Rehabilitation Psychology

Psychopathology and resilience following traumatic injury: A latent growth mixture model analysis.
Objective: To investigate trajectories of PTSD and depression following traumatic injury using latent class growth curve modeling. Method: A longitudinal study of 330 injured trauma survivors was conducted and participants were assessed during hospitalization, and at 1, 3, and 6 months follow-up. Acute Stress Disorder (ASD) was assessed during hospitalization using the Acute Stress Disorder Interview (ASD-I), PTSD was measured at all follow-up with the Post-Traumatic Stress Diagnostic Scale (PDS) and depression was measured at hospitalization with the (BSI) and at follow-up with the Center for Epidemiologic Studies Depression Scale (CESDS). Covariates were explored, including coping self-efficacy, anger, education level, and mechanism of injury. Results: Four latent classes were identified for PTSD and Depression symptoms: chronic distress, delayed distress, recovered, and resilience. When compared to the resilient group, individuals with chronic distress were more likely to have been assaulted, had higher levels of anger, and had less coping self-efficacy. The delayed distress group had lower education levels, higher levels of coping self-efficacy, and higher levels of anger. Individuals in the recovered group had fewer years of education, and higher levels of anger. Conclusion: The majority of the injured trauma sample demonstrated resiliency, with those exhibiting distress doing so as a delayed, chronic, or recovered trajectory. Coping self efficacy, education, assaultive trauma type, and anger were important covariates of depression and PTSD trajectories. These results are similar to studies of individuals who experienced a major health threat and with survivors from the World Trade Center attacks in the U.S. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Resilience in the face of coping with a severe physical injury: A study of trajectories of adjustment in a rehabilitation setting.
Objective: Despite the popularity of the concept of resilience, little research has been conducted on populations in physical rehabilitation settings. Our purpose was to identify three trajectories of psychological adjustment to an acquired severe physical injury characterized by resilience, recovery, or distress in a longitudinal design. Participants: Eighty inpatients with a severe injury at a rehabilitation hospital. The participants had spinal cord injury or multiple traumas. Design: Classification into the three trajectories was based on symptoms of psychological distress (posttraumatic stress disorder, depression, anxiety, and negative affect) and participants’ level of positive affect at admission to and discharge from the rehabilitation hospital. Results: The most common trajectory was the resilience trajectory (54%), followed by the recovery trajectory (25%) and the distress trajectory (21%). The most interesting differences between the trajectories were the result of optimism, affect, social support, and pain. Trait negative and positive affect predicted classification into the trajectories. Conclusions: An adaptation pattern characterized by resilience was found to be the most common response to an acquired severe injury, and trait affect predicts the outcome pattern. Interventions based on resilience are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Resilience and indicators of adjustment during rehabilitation from a spinal cord injury.
Objectives: The purposes of this study were to (a) identify changes in resilience and indicators of adjustment (i.e., satisfaction with life, depressive symptomatology, spirituality, functional independence) during inpatient rehabilitation after spinal cord injury (SCI) and (b) examine the relationship between each variable at different stages of the rehabilitation process. Design: The sample consisted of 42 individuals with a SCI, including 33 men and 9 women who were inpatients for a mean stay of 51 days (SD = 14.63). A repeated measures design was employed, with questionnaires completed at 3 times during the rehabilitation program (admit, 3 weeks, and discharge). Results: Results from the repeated measures multivariate analysis of covariance and post hoc follow-up tests indicated that there was no significant change in resilience, but that there was significant change for each indicator of adjustment during inpatient rehabilitation. Findings also indicated significant correlations between resilience, satisfaction with life, spirituality, and depressive symptoms. Conclusion: Future studies that focus on developing interventions and examine the factors that predict resilience could help build resilience, which in turn may improve rehabilitation outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Change in positive emotion and recovery of functional status following stroke.
Objectives: To investigate change in positive emotion over a 3-month follow-up period and determine whether this change is associated with recovery of functional status in persons with stroke. Design: A longitudinal study using information from the Stroke Recovery in Underserved Patients (SRUP) database. Positive emotion and functional status were assessed within 72 hours of discharge from an in-patient medical rehabilitation facility and at 3-month follow-up using established measurement instruments. Participants: The study included 840 adults 55 years old or older with a first-time stroke and admitted to one of eleven in-patient medical rehabilitation facilities in the United States. Results: The mean age was 72.9 (SD = 9.52) years, 78.6% were non-Hispanic white and 51.7% were women. The average length of stay was 20.2 (SD =10.1) days and the most prevalent type of stroke was ischemic (75.0%). Positive emotion increased for 35.6% of the sample, decreased for 29.2%, and 35.2% reported no change. Increases in positive emotion change score compared to no change (b = -3.2, SE = 1.5, p = .032) or a decline (b = -8.9, SE = 1.4, p =
Positive psychological variables in the prediction of life satisfaction after spinal cord injury.
Objective: To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge. Design: Prospective observational design; correlational and regression analyses. Eighty-seven adults who were participating in in-patient, acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures: Benefit finding Scale, Hope Scale, Brief Symptom Inventory, COPE, Positive and Negative Affect Schedule, and Satisfaction with Life Scale. Results: Hypothesized relationships of hope and positive affect (facilitator variables) with greater life satisfaction during the initial acute rehabilitation period were supported. Facilitators, as measured at baseline, accounted for a significant amount of variance in life satisfaction above and beyond barrier variables (depression, negative affect, and avoidant coping) both during the acute rehabilitation phase (R² change = .20, p <.0001) and at 3 months after discharge (R² change = .09, p <.029). Conclusions: Findings suggest that positive psychological variables play a significant role in postrehabilitation subjective well-being for persons with spinal cord injury and may provide potential avenues for interventions to facilitate positive outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury.
Objective: This study looked at the emergence of clinically significant problems in behavior, executive function skills, and social competence during the initial 18 months following traumatic brain injury (TBI) in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Participants: Children, ages 3–7 years, hospitalized for severe TBI, moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Design: Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point postinjury. Results: Results suggest that, compared with the OI group, the severe TBI group developed significantly more externalizing behavior problems and executive function problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Conclusions: Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low socioeconomic status. The findings are similar to those found in school-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Girls with spinal cord injury: Social and job-related participation and psychosocial outcomes.
Objective: To examine social and job-related participation among girls with spinal cord injury (SCI) and relationships between participation, depression, and quality of life. Participants and Setting: This sample included 97 girls (aged 7–17 years) who had sustained SCI at least 1 year prior to interview, and who were receiving care at three pediatric SCI centers within a single hospital system. Measures: Participants completed the Children’s Assessment of Participation and Enjoyment, Children’s Depression Inventory, and Pediatric Quality of Life Inventory. Caregivers completed a demographics form. Results: Girls participated more often in social activities than in job-related activities and participated in social activities with a more diverse group and further from home. A broader context of social participation was related to lower depression, which in turn was related to higher quality of life. Higher frequency of job-related participation was related to lower depression, which in turn was related to higher quality of life. Conclusions: Social and job-related participation are related to psychosocial outcomes among girls with SCI. Participation in social and job-related activities should be a focus of rehabilitation for girls, because the skills gained from this involvement may help build resilience against future obstacles to socialization and employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Making those who cannot see look best: Effects of visual resume formatting on ratings of job applicants with blindness.
Objective: Although general attitudes toward individuals with disabilities are often positive, these perceptions do not always lead to equal footing in the hiring process. This study examined stereotypes of job applicants perceived to be blind and the role of applicant blindness in hireability ratings made by human resource managers. Specifically, we highlighted a unique challenge for individuals who cannot see: the visual formatting of resumes. Design: Human resource managers (N = 249) evaluated the visually formatted or unformatted resumes of hypothetical job applicants who were portrayed as blind or sighted and rated applicant hireability and personality characteristics. Results: Although applicants perceived to be blind were perceived as more conscientious and agreeable by human resource managers, these positive evaluations did not translate into favorable hireability evaluations. Conclusion: Because human resource managers severely penalize applicants who do not attend to visual, nonfunctional resume presentation, applicants who cannot see are apt to find themselves disadvantaged in the hiring process. The implications of these findings for organizations, job seekers, and rehabilitation professionals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Promoting self-determined motivation for exercise in cardiac rehabilitation: The role of autonomy support.
Objective: Using self-determination theory (SDT), we examined relationships between cardiac rehabilitation (CR) participants’ perceived autonomy support, motivation for exercise, and exercise behavior. Research Method/Design: Male CR outpatients (N = 53; Mage = 62.83 ± 10.78 years). The design was correlational (cross-sectional and prospective), examining relationships between perceived autonomy support and motivation for exercise at Week 4 of CR participation as well as motivation and CR attendance and other indicators of exercise behavior (frequency, duration, total exercise time) at a 1-week follow-up, 10 weeks later. Results: Perceived autonomy support was correlated with self-determined motivation, r(53) = .32, p <.05. Self-determined motivation predicted total exercise volume at follow-up, r(53) = .34, p <.05, as well as length of exercise session duration (R² = .27; ß = .52, p <.001). Conclusion: Results support SDT and the potential for autonomy support from interventionists to affect self-determined motivation and exercise behavior of participants involved in CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Psychosocial predictors of employment status among men living with spinal cord injury.
Objective: To explore the relationship between employment status and community access, perceived community discrimination, social support from significant others, depressive symptoms, and gender-related variables for 83 men living with spinal cord injury. Study Design: Correlational research. Setting: Internet-based investigation employing spinal cord injury listservs. Main Outcome Measure: Participant employment status. Results: A forced-entry hierarchical logistic regression indicated that means of injury, community access and perceived community discrimination, social support from significant others, depressive symptoms, and men’s adherence to masculine norms for primacy of work, self-reliance, and emotional control significantly predicted employment status. Conclusions: Psychosocial variables such as community access, perceived discrimination, social support from significant others, depressive symptoms, and gender identity represent important and understudied predictors of employment status among men living with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Cognitive appraisals and posttraumatic stress disorder symptoms in informal caregivers of stroke survivors.
Objective: To examine associations between cognitive appraisals (i.e., negative appraisals about the self, negative appraisals about the world, and self-blame) and the severity of posttraumatic stress disorder (PTSD) symptoms in informal caregivers (i.e., family relatives or close associates) of stroke survivors. Method: A cross-sectional study was conducted in which informal caregivers (N = 51) of recent stroke survivors completed the Posttraumatic Diagnostic Scale and the Posttraumatic Cognitions Inventory. Results: PTSD symptom severity correlated significantly with the Posttraumatic Cognitions Inventory Self, World, and Self-Blame subscales and with time since stroke and age (negative relationship). Cognitive appraisals explained 58% of the variance in PTSD symptom severity. Conclusion: The associations found between negative cognitive appraisals and the severity of PTSD symptoms are consistent with current cognitive models of PTSD and the recommended use of trauma-related cognitive–behavioral therapy for individuals with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Rehabilitation Psychology - Vol 55, Iss 1