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PubMed2006

Stage-specific effects of an action control intervention on dental flossing.

Health behavior interventions may have different effects when targeting individuals at different stages of change. A 'motivation' stage, during which intentions are formed, has been distinguished from a 'volition' stage, implying that the latter requires self-regulatory effort in implementing and maintaining behavior. To test this stage assumption, an action control intervention (self-monitoring tool for dental flossing) matched to the volition stage and mismatched to the motivation stage was provided to 151 university students, with follow-up measures of action control and flossing after 2 and 6 weeks. Separate regression analyses for motivational and volitional participants indicated that only volitional participants benefited from the volitional intervention. This supports the usefulness of stage assumptions and the advantage of tailoring interventions to participants who reside either in the motivational or in the volitional stage.

Adolescent↗
PubMed1991

A prospective comparison of four insanity defense standards.

OBJECTIVE: Controversy about the formulation of the insanity defense has been intense, but little empirical work is available regarding how different standards affect court findings. The major aims of the present study were to determine if different standards for determining insanity produced different judgments and to provide a broad descriptive picture of those cases in which the standards appeared to make a difference. METHOD: Four forensic psychiatrists were asked to indicate whether they thought 164 defendants met any or all of four insanity tests: 1) the American Law Institute (ALI) cognitive criterion, 2) the ALI volitional criterion, 3) the APA test, and 4) the M'Naghten rule. RESULTS: The four psychiatrists determined that 97.5% of the defendants met the ALI volitional criterion, 73.9% met the APA criterion, 70.3% met the M'Naghten rule, and 69.5% met the ALI cognitive criterion. Nearly two-thirds of the defendants met all four insanity tests, and 24.4% met only the ALI volitional test. Few defendants met cognitive tests without also meeting the ALI volitional test. Elimination of the volitional test for insanity reduced the rate of psychiatric recommendations of acquittal by 24.4%. CONCLUSIONS: These findings highlight the fact that the primary logical division between volitional and cognitive standards appears to be powerful but that distinctions between types of cognitive standards are not terribly powerful. In addition, the variation among individual raters must be viewed as an important determinant of how any insanity standard is applied.

Adolescent↗
PubMed1996

Spinal cord injury and bladder recovery.

OBJECTIVE: To investigate whether spinothalamic tract preservation and posterior column sparing are predictors of neurogenic recovery of bladder function after spinal cord injury (SCI). DESIGNS AND PARTICIPANTS: In a retrospective review, the initial perianal pinprick sensation (S4.5 dermatomes) and position sense of the great toes were examined and correlated with bladder function at 1 year after SCI in 19 consecutive spinal cord injured patients (age 18 to 68 years), Frankel A-D, with spinal injury (level C-4-T-12). All patients were admitted to the Regional Spinal Cord Injury Center of Delaware Valley (RSCIDDV) within 72 hours of injury between July 1990 and June 1991 and were available for a 1-year follow-up evaluation. MAIN OUTCOME MEASURES: The correlation of initial perianal pinprick and great toe position sensation with bladder management approximately 1 year after SCI. RESULTS: During the initial 72 hours, 10 of the 19 patients had positive perianal pinprick sensation and 9 did not feel the pin. Eight patients had positive great toe position sense, and 11 had no proprioception. At the 1-year follow-up visit, 7 of the 10 patients with initial preserved perianal pinprick were voiding volitionally, whereas none of the 9 patients who did not have pinprick voided volitionally at 1-year after SCI. Six of the 8 with initial preserved great toe position sense were voiding volitionally at 1 year, but only 1 of the original 11 without initial toe position sense was voiding volitionally. CONCLUSIONS: Both perianal pinprick sensation and toe position sense are sensitive in predicting return of bladder function. Although both tests have positive predictive value, their negative predictive values are much more noteworthy. A patient without initial position sense of the great toes will likely not regain volitional voiding, whereas a patient without initial perianal pinprick sensation will definitely not regain volitional voiding.

Adolescent↗
PubMed2006

The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty.

STUDY DESIGN: Case report. BACKGROUND: Long-term deficits in quadriceps femoris muscle strength and impaired muscle activation are common among individuals with total knee arthroplasty (TKA). Failure to address strength-related impairments results in poor surgical and functional outcomes, which may accelerate the progression of osteoarthritis in other lower extremity joints. The purpose of the current case report was to implement a neuromuscular electrical stimulation (NMES) treatment protocol in conjunction with an intense weight-training program, with the aim of reversing persistent quadriceps muscle impairments after TKA. CASE DESCRIPTION: The patient was a 62-year-old male cyclist 12 months following simultaneous, bilateral TKA with impairments in left quadriceps strength and volitional muscle activation. His left quadriceps strength was 26% weaker than his right and central activation ratio (CAR) of his left quadriceps was 13% lower than his right quadriceps CAR. NMES to the left quadriceps was implemented for 6 weeks, in addition to an intense volitional weight-training program with emphasis on unilateral lower extremity exercises. OUTCOMES: The patient demonstrated a 25% improvement in left quadriceps femoris maximal volitional force output following 16 treatments of combined NMES and volitional strength training over a 6-week period. The patient's volitional muscle activation improved from a CAR of 0.83 before treatment to 0.97 after treatment. At discharge from physical therapy and at his 18-month postoperative follow-up, the patient's left quadriceps strength was only 4% lower than his right quadriceps strength. At the 24-month follow-up, the patient's left quadriceps strength was 6% stronger than his right quadriceps strength. DISCUSSION: The patient was able to achieve symmetrical quadriceps strength and complete muscle activation following 6 weeks of NMES and volitional strength training. An intense strengthening program may have the potential to reverse persistent strength-related impairments following TKA.

Arthroplasty, Replacement, Knee↗
PubMed1993

The relationship between insight and control in obsessive-compulsive disorder: implications for the insanity defense.

In this paper the authors examine the relationship between insight and control in patients with obsessive-compulsive disorder (OCD) in an effort to better understand the concept of volitional control of behavior especially as it relates to changes in the insanity defense that were recommended by the American Psychiatric Association (APA), specifically that the volitional prong be dropped. Yale-Brown Obsessive Compulsive Scale ratings in 56 subjects with OCD were reviewed with specific attention to items measuring the patients' subjective sense of decreased volitional control over their compulsions and their insight into their behavior. No statistically significant correlation was found between the control over compulsions item and the insight item. The authors conclude that the experience of volitional control in patients with OCD is not significantly related to the level of insight they have into the irrationality of their behavior. The authors then review cognitive therapy literature and show that though cognition and volition may appear to be dissociated in some disorders, even in the absence of insight, a relatively gross measure of legally relevant cognitive disturbance, subtle cognitive changes can be identified in patients with seemingly purely volitional disorders such as OCD.

Adult↗
PubMed1994

The will of the brain: cerebral correlates of willful acts.

Current imaging techniques can depict physiological events in the brain which accompany sensory perception and motor activity, as well as cognition and speech. "Pure" mental events unaccompanied by sensory input or motor/behavioral output also induces cerebral functional changes which apparently are related to inner representations of thoughts, ideas, visions, inner speech and so forth. Cerebral events during cognition, mental effort, imagined volitional acts, augment the activity in the prefrontal cortex. An augmentation in the cerebellum is also recorded. It is known that temporally organized (sequential) neuronal activity takes place in these structures. The prefrontal activation accompanying volitional acts most likely corresponds to a willful mobilization of inner representations of future events. These representations serve as action programs for the achievement of the goal. Phylogenetically older parts of the cerebral cortex close to the midline (the cingulate gyrus) participate in willful acts. They are possibly involved in emotional/motivational ("value") aspects of volition. Abnormal volition ("sick will") is encountered in organic dementia, Parkinson's disease, depression, and schizophrenia. Such disorders are characterized by inactivity, lack of ambitions, and a reduced motor and verbal output. Patients in these groups often show a decreased activity in prefrontal regions. Individuals with supraorbital and mesial frontal lesions may develop a so-called psychopathic behavior including abnormalities of volition with lack of impulse control, boredom susceptibility, sensation-seeking behavior, and abnormal risk taking. Knowledge about cerebral events coupled to willful acts may shed some light on the "collective will" expressed by groups of individuals and organizations.

Brain↗
PubMed2006

Respiratory muscle testing: a valuable tool for children with neuromuscular disorders.

RATIONALE: Data on respiratory muscle performance in children with neuromuscular disorders are limited. OBJECTIVES: The aim of this study was to assess respiratory muscle strength by volitional and nonvolitional tests and to compare these tests with forced vital capacity. METHODS: Inspiratory muscle strength was assessed by measuring transdiaphragmatic and esophageal pressures generated during volitional and nonvolitional maneuvers, whereas expiratory muscle strength was assessed by measuring the gastric pressure generated during a cough maneuver. Lung volumes were assessed by measuring forced vital capacity. MEASUREMENTS AND MAIN RESULTS: Forty-one patients with Duchenne muscular dystrophy (n = 20), spinal amyotrophy (n = 8), and congenital myopathy (n = 13) were included, aged 2 to 18 yr. All the patients were able to perform the sniff and the cough maneuver. Sniff transdiaphragmatic pressure decreased with age in Duchenne patients, whereas it increased with age in patients with spinal amyotrophy and congenital myopathy. Magnetic stimulation of the phrenic nerves was obtained in all patients. Twenty-five (61%) patients were able to perform forced vital capacity. In the three groups of patients, a positive correlation was observed between volitional, assessed by the sniff maneuver, and nonvolitional respiratory muscle tests, assessed by the magnetic stimulation of the phrenic nerves. Also, forced vital capacity correlated with sniff transdiaphragmatic pressure and cough gastric pressure. CONCLUSIONS: Volitional respiratory muscle tests correlated with nonvolitional tests and with forced vital capacity. Simple volitional respiratory muscle tests constitute a valuable tool for the assessment of respiratory muscle strength in young patients with neuromuscular disorders.

Adolescent↗
PubMed1986

Effect of body posture and common hand tools on peak torque exertion capabilities.

An experimental investigation was conducted to investigate the effects of body posture and of different types of common non-powered hand tools on maximum volitional torque exertion capabilities of males and females. Thirty-six males and 14 females applied peak torque in 21 different body postures while using nine different hand tools. The data analysis indicated that, for both males and females, the magnitude of volitional torque is strongly influenced by the type of tool used and the posture assumed. Between the two, however, the effect of hand tool is more profound. The correlation between the tool type and volitional torque was of the order of 0.71. No other variable was as strongly correlated with volitional torque. Maximum volitional torque profiles, as a function of posture and tool type, are provided for males and females.

Journal Article↗
PubMed2001

Cognitive theory and illness behavior in disability syndromes.

There are many controversial disability syndromes, representing medicolegal and social dilemmas for a variety of medical disciplines. While illness behavior and sick role phenomena are often invoked to explain many of these syndromes, the extent to which such phenomena are under volitional control has not been thoroughly explored. The volitional control of illness behavior has important treatment implications, and may explain why cognitive therapy can be effective in these patients. Further understanding of the relevance of cognitive theory to illness behavior, the sick role, secondary gain, and disability may render even more effective cognitive therapy approaches. This review explores the consciousness states, the role of each state in information processing (in this case processing illness information), the automaticity and hence volitional state of each level of information processing, and the likelihood that illness behavior in disability syndromes is volitional. The cognitive model of these syndromes considers the interaction of automaticity, volition, and illness behavior and likely has numerous clinical, social, and legal applications.

Cognition↗
PubMed1994

Diaphragmatic movement in hemiplegic patients measured by ultrasonography.

BACKGROUND: It is known that automatic breathing is controlled by centres in the lower brain stem, whereas volitional breathing is controlled by the cerebral cortical centres. In hemiplegia, lesions above the brain stem result in paralysis of limb muscles. This study was performed to determine whether the diaphragm might also be affected in patients with hemiplegia. METHODS: Studies were performed in six normal control subjects and in eight patients with complete hemiplegia caused by a lesion above the brain stem, all with no known chest disease. Full lung function tests were performed. Diaphragmatic excursion and inspired volume (VT) were measured simultaneously by M mode ultrasonography and respiratory airflow measurements. Recordings of diaphragmatic excursion were performed on each side separately during volitional and automatic breathing at a similar range of VT. RESULTS: Lung function tests lay within the normal range in all the control subjects. In the hemiplegic patients mean (SD) vital capacity was 79 (18)% and residual volume was 123(30)% of predicted. Total lung capacity and functional residual capacity were in the normal range. In the control subjects no significant difference in diaphragmatic excursion was found between volitional and automatic breathing for the same range of inspired volume. By contrast, there was a significant decrease in diaphragmatic excursion during volitional breathing compared with automatic breathing on the affected side in four of the eight hemiplegic patients. CONCLUSIONS: In four of eight hemiplegic patients reduced diaphragmatic movement was present on the paralysed side during volitional inspiration when compared with automatic inspiration. The hemidiaphragm may be involved on the affected side in patients with hemiplegia.

Aged↗
PubMed2005

The influence of virtual reality play on children's motivation.

PURPOSE: This study explored the degree of motivation children exhibit during virtual reality (VR) play sessions. METHOD: Sixteen children with cerebral palsy aged 8 to 12 years participated. They were observed during a variety of VR environments that were video recorded. The Pediatric Volitional Questionnaire (PVQ) was used to measure children's motivation. The PVQ provides insights into children's inner motives as well as how the virtual environment enhances or attenuates children's motives. Nine VR environments were randomly selected to score with the PVQ. RESULTS: Data were analyzed and descriptive statistics were calculated for modes and medians of total volition scores for each VR environment. Different environments produced varying levels of volitional behaviour. The features of environments that produced higher levels of volition included challenge, variability and competition. PRACTICE IMPLICATIONS: The overall volitional scores of children with cerebral palsy in the current study indicate that VR play is a motivating activity and thus has potential as a successful intervention tool.

Cerebral Palsy↗
PubMed2005

Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials.

Devices for neuromuscular electrical stimulation (NMES) are increasingly used by individuals without specific injuries and are standard equipment in most physical therapy practices. The most often stimulated muscle group is the quadriceps femoris. We designed a systematic review and meta-analysis of randomised controlled trials to determine whether NMES is an effective modality for strength augmentation of the quadriceps femoris. A full content search for randomised controlled trials was performed in Medline, Embase, Cinahl, the Cochrane Controlled Trials Register and the Physical Therapy Evidence Database. Maximum volitional isometric or isokinetic muscle torque in Nm was used as main outcome measure.Thirty-five trials were included and evaluated. A fundamental distinction was made between the trials using subjects with unimpaired quadriceps femoris muscles and the trials using post-injury or post-operative subjects. In the unimpaired quadriceps subgroup, meta-analyses were performed for the comparisons 'NMES versus no exercises' and 'NMES versus volitional exercises'. All other comparisons were evaluated descriptively. The included trials were generally of poor quality and meta-analytic data indicate that publication bias may be present. The evaluated data suggest that, both for the unimpaired and impaired quadriceps, NMES makes sense compared with doing no exercises but volitional exercises appear to be more effective in most situations.Based on the available evidence, NMES may only be preferred over volitional training for within-cast muscle training and perhaps in specific situations where volitional training does not receive sufficient patient compliance. Further research should be directed toward identifying the clinical impact at activity and participation levels and the optimal stimulation parameters of this modality.

Electric Stimulation↗
PubMed2004

Self-regulation and recovery: approaching an understanding of the process of recovery from stress.

Stress has been studied extensively in psychology. Only recently, however, has research started to address the question of how individuals manage to recover from stress. Recovery from stress is analyzed as a process of self-regulation. Several individual difference variables which affect the efficiency of self-regulation have been integrated into a structured model of the recovery process. Such variables are action versus state orientation (a tendency to ruminate, e.g., about a past experience) and volitional components, such as self-determination, self-motivation, emotion control, rumination, and self-discipline. Some of these components are assumed to promote recovery from stress, whereas others are assumed to further the perseverance of stress. The model was supported by the empirical findings of three independent studies (Study 1, N=58; Study 2, N=221; Study 3, N= 105). Kuhl's Action Control Scale measured action versus state orientation. Volitional components were assessed with Kuhl and Fuhrmann's Volitional Components Questionnaire. The amounts of experienced stress and recovery from stress was assessed with Kellmann and Kallus's Recovery-Stress Questionnaire. As hypothesized in the model, the disposition towards action versus state orientation was a more distant determinant of the recovery from stress and perseverance of stress. The volitional components are more proximal determinants in the recovery process. Action orientation promotes recovery from stress via adequate volitional skills, e.g., self-determination, self-motivation, emotion control, whereas state orientation furthers a perseverance of stress through rumination and self-discipline.

Adaptation, Psychological↗
PubMed2005

Motor control in patients with incomplete spinal cord injuries and various voluntary movement capabilities.

BACKGROUND: In this study, we attempted to verify the hypothesis that further improvements in volitional movement of patients with a spinal cord injury would diminish and ultimately suppress the segmental responses, while enhancing the supraspinal inhibitory influence. METHODS: Eleven patients with an incomplete spinal cord injury and partial preservation of motor function (ASIS grades C and D) were recruited. Their lower limbs were evaluated using polyelectromyography (PEMG) during voluntary movements, reinforcement maneuvers, tonic vibratory reflex, passive stretch reflex, irradiation of the passive stretch reflex (PSRirrad), and plantar reflex suppression. RESULTS: The reinforcement maneuver response, tonic vibratory response, passive stretch reflex, and PSRirrad were most active in limbs with partially preserved volitional movement, but for which patients were still incapable of lifting their heel off the examination table. In contrast, plantar reflex suppression was strongest in limbs with partially preserved volitional movement, for which patients were capable of lifting the heel off the examination table. CONCLUSIONS: Supraspinal inhibitory effects were most active in those limbs which were capable of lifting the heel off the examination table, compared to limbs with partially preserved volitional activity but without visible movement or which were incapable of lifting the heel off the examination table. The capability for volitional activity paralleled the supraspinal inhibitory effects.

Adult↗
PubMed1991

Electrical stimulation of the thigh muscles after reconstruction of the anterior cruciate ligament. Effects of electrically elicited contraction of the quadriceps femoris and hamstring muscles on gait and on strength of the thigh muscles.

The effects of neuromuscular electrical stimulation on the strength of the thigh muscles and on gait were examined in ten patients after reconstruction of the anterior cruciate ligament. The patients were randomly assigned to one of two treatment groups: neuromuscular electrical stimulation and volitional exercise, or volitional exercise alone. A four-week course of electrically elicited co-contraction of the thigh muscles resulted in significant attenuation of the characteristic loss of strength of the quadriceps as compared with volitional exercise. There was no significant difference between groups in any measure of performance of the hamstring muscles. In the group that received neuromuscular electrical stimulation, the values for cadence, walking velocity, stance time of the involved limb, and flexion-excursion of the knee during stance were significantly different from those of the volitional exercise group. Flexion-excursion of the knee during stance was directly and significantly correlated with strength of the quadriceps femoris muscle. Flexion of the knee during stance was qualitatively different in the involved extremity as compared with the uninvolved extremity in all patients. There is a rapid flexion of the knee at weight acceptance that is maintained throughout stance and probably reflects stabilization of the joint by muscular coactivation to compensate for weakness of the quadriceps. The patients who received neuromuscular electrical stimulation had stronger quadriceps muscles and more normal gait patterns than those in the volitional exercise group.

Adolescent↗
PubMed1994

Dose dependency of perceived breathlessness on hypoventilation during exercise in normal subjects.

To determine whether a dose-dependent relationship exists between the subjective sensation of breathlessness and hypoventilation during steady-state exercise, we measured breathlessness at six levels of volitionally suppressed ventilation. To achieve this, subjects targeted their breathing at 0, 5, 10, 15, 20, and 25% below their spontaneous exercise level. All 12 subjects were successful in hypoventilating in a graded manner. However, in general, the degree of hypoventilation achieved was less than that of the target level set; this discrepancy was greatest at the higher target levels. Volitional hypoventilation at target levels of > or = 10% caused significant decreases in ventilation and significant increases in end-tidal PCO2. All levels of volitional hypoventilation caused increased ratings of breathlessness, reaching statistical significance at a set target level of 15%. Significant increases in breathlessness intensity were associated with increases in end-tidal PCO2 of 2-3 Torr. We conclude that, during steady-state exercise, there appears to be a dose-dependent relationship between breathlessness and volitionally induced inappropriately low ventilation. The need to minimize such subjective sensations of breathlessness may play a role in the increased ventilation observed during exercise.

Adult↗
PubMed2005

Cortical and subcortical brain effects of transcranial magnetic stimulation (TMS)-induced movement: an interleaved TMS/functional magnetic resonance imaging study.

BACKGROUND: To date, interleaved transcranial magnetic stimulation and functional magnetic resonance imaging (TMS/fMRI) studies of motor activation have not recorded whole brain patterns. We hypothesized that TMS would activate known motor circuitry with some additional regions plus some areas dropping out. METHODS: We used interleaved TMS/fMRI (11 subjects, three scans each) to elucidate whole brain activation patterns from 1-Hz TMS over left primary motor cortex. RESULTS: Both TMS (110% motor threshold) and volitional movement of the same muscles excited by TMS caused blood oxygen level-dependent (BOLD) patterns encompassing known motor circuitry. Additional activation was observed bilaterally in superior temporal auditory areas. Decreases in BOLD signal with unexpected post-task "rebounds" were observed for both tasks in the right motor area, right superior parietal lobe, and in occipital regions. Paired t test of parametric contrast maps failed to detect significant differences between TMS- and volition-induced effects. Differences were detectable, however, in primary data time-intensity profiles. CONCLUSIONS: Using this interleaved TMS/fMRI technique, TMS over primary motor cortex produces a whole brain pattern of BOLD activation similar to known motor circuitry, without detectable differences from mimicked volitional movement. Some differences may exist between time courses of BOLD intensity during TMS circuit activation and volitional circuit activation.

Adult↗
PubMed2003

Evaluation of three interventions to promote workplace health and safety: evidence for the utility of implementation intentions.

This article evaluates a motivational intervention based on the theory of planned behavior, a volitional intervention based on implementation intentions, and a combined motivational plus volitional intervention in promoting attendance at workplace health and safety training courses in the UK. Intervention manipulations were embedded in postal questionnaires completed by participants (N=271). Subsequent attendance over a 3-month period was determined from course records. Findings showed that the volitional and combined interventions doubled the rate of attendance compared to the motivational and control conditions (rates were 39%, 32%, 12%, and 16%, respectively). The effects of the volitional intervention were independent of the effects of previous attendance, demographic variables, employment characteristics, and variables from the theory of planned behavior.

Adult↗