Poststroke Fatigue and Daily Activity Patterns During Outpatient Rehabilitation:An Experience Sampling Method Study

OBJECTIVE: To advance our understanding of poststroke fatigue by investigating its momentary and time-lagged relationship with daily activities.DESIGN: Longitudinal observational study using the experience sampling method (ESM).SETTING: Outpatient rehabilitation care.PARTICIPANTS: Thirty individuals with stroke (N=30).INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: ESM is a structured diary method that allows assessing real-time symptoms, behavior, and environment characteristics in the flow of daily life, thereby capturing moment-to-moment variations in fatigue and related factors. Using a mobile application, individuals with stroke were followed during 6 consecutive days, and were prompted at 10 random moments daily to fill in a digital questionnaire about their momentary fatigue and current activity: type of activity, perceived effort and enjoyment, and physical activity levels.RESULTS: Based on all completed digital questionnaires (N=1013), multilevel regression analyses showed that fatigue was significantly associated with type of activity and that fatigue was higher when participants had engaged in physical activity. Fatigue was also higher during activities perceived as more effortful and during less enjoyable activities. Time-lagged analyses showed that fatigue was also predicted by physical activity and perceived effort earlier during the day. Importantly, the relationship between these daily activity characteristics and fatigue differed substantially across individuals.CONCLUSIONS: This study illustrates the need for ESM to design personalized rehabilitation programs and to capture fatigue and other patient-reported outcomes in daily life.</p

Executive functions deficits impair extinction of generalization of fear of movement‐related pain

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background Generalization of fear of movement‐related pain across novel but similar movements can lead to fear responses to movements that are actually not associated with pain. The peak‐shift effect describes a phenomenon whereby particular novel movements elicit even greater fear responses than the original pain‐provoking movement (CS+), because they represent a more extreme version of the CS+. There is great variance in the propensity to generalize as well as the speed of extinction learning when these novel movements are not followed by pain. It can be argued that this variance may be associated with executive function capacity, as individuals may be unable to intentionally inhibit fear responses. This study examined whether executive function capacity contributes to generalization and extinction of generalization as well as peak‐shift of conditioned fear of movement‐related pain and expectancy. Methods Healthy participants performed a proprioceptive fear conditioning task. Executive function tests assessing updating, switching, and inhibition were used to predict changes in (extinction of) fear of movement‐related pain and pain expectancy generalization. Results Low inhibitory capacity was associated with slower extinction of generalized fear of movement‐related pain and pain expectancy. Evidence was found in favor of an area‐shift, rather than a peak‐shift effect, which implies that the peak conditioned fear response extended to, but did not shift to a novel stimulus. Conclusions Participants with low inhibitory capacity may have difficulties withholding fear responses, leading to a slower decrease of generalized fear over time. The findings may be relevant to inform treatments. Significance Low inhibitory capacity is not associated with slower generalization, but extinction of fear generalization. Fear elicited by a novel safe movement, situated outside the CS+/− continuum on the CS+ side, can be as strong as to the original stimulus predicting the pain‐onset

Related to Anxiety: Arbitrarily Applicable Relational Responding and Experimental Psychopathology Research on Fear and Avoidance

Humans have an unparalleled ability to engage in arbitrarily applicable relational responding (AARR). One of the consequences of this ability to spontaneously combine and relate events from the past, present, and future may, in fact, be a propensity to suffer. For instance, maladaptive fear and avoidance of remote or derived threats may actually perpetuate anxiety. In this narrative review, we consider contemporary AARR research on fear and avoidance as it relates to anxiety. We first describe laboratory-based research on the emergent spread of fear- and avoidance-eliciting functions in humans. Next, we consider the validity of AARR research on fear and avoidance and address the therapeutic implications of the work. Finally, we outline challenges and opportunities for a greater synthesis between behavior analysis research on AARR and experimental psychopathology

Generalization in psychopathology: The role of memory

Generalization on the basis of prior experience is a central feature of human and non-human behavior. Generalization occurs when a stimulus elicits a change in behavior due to prior experience of a regularity in the environment that did not involve that stimulus. Although adaptive in general, anomalies in generalization can give rise to a wide array of problems. For instance, elevated levels of generalization have been shown in individuals suffering from an anxiety disorder. In the first part of this dissertation, generalization is approached from a memory perspective. After a general introduction describing how different cognitive processes such as attention and memory may influence generalization (Chapter 1), we report on a study investigating generalization in relation to working memory (Chapter 2). In a community sample, we found that the extent of generalization was a function of individual differences in the capacity to filter out irrelevant information from access to working memory. In Chapter 3, generalization is investigated in relation to autobiographical memory specificity, referring to memory for personally experienced events. In a sample of individuals suffering from an anxiety disorder, we found that individuals who had difficulty reporting specific memories of personally experienced events showed impaired discrimination learning in a predictive learning task. No differences in generalization were found. Further, we used an experimental approach to memory and manipulated the retention interval between the encoding of a learning experience and the test of generalization in a face recognition paradigm (Chapter 4), and a fear generalization paradigm (Chapter 5). We did not find convincing evidence for changes in generalization over time in either of these studies. In the second part of this dissertation, we report on longitudinal studies that focus on the identification of premorbid markers of (risk for) psychopathology. In Chapter 6, we investigated the exact nature of the relationship between discrimination learning, generalization and anxiety symptomatology. Although both impaired discrimination learning and elevated levels of generalization have previously been shown in individuals suffering from clinical or subclinical anxiety, it remains largely unclear whether these learning abnormalities represent antecedents or consequences of pathological anxiety (vulnerability factors or diagnostic markers, respectively). In a six month longitudinal study, we found that impaired discrimination learning and elevated generalization predicted higher levels of self-reported anxiety at follow-up. The final study of this dissertation (Chapter 7) deals neither with generalization, nor with memory, but nevertheless fits nicely within our efforts to identify individuals at risk for psychopathology. More precisely, we report on a questionnaire on attentional control that we helped to develop, and discuss its capacity to predict changes in diurnal cortisol values after exposure to a prolonged psychosocial stressor. Disturbances in diurnal cortisol secretion in response to psychosocial stressors have been implicated in – and proposed as a risk factor for – several psychological disorders, including major depressive disorder, and anxiety disorders. We found that individuals who reported low attentional control in the presence of emotion at Time 1 exhibited elevated cortisol responding at Time 2, following academic examination. Finally, we end this dissertation with a general discussion of our findings, and discuss several research topics in a series of freestanding commentaries (Chapter 8).status: publishe

Fear generalization predicts post-traumatic stress symptoms:A two-year follow-up study in Dutch fire fighters

IntroductionExcessive fear generalization has been associated with pathological anxiety, including posttraumatic stress disorder (PTSD). However, studies investigating the longitudinal relationship between generalization and the development of anxiety symptomatology are scarce. This study aims to test the predictive value of fear generalization for PTSD symptoms in a high-risk profession sample and to explore the relationship between generalization and neuroticism, which are both linked to PTSD.MethodLongitudinal data from a multi-wave study in 529 Dutch fire-fighters were used. Fear generalization, PTSD symptoms and neuroticism were assessed at baseline. PTSD symptoms were reevaluated at six, 12, 18, and 24 months. Generalization was assessed in a differential conditioning paradigm by measuring expectancies of an aversive outcome when presented with stimuli similar to previously conditioned stimuli.ResultsHigher expectancy ratings towards stimuli most similar to safety signals predicted PTSD symptoms at follow-up after controlling for baseline PTSD symptoms, whereas higher expectancy ratings towards stimuli most similar to danger signals was associated with neuroticism. Neuroticism weakened the predictive power of fear generalization when considered simultaneously.DiscussionThese findings suggest that heightened fear generalization is associated with the development of anxiety and trauma-related symptoms. Targeting problematic fear generalization may be a promising intervention approach

Tired of pain or painfully tired? A reciprocal relationship between chronic pain and fatigue

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Transosseous ‘over the top’ reconstruction of capsule and tendons in primary total hip arthroplasty using a posterior approach.

Background: Dislocation after total hip arthroplasty (THA) remains a devastating complication and a primary cause for revision arthroplasty. Historical data indicate that a posterior approach is associated with a higher dislocation rate. In this study, we present a highly reliable and anatomical reconstruction, based on the biomechanical findings of a previous cadaveric experiment.  Description of Technique: The posterior soft tissues were repaired in 2 layers. First a reattachment of the posterior orbicular ligament is performed at the anterior capsule. Subsequently a transosseous ‘over the top’ reinsertion of both capsule and tendons is performed close to there anatomical insertion.  Patients and Methods: We prospectively collected data of 408 THAs from January 2004 until December 2013, through a posterior approach and with a capsule and tendon reconstruction based on a previous cadaveric study.  Results: There was a low early dislocation rate in primary THA (one of 408 THAs, 0,2%) and no complications related to the technique.  Conclusions: This anatomical reconstruction of both capsule and tendons is associated with a low dislocation rate without complications at the level of the greater trochanter