Using hypnotic suggestion in the rehabilitation of working memory capacity after acquired brain injury: study protocol for a randomized controlled trial.

OBJECTIVES: Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change. METHODS: Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy. DISCUSSION: Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent. TRIAL REGISTRATION: ClinicalTrials.gov NCT05287542. Registered on March 2022 PROTOCOL VERSION: Protocol version 2.0, December 2023.

Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation.

INTRODUCTION: The consequences of stroke on sexual life in stroke patients in need of specialized cognitive rehabilitation have been limited explored. A biopsychosocial perspective in post-stroke sexuality studies is warranted to capture the complex picture of stroke consequences and sexual life after stroke and sexual satisfaction is an important outcome measure when exploring such multifactorial associations. AIM: To explore sexual satisfaction and associated biopsychosocial factors in stroke patients admitted to specialized cognitive rehabilitation. METHODS: A cross-sectional study was performed including 91 consecutive stroke patients admitted to specialized cognitive rehabilitation. Data were collected from medical records and by face-to-face interviews using a structured interview guide and questionnaires. Descriptive and inferential statistics were applied. MAIN OUTCOME MEASURES: A wide range of biopsychosocial variables including medical and sociodemographic characteristics, social support, sexual complaints, aspects of sexual life, psychological distress and life satisfaction were analyzed in relation to the main outcome "Satisfaction with sexual life." RESULTS: Only 33 % were satisfied with sexual life. Prevalence of sexual complaints was high, more frequent in women (84%) than in men (64%). Three-quarters were less sexually active than before stroke. Multivariable analyses showed that anxiety, sleep problems, manifested sexual complaint, decrease in sexual activity and fear of partner rejection were significantly associated with low odds of sexual satisfaction, while affectionate support and partnership satisfaction were significant for sexual satisfaction. When combined in a biopsychosocial multivariable model only fear of partner rejection (OR 0.07; 95 % CI: 0.01-0.42) and decrease in sexual activity (OR 0.11; 95 % CI: 0.02-0.58) showed significant contribution to sexual satisfaction. CONCLUSION: The variety of predictors for sexual satisfaction indicates that therapeutic actions need to be individualized and points towards a broad assessment and interventional approach to meet the sexual rehabilitation needs of stroke patients with cognitive impairments in need of specialized rehabilitation. Vikan JK, Snekkevik H, Nilsson MI, et al. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021;9:100424.

Current knowledge of medical complications in adults with achondroplasia: A scoping review.

This article provides an overview of the current knowledge on medical complications, health characteristics, and psychosocial issues in adults with achondroplasia. We have used a scoping review methodology particularly recommended for mapping and summarizing existing research evidence, and to identify knowledge gaps. The review process was conducted in accordance with the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews). The selection of studies was based on criteria predefined in a review protocol. Twenty-nine publications were included; 2 reviews, and 27 primary studies. Key information such as reference details, study characteristics, topics of interest, main findings and the study author's conclusion are presented in text and tables. Over the past decades, there has only been a slight increase in publications on adults with achondroplasia. The reported morbidity rates and prevalence of medical complications are often based on a few studies where the methodology and representativeness can be questioned. Studies on sleep-related disorders and pregnancy-related complications were lacking. Multicenter natural history studies have recently been initiated. Future studies should report in accordance to methodological reference standards, to strengthen the reliability and generalizability of the findings, and to increase the relevance for implementing in clinical practice.

Sexual health policies in stroke rehabilitation: A multi national study.

OBJECTIVE: To identify and explore sexual health policies at specialized stroke rehabilitation centres in relation to the perspectives of healthcare personnel concerning sexual health. DESIGN: Cross-sectional study. SUBJECTS: Nine specialized rehabilitation centres representing 7 countries, and healthcare personnel (n = 323) working with stroke rehabilitation at the 9 centres were included in the study. METHODS: Two structured questionnaires were used: (i) an organizational-audit on sexual health policies; (ii) an anonymous web-questionnaire assessing the perspectives of healthcare personnel concerning sexual health. RESULTS: Of the 9 centres, 5 scored high on having sexual health policy in stroke rehabilitation and 4 scored low. Healthcare personnel working at centres with high scores reported higher levels of knowledge and comfort in working with sexual health, and looked more positively on the workplace sexual health policies, than personnel working at centres scoring low on these factors. Most personnel expressed a need for knowledge on the topic. Being comfortable about addressing sexuality was significantly associated with higher levels of knowledge about sexuality and working at centres having sexual health policies. CONCLUSION: A lack of sexual health policy represents a barrier to evidence-based practice in stroke rehabilitation. Such protocols need to be implemented in standard care in order to meet the sexual rehabilitation needs of stroke patients and partners.

Fatigue and depression in sick-listed chronic low back pain patients.

OBJECTIVE: The relationship between fatigue and pain has been investigated previously, but little is known about the prevalence of substantial fatigue in patients sick-listed for chronic low back pain (CLBP) and about how fatigue is associated with depression, pain, and long-term disability. The aims of the study were to examine the prevalence of substantial fatigue; associations between fatigue, depression, and pain; and whether fatigue predicted long-term disability. METHODS: Five hundred sixty-nine patients participating in a randomized controlled trial and sick-listed 2-10 months for LBP were included in the study. Cross-sectional analyses were conducted to investigate the prevalence and independent associations between fatigue, depression, pain, and disability, while longitudinal analyses were done to investigate the association between fatigue and long-term disability. RESULTS: The prevalence of substantial fatigue was 69.7%. Women reported significantly more fatigue than men (t = -3.6, df = 551; P < .001). Those with substantial fatigue had higher pain intensity (t = -3.3, df = 534; P = 0.01), more depressive symptoms (t = -10.9, df = 454; P < 0.001), and more disability (t = -7.6, df = 539; P < 0.001) than those without substantial fatigue. Musculoskeletal pain and depression were independently associated with substantial fatigue. In the longitudinal analyses, fatigue predicted long-term disability at 3, 6, and 12 months' follow-up. After pain and depression were controlled for, fatigue remained a significant predictor of disability at 6 months' follow-up. CONCLUSIONS: The vast majority of the sick-listed CLBP patients reported substantial fatigue. Those with substantial fatigue had more pain and depressive symptoms and a significant risk of reporting more disability at 3, 6, and 12 months. Substantial fatigue is disabling in itself but also involves a risk of developing chronic fatigue syndrome and long-term disability.

Mortality after spinal cord injury in Norway.

OBJECTIVES: To study mortality, cause of death and risk indicators for death in Norwegian patients with spinal cord injury. DESIGN: A cross-sectional study with retrospective data. SUBJECTS: All patients (n=387) with traumatic spinal cord injury admitted to Sunnaas Rehabilitation Hospital, Norway, during the period 1961-82. METHODS: Medical records were reviewed retrospectively. Causes of death were collected from Statistics Norway and death certificates. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. To explore risk indicators for death, a Cox regression model was used. RESULTS: During the observation period, 1961-2002, 142 patients died. The main causes of death were pneumonia/influenza (16%), ischaemic heart diseases (13%) and urogenital diseases (13%). SMR was 1.8 for men and 4.9 for women. Cause-specific SMRs were markedly elevated for urogenital diseases, suicide, pneumonia/influenza, urogenital cancer, and diseases of the digestive system. Risk indicators for death were: higher age at injury, tetraplegia, functionally complete spinal cord injury, pre-injury cardiovascular disease, alcohol or substance abuse and psychiatric diagnosis. CONCLUSION: The SMRs show that life expectancy is reduced in chronic spinal cord injury in Norway, more for women than for men. Cause-specific SMRs and risk indicators suggest that the high mortality rates after spinal cord injury to a certain degree are related to preventable aetiologies. To maximize longevity in chronic spinal cord injury, more attention must be paid to co-morbidity.

Is sense of coherence stable after multiple trauma?

OBJECTIVES: To explore whether sense of coherence (SOC) is stable over time after multiple trauma. The associations between SOC and satisfaction with life as a whole, as well as aspects of psychological well-being, were explored. Finally, an overriding aim was to assess whether SOC has long-term prognostic value for global life satisfaction or psychological well-being. DESIGN: Prospective study. SETTING: Sunnaas Rehabilitation Hospital. SUBJECTS: Twenty-six subjects with severe multiple trauma, without neuropsychological deficits. MAIN OUTCOME MEASURES: Questionnaires that were answered at admission, at discharge and at follow-up 1-3 years after trauma were: Sense of Coherence Scale 13 items (SOC-13), satisfaction with life as a whole, General Health Questionnaire 20 items (GHQ-20), Hospital Anxiety and Depression Scale (HAD). RESULTS: While median SOC scores were fairly stable, individual scores were not stable over time, and for some subjects showed large variations. SOC score had neither long-term prognostic value for satisfaction with life as a whole nor for psychological well-being, at least not in the first years after severe multiple trauma. However, SOC was closely associated with overall life satisfaction when measured simultaneously. Furthermore, a weak SOC correlated with scores on psychological distress, anxiety and depression. SOC scores were also significantly related to being or not being in a state of anxiety, but not to being or not being depressed. Global life satisfaction was considerably reduced from before trauma (reported at admission) to the time of follow-up. CONCLUSION: SOC was not stable over time after severe multiple trauma. SOC measured at admission could neither predict future satisfaction with life as a whole nor future psychological well-being. Measured simultaneously, overall life satisfaction and occurrence of anxiety were significantly associated with SOC.