change their self-appraisal in response to completing neuropsychological testing alone. In conjunction with our findings that suggest global self-awareness measures may not adequately capture domain-specific self-awareness deficits in chronic TBI, this study provides support for development of targeted self-awareness assessment tools and the need for structured feedback, rather than naturalistic feedback alone, to improve self-awareness in chronic TBI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Physical activity status and quality of life in patients with epilepsy - Survey from level four epilepsy monitoring units.

PURPOSE: People with epilepsy (PWE) tend to have sedentary lifestyles which may predispose them to a lower perceived quality of life (QOL). Moreover, the relationship between physical activity (PA) and QOL in populations of PWE with high disease burden has been under-studied. The goal of this study was to evaluate PA level and its impact on health-related QOL in PWE who were admitted to Level-4 epilepsy monitoring units (EMU). METHODS: In this prospective observational study, 200 patients from two EMUs in Dallas, Texas completed the following standard surveys: Rapid Assessment of Physical Activity (RAPA), the Quality of Life in Epilepsy (QOLIE-31), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7) questionnaire. Information on self-reported epilepsy history, severity of disease, and socioeconomic status were also collected. The diagnosis of epilepsy was confirmed by video-EEG monitoring. RESULTS: Among the 200 who completed the survey, 113 had a diagnosis of epilepsy and 109 of them completed the RAPA. Ninety-two (84 %) of these PWE reported a sedentary level of physical activity (RAPA < 6) and 16 % reported an active level (RAPA ≥ 6). Self-reported QOL was slightly higher in PWE with an active level of PA compared to PWE with a sedentary level of PA (63.8 ± 15.0 vs 53.7 ± 17.9, p = 0.07), even though there was no difference in the severity of self-reported mood symptoms. After controlling for employment and seizure frequency, physical activity level measured by RAPA score was also positively related to QOL (r = 0.39, p = 0.01) and negatively correlated with anxiety symptoms (r = -0.28, p = 0.02) and depression symptoms (r = -0.25, p = 0.04). CONCLUSION: The majority of PWE in this survey reported sedentary lifestyles despite most of them being young to middle-aged adults. Higher PA level was associated with fewer self-reported mood symptoms and higher QOL. In conjunction with the literature, these results suggest that PWE with a wide range of disease burden should be encouraged to participate in regular exercise to potentially improve QOL.

Emergent Tact Control Following Stimulus Pairing: Comparison of Procedural Variations.

We examined emergent tact control following stimulus pairing, using 2 different stimulus presentation arrangements. In the word-first condition, presentation of the auditory stimulus preceded the visual stimulus, and in the image-first condition, the visual stimulus preceded the auditory stimulus. Eight children (2-5 years old) participated. In Experiment 1, 4 children were exposed to 3 sessions in each condition with a new set of stimuli in each session. In Experiment 2, 2 of the same children received repeated exposure to the same stimulus sets. Experiment 3, with new participants, was identical to Experiment 1, except visual and auditory stimuli overlapped during the presentation. Postsession probes documented emergent stimulus control over 1 or more vocal responses for 7 of the 8 participants. Participants were more likely to make echoic responses with the visual stimulus present in the word-first condition; however, emergent tact control was unaffected by the order of the stimulus presentation. Additional research is needed on stimulus-pairing procedures and on the role of echoic responding in emergent tact control.