Decisional Informatics for Psychosocial Rehabilitation: A Feasibility Pilot on Tailored and Fluid Treatment Algorithms for Serious Mental Illness.

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At posttreatment and follow-up, group differences and moderate-to-large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a General Education Diploma as their goal, 73% in FORT passed the examination compared with 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. Although the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency.

The synergistic benefits of physical and cognitive exercise in schizophrenia: Promoting motivation to enhance community effectiveness.

Emerging research highlights the potential cognitive benefits of physical exercise (PE) programs for schizophrenia (SCZ). The few recent efficacy studies that examined augmenting cognitive training (CT) with PE suggest superior effects of the combination. The next step is to consider strategies to enhance adherence in real-world settings if this type of combined treatment is going to be effective. We present the first community effectiveness data for PE and CT that included a motivationally-enhancing, self-determined approach to exercise, in lieu of participant payment. Eighty-five outpatients with schizophrenia attending an intensive outpatient program were randomized to 18 h of either (A) self-determined PE regimen with choice from a menu of different activities; (B) tablet-based neurofeedback CT focused on processing speed (PS) and working memory (WM), or (C) a time-matched combination of PE and CT. Assessments were conducted at baseline, post, and follow-up (2 mo). All groups improved in WM from baseline to post, with greatest gains in the PE only group. At follow-up, cognitive gains originally observed in the PE-only group disappeared, while the PE + CT group evidenced improvements in WM and psychotic symptoms. Notably, attrition for PE was only 7%. Our data shows that combining PE and CT leads to lasting effects that are superior to those of either intervention alone. The low PE drop-out rate suggests a self-determined approach to the exercise regimen was tolerable, and may be an important component of future community implementation efforts.

Pupillometer-based neurofeedback cognitive training to improve processing speed and social functioning in individuals at clinical high risk for psychosis.

OBJECTIVE: Among individuals at clinical high risk (CHR) for psychosis, processing speed (PS) has been related to social and role functioning regardless of conversion to schizophrenia. This information processing dysfunction is a gateway to broader behavioral deficits such as difficulty executing social behaviors. We examined the feasibility of improving information processing relevant to social situations in CHR, including its sustainability at 2-month follow-up, and its association with concurrent social function. METHOD: This was a double-blind RCT in which 62 CHR participants were randomized to Processing Speed Training (PST) or an active control matched for training format and the same dose and duration of treatment. PST is a tablet-based program that uses pupillometry-based neurofeedback to continually adjust training parameters for an optimal neurocognitive load and to improve visual scanning efficiency by inhibiting selection of nonessential targets and discriminating figure-ground details. RESULTS: The PST group showed faster motoric and nonmotoric PS at post training and 2-month follow-up. At 2 month follow-up, the PST group reported better overall social adjustment. Changes in PS from baseline to 2 months were correlated with overall social adjustment and social avoidance in the entire sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study to test focal neurofeedback-based cognitive training for PS deficits in the putatively prodromal phase of schizophrenia to address associated social morbidity. Targeting PS appears to be a promising pathway to decreasing comorbidity and mitigating a risk factor for psychosis. (PsycINFO Database Record

Pelvic and femoral contributions to bilateral hip flexion by subjects suspended from a bar.

OBJECTIVE: To quantify the contribution of the pelvis and femur to active bilateral hip flexion conducted while subjects are suspended by their hands from a bar. DESIGN: Descriptive and experimental. BACKGROUND: Voluntary hip flexion while in a suspended position is used in abdominal strengthening regimens and is required for certain athletic activities. The degree to which pelvic rotation contributes to this maneuver has not been established. METHODS: Pelvic and femoral motions were documented in 14 subjects who performed bilateral hip flexion while they hung by their hands from a bar. A supporting board as well as the trunk, pelvis and thigh were marked with reflective spheres; motion of the pelvis and thigh relative to the board was captured by video analysis. Ratios of pelvic to femoral motion were calculated and the influence of hamstring length (<78 degrees vs >78 degrees of straight leg raising) and knee position (flexed vs extended) on the ratio was determined. RESULTS: The mean pelvifemoral ratio ranged from 0.131 to 0.355, depending on hamstring length and knee position. Pelvic rotation therefore contributed a mean 13.1-35.5% of the observed hip flexion. A 2 x 2 mixed-model analysis of variance showed that the ratio was influenced significantly by each of these two independent variables. The largest pelvic contribution occurred during hip flexion with the knee in the extended position among subjects with shorter hamstrings. CONCLUSIONS: Pelvic motion is an integral part of hip flexion conducted while subjects are suspended their hands from a bar. The pelvic contribution depends on knee position and hamstring length. RELEVANCE: During suspended activities involving hip flexion (e.g. gymnastics), pelvic rotation plays an integral role throughout the range. Inherent or imposed differences in hamstring length can alter the contribution of the pelvis to the motion. Hip flexion, therefore, might be influenced by conditions affecting the ability of the pelvis to rotate (e.g. spinal fusion), or the femur to move on the pelvis (e.g. degenerative joint disease), or be altered by hamstring tension.

Kinematics of the double-leg-lowering test for abdominal muscle strength.

STUDY DESIGN: Prospective descriptive study. OBJECTIVE: To investigate the kinematics of the double-leg-lowering (DLL) test of abdominal muscle strength. BACKGROUND: Adequate strength of the abdominal muscles is necessary for many household, occupational, and sports activities. Therapists, therefore, need valid measures of abdominal muscle strength. METHODS AND MEASURES: A convenience sample of 17 subjects (7 women, 10 men) was tested. Using reflective spheres to identify specific body segments, subjects were videotaped while performing DLL under 2 conditions: attempting (controlled) prevention of anterior pelvic tilting versus not attempting (uncontrolled) prevention of anterior pelvic tilting. Videotape was analyzed using the PEAK 5 2-dimensional system. RESULTS: The pelvis tilted anteriorly by the time the extremities were lowered a mean 3.6 degrees, regardless of condition. No significant difference in anterior pelvic tilting was associated with the 2 DLL conditions (F = 2.95, P = 0.105) but pelvic tilting did increase significantly as the lower extremities were lowered from vertical (F = 98.41, P < 0.001). CONCLUSIONS: There appears to be a natural tendency for the pelvis to tilt anteriorly from very early in the DLL maneuver. As healthy young subjects do not appear able to prevent the tilting, the scoring system associated with the DLL test should be questioned.