Association of Behavioral Self-Regulation with Concurrent Functional Capacity Among Stroke Rehabilitation Patients

Journal of Clinical Geropsychology - Tập 8 - Trang 25-33 - 2002
Jim Grigsby1, Kathryn Kaye1,2, Jacqueline Kowalsky1,3, Andrew M. Kramer1,3
1Department of Medicine, Division of Geriatrics, University of Colorado Health Sciences Center, Denver
2V.A. Medical Center, Denver, Colorado
3Center on Aging, University of Colorado Health Sciences Center, Denver

Tóm tắt

The purpose of this study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the executive cognitive capacity to use an intention to guide purposeful, goal-directed activity would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression, and general mental status, in a sample of 246 elderly inpatients receiving rehabilitation services following hospitalization for stroke. Functional status was assessed by rehabilitation nurses' ratings of patients on 11 ADL items and on the Barthel Index. The BDS was the strongest predictor for 11 of the 12 dependent variables. Although it correlated significantly with all outcomes, the MMSE entered only one of the regression models. Of the other covariates, only age and severity of pain made an additional contribution to the prediction of functional ability for more than 1 dependent variable. Consistent with prior results in several other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.

Tài liệu tham khảo

Alexander, G. E., and Crutcher, M. D. (1990). Functional architecture of basal ganglia circuits: Neural substrates of parallel processing. Trends Neurosci. 13: 26–271. Charlson, M. E., Pompei, P., Ales, K. L., and McKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 40: 373–383. Della Sala, S., Gray, C., Spinnler, H., and Trivelli, C. (1998). Frontal lobe functioning in man: The riddle revisited. Arch. Clin. Neuropsychol. 13: 663–682. Folstein, M. F., Folstein, S. W., and McHugh, P. R. (1975). “Mini Mental State”: A practical method of grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198. Fuster, J. M. (1997). The Prefrontal Cortex: Anatomy, Physiology, and Neuropsychology of the Frontal Lobe, 3rd edn., Lippincott-Raven, Philadelphia. Grigsby, J., Kaye, K., Baxter, J., Shetterly, S. M., and Hamman, R. F. (1998). Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study. J. Am. Geriatr. Soc. 46: 590–596. Grigsby, J., Kaye, K., Eilertsen, T. B., and Kramer, A.M. (2000). The Behavioral Dyscontrol Scale and functional status among elderly medical and surgical rehab patients. J. Clin. Geropsychol. 6: 259–268. Grigsby, J., Kaye, K., and Robbins, L. J. (1992). Reliabilities, norms, and factor structure of the Behavioral Dyscontrol Scale. Percept. Mot. Skills 74: 883–892. Grigsby, J., Kaye, K., Shetterly, S. M., Baxter, J., and Hamman, R. F. (2000). Prevalence of executive disorder among Hispanic and non-Hispanic elderly in the San Luis Valley Health and Aging Study [Abstract]. J. Int. Neuropsychol. Soc. 6: 111. Grigsby, J, Kramer, A. M., Eilertsen, T. B., and Kaye, K. (1999). Behavioral self-regulation and functional capacity among geriatric hip fracture rehabilitation patients. J. Int. Neuropsychol. Soc. 5: 115. Grigsby, J., Kravcisin, N., Ayarbe, S. D., and Busenbark, D. (1993). Prediction of deficits in behavioral selfregulation among persons with multiple sclerosis. Arch. Phys. Med. Rehabil. 74: 1350–1353. Kaye, K., Grigsby, J., Robbins, L. J., and Korzun, B. (1990). Prediction of independent functioning and behavior problems in geriatric patients. J. Am. Geriatr. Soc. 38: 1304–1310. Luria, A. R. (1966). Human Brain and Psychological Processes, Harper and Row, New York. Luria, A. R. (1980). Higher Cortical Functions in Man, 2nd edn., Basic Books, New York. Mahoney, F. I., and Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Med. J. 14: 61–65. McCarthy, R. A., and Warrington, E. K. (1990). Cognitive Neuropsychology, Academic Press, London. Middleton, F. A., and Strick, P. L. (1997). New concepts about the organization of basal ganglia output. In Obeso, J. A., DeLong, M. R., Ohye, C., and Marsden, C. D. (eds.), The Basal Ganglia and New Surgical Approaches for Parkinson's Disease, Advances in Neurology, Vol. 74, Lippincott-Raven, Philadelphia, pp. 57–68. Prigitano, G. P., and Schachter, D. L. (1991). Awareness of Deficit After Brain Injury, Oxford University Press, New York. Roland, P. E. (1984). Metabolic measurements of the working frontal cortex in man. Trends Neurosci. 7: 430–435. Scarnati, E., and Florio, T. (1997). The pedunculopontine nucleus and related structures: Functional organization. In Obeso, J. A., DeLong, M. R., Ohye, C., and Marsden, C. D. (eds.), The Basal Ganglia and New Surgical Approaches for Parkinson's Disease, Advances in Neurology, Vol. 74, Lippincott-Raven, Philadelphia, pp. 97–110. Shallice, T., and Evans, M. E. (1978). The involvement of the frontal lobes in cognitive estimation. Cortex 14: 294–303. Stroke, Behavioral Dyscontrol, and Functional Capacity 33 Sheikh, J. I., and Yesavage, J. A. (1986). Geriatric Depression Scale: Recent evidence and development of a shorter version. In Brink, T. (ed.), Clinical Gerontology: A Guide to Assessment and Intervention, Haworth, New York, pp. 165–173. Stuss, D. T., and Benson, D. F. (1986). The Frontal Lobes, Raven Press, New York. Suchy, Y., Blint, A., and Osmon, D. C. (1997). Behavioral Dyscontrol Scale: Criterion and predictive validity in an inpatient rehabilitation unit population. Clin. Neuropsychol. 11: 258–265.