ABSTRACT
OBJECTIVE: To examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage. DESIGN: Cohort study. PATIENTS: Eighty-seven patients admitted to an inpatient neurology unit for elective cerebrospinal fluid drainage for suspected normal pressure hydrocephalus. METHODS: Before and after a protocol of continuous cerebrospinal fluid drainage via spinal catheter, patients were administered the Functional Independence Measure (FIMTM), Timed Up and Go (TUG), Tinetti Assessment Tool of Gait and Balance, 9-hole peg test, and Cognitive Assessment of Minnesota (CAM). Following cerebrospinal fluid drainage, changes in functional performance were compared for responders to cerebrospinal fluid drainage and non-responders to cerebrospinal fluid drainage. RESULTS: At baseline, CAM was more sensitive than the Mini Mental State Exam in predicting responders. Post-drainage: responders improved on 52% of tests while non-responders improved on only 11%. Assessments that differentiated magnitude of improvement in responders vs non-responders were: TUG (p<0.05), Tinetti total (p<0.001), Tinetti balance (p<0.001), Tinetti gait (p<0.001), FIM toilet transfer (p<0.001), and FIM lower body dressing (p<0.001). CONCLUSION: Specific occupational therapy and physical therapy assessments demonstrate sensitivity to change and predictive value with patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage.
Subject(s)
Hydrocephalus, Normal Pressure/rehabilitation , Outcome Assessment, Health Care/methods , Activities of Daily Living , Adult , Aged , Cerebrospinal Fluid Shunts , Cognition , Cohort Studies , Female , Humans , Hydrocephalus, Normal Pressure/diagnosis , Hydrocephalus, Normal Pressure/physiopathology , Intracranial Pressure , Male , Mental Status Schedule , Middle Aged , Occupational Therapy , Physical Therapy Modalities , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
Defensive pessimism (Norem & Cantor, 1986a) is conceived as an adaptive motivational strategy employed in academic contexts. The present research investigates some potentially deleterious correlates of the defensively pessimistic strategy. We examined the hypothesis that defensive pessimists would have a relatively high ratio of negative-to-positive academically relevant self-thoughts, and these accessible thoughts would be related to high self-esteem instability. Mediational analyses generally supported this hypothesis. However, defensive pessimism-optimism differences in self-esteem seemed to partially account for the mediated effects. We also found support for the hypothesis that, relative to optimists, defensive pessimists would tend to be less oriented toward mastery goals and more oriented toward performance-avoidance achievement goals in academic settings. Results were discussed in terms of the processing correlates and adaptive trade-offs of defensive pessimism.