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.
Methods
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 non-essential targets and discriminating figure-ground details.
Results
The PST group showed faster motoric and non-motoric 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 co-morbidity and mitigating a risk factor for psychosis.
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°, 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 Ͻ 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.
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.
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