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At least 811 records · Page 45Linked to original sources
PubMed2005

Auditory steady-state responses (ASSR): effects of modulation and carrier frequencies.

Presented are results relevant to extending the utility of the auditory steady-state response (ASSR) in threshold estimation at high-frequency carriers and to the accuracy of thresholds estimated using modulation frequencies near 40 versus 80 Hz. Initially, efforts were directed at confirming various findings reported in the literature apropos effects of several basic ASSR parameters. Results supplement others' observations suggesting that ASSR detection limits overestimate behavioral thresholds for conventional audiometric (carrier) frequencies from 500 to 4000 Hz. Further investigation revealed even greater errors of threshold estimates for 8000 and 12000 Hz, by about 14 and 22 dB on average, respectively. Although suggesting high-frequency ASSR testing to be efficacious, technical advances and additional work is needed to establish clinical utility. Comparison of effects of modulation frequency suggested ASSR thresholds with 40 Hz modulation to fall closer to behavioral threshold than those estimated at 80 Hz. Consequently, when circumstances permit, 40 Hz ASSR testing may be the method of choice (e.g. in the assessment of malingers, who may be tested awake/alert).

Adolescent↗
PubMed2004

The economics of telerehabilitation.

This paper is an analysis of the economics of physical telerehabilitation, at home, in the clinic, and at work. This study was a precursor to generating a business case for manufacturing telerehabilitation systems. Pilot studies were performed and structured interviews conducted with providers, payers, patients, and employers. The data obtained were analyzed, in conjunction with published data, to understand the economics with respect to parameters such as lost opportunity costs at work, faster rehabilitation, and cost savings to patients, providers, payers, and employers. The results showed that telerehabilitation has a positive business case with respect to all the stakeholders. The ability to quantify and analyze data from patients remotely is convenient and economical to providers. Patients benefit by getting back to their normal activities faster, both at home as well as work. Telerehabilitation at work allows employees to be treated at work without having to take time to go to a clinic. Lost opportunity costs for employers are minimized when workers return to work faster and are treated onsite. The ability to measure progress quantitatively is beneficial for patients, providers, payers, and employers. Additionally, malingering can be detected and eradicated using telerehabilitation. Proper application of appropriate telerehabilitation technologies makes eminent economical sense. There is a strong business case for the application of telerehabilitation, onsite, in large corporations and therefore is profitable to medical device manufacturers.

California↗
PubMed1996

Ethical assumptions and ambiguities in the Americans With Disabilities Act.

The Americans With Disabilities Act (ADA) promotes social justice by protecting disabled persons from discrimination and prejudice. It seeks equality of opportunity for them and protects their well being by giving them fair access to goods, services and benefits. These rights are circumscribed in the ADA, however, by constraints of cost, efficiency, utility, and certain social mores. The ADA offers little direction about how to set priorities when these values come into conflict, or about whether equality or opportunity favors equivalent or preferential treatment for disadvantaged people. Until these ambiguities and potential value conflicts are resolved, a central moral and social problem remains unresolved: How can we demonstrate commitment to the rights and welfare of those with severe disabilities while placing fair limits upon their claims? Five special concerns are discussed: (1) eligibility and the allocation of health care; (2) the meaning of 'qualified but disabled' in employing people with mental disabilities; (3) equal opportunity and problems of envy and malingering; (4) ADA accommodation and public protection through testing and licensure; and (5) ADA protection and problems of backlash. Rather than simply wait to see what courts and administrative agencies decide, we should evaluate the moral conflicts, articulate criteria, and help make some difficult choices on morally defensible grounds.

Beneficence↗
PubMed1997

Screening for psychological factors in patients with low back problems: Waddell's nonorganic signs.

The role of Waddell's nonorganic signs test as a screening tool for psychological factors in the examination of patients with low back problems has been described. The presence of nonorganic signs should alert the physical therapist to the need for additional psychological tests and should not necessarily be considered an indicator of malingering. Nonorganic signs may coexist with organic findings. An illness behavior role of the nonorganic signs is suggested, as they have been related with disability in addition to physical impairments. Physical therapy management for these patients should focus on treatment of illness behavior and on combating disability.

Humans↗
PubMedDate not supplied

The problem of pain.

Pain problems, especially posttraumatic headache, are very common following head trauma. Pain may be the most significant problem, more disabling than any brain or other injuries, and interfering with aspects of cognition or other function. However, posttraumatic headache and most other chronic posttraumatic pain problems remain poorly understood. This article reviews fundamental issues that should be considered in understanding the nature of chronic pain including the distinction between acute and chronic pain; neurobiological distinctions between the lateral and medial pain system; nociceptive versus neuropathic or other central pain; sensitization effects; the widely accepted view of chronic pain as a multidimensional subjective experience involving sensory, motivational-affective and cognitive-behavioral components; the problem of mind-body dualism; the role of psychosocial factors in the onset, maintenance, exacerbation or severity of pain; plus issues of response bias and malingering.

Brain Injuries↗
PubMed1997

Rheumatic manifestations of neurologic and psychiatric diseases.

Rheumatic diseases have not proved to be more prevalent among neurologic or psychiatric patients than in the general population, except for osteoarthritis in some chronic disabling neurologic conditions (poliomyelitis, spinal cord injury). Some neurologic entities with relevant musculoskeletal manifestations are described here. The lower prevalence of rheumatoid arthritis in schizophrenia patients is mentioned, and a brief description is presented of somatoform disorders that may confound diagnosis with rheumatic diseases. Factitious disorders and malingering are frequently presented with rheumatic complaints such as low back pain and may have an important impact on the costs associated with the disease. Finally, some of the immune system abnormalities described in major depression and schizophrenia are mentioned with a clear reference to the growing field of psychoneuroimmunology. This paper will not address the issue of neurologic or psychiatric manifestations of rheumatic diseases.

Arthritis, Rheumatoid↗
PubMed1997

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Epidemiologic studies report the prevalence of low back pain to vary from 7.6% to 37% in different populations. Genetic factors play an important role in the development of back pain and intervertebral disk degeneration in adults. An animal model of spinal fusion using osteoinductive growth factors has important implications for surgical spinal fusions in humans. Physical findings have significance in identifying patients with radiculopathy, spinal stenosis, and malingering. Magnetic resonance imaging differentiates metastatic spinal fractures from osteoporotic lesions. Clinical entities reviewed in the literature this year include herniated intervertebral disk-associated radiculopathy, facet joint syndrome, back pain during pregnancy, and spontaneous infectious diskitis. Primary care physicians do not follow published guidelines for treatment of low back pain. Surgical decompression of spinal stenosis is most successful for patients with severe disease.

Adult↗
PubMed1997

Compensation neurosis: financial reward for illness as nocebo.

Results of medical treatment are notoriously poor in patients with pending litigation after personal injury or disability claims, and for those covered by workers' compensation programs. Although some instances of overt malingering are documented by surveillance videos, most exaggerated illness behavior in compensation situations takes place because of a combination of suggestion, somatization, and rationalization. A distorted sense of justice, victim status, and entitlement may further the exaggerated sick role. Adversarial administrative and legal systems challenging the claimant to prove repeatedly he or she is permanently ill harden the conviction of illness and the individual's defense of the claim. Unfortunately, after advocating for one's injury before a sometimes doubting public for the several years required to resolve such claims, care eliciting behavior too often remains permanent. Because any improvement in the claimant's health condition may result in denial of disability status in the future, the claimant is compelled to guard against getting well and is left with no honorable way to recover from illness. Financial reward for illness thus functions as a powerful nocebo, a nonspecific force creating and exacerbating illness. Solutions require recognition that judging disability and work incapacity in others is an unscientific process and that adversarial systems rewarding permanent illness or injury, particularly self reported pain, are often permanently harmful. The remainder of the solution must be political.

Disability Evaluation↗
PubMed1990

Duodenal ulcer in sickle cell anemia.

A 14-year-old black male with sickle cell anemia developed a duodenal ulcer that masqueraded as sickle cell-related abdominal pain crisis on multiple occasions. Malingering and poor therapeutic compliance aggravated the ulcer in this patient, who ultimately succumbed to a catastrophic bleed. Duodenal ulcer appears to be an infrequent but difficult to treat lesion in sickle cell disease. An in-depth review on the occurrence of duodenal ulcer in sickle cell anemia is presented. The etiological mechanisms of peptic ulcer disease in this population and the potential benefits of transfusion therapy are discussed.

Abdominal Pain↗
PubMed1997

A classification scheme for paradoxical vocal cord motion.

Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1. brainstem compression; 2. cortical or upper motor neuron injury; 3. nuclear or lower motor neuron injury; 4. movement disorder; 5. gastroesophageal reflux; 6. factitious or malingering disorder; 7. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well-directed diagnostic evaluation and treatment.

Adolescent↗
PubMed1976

New design principles for visual acuity letter charts.

This paper intoduces new principles for the design and use of letter charts for the measurement of visual acuity. It is advocated that the test task should be essentially the same at each size level on the chart. Such standardization of the test task requires the use of letters of equal legibility, the same number of letters on each row, and uniform between-letter and between-row spacing. It is also advocated that, combined with the test task standardization, there should be a logarithmic progression of letter size. Charts incorporating these design features have been made. These charts facilitate the use of nonstandard testing distances which might be used when there is low visual acuity, when examination room layout prevents testing at the standard distance, or when it is necessary to validate visual acuity scores or detect malingering. Adjusting the visual acuity score according to the chosen testing distance is simplified by the use of logarithmic scaling.

Humans↗
PubMed2001

Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study.

STUDY DESIGN: The efficacy of radiofrequency medial branch neurotomy to treat cervical zygapophysial joint pain from whiplash was compared prospectively in litigants and nonlitigants. OBJECTIVES: 1) To assess the effect of monetary gain on treatment of zygapophysial joint pain in cervical whiplash. 2) To determine whether radiofrequency medial branch neurotomy is effective treatment for whiplash. SUMMARY OF BACKGROUND DATA: The influence of litigation on treatment outcome is a subject of controversy in both the medical and legal professions. This is the first study to examine this issue in a prospective manner using a previously proven diagnostic and therapeutic method. METHODS: Sixty patients with cervical whiplash who remained symptomatic after 20 weeks of conservative management were referred for radiofrequency cervical medial neurotomy. The patients were classified as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed. Each group underwent identical evaluation and treatment. Patients were observed for 1 year. Visual analogue scores and self-reported improvement were obtained before, immediately after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS: Forty-six patients completed the study. The overall reduction in cervical whiplash symptoms and visual analogue pain scores were significant immediately after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1 year (nonlitigants vs. litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up scores were higher than immediate post-treatment scores (nonlitigants vs. litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in the degree of symptomatology or response to treatment did not reach significance. CONCLUSIONS: These results demonstrate that the potential for secondary gain in patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment. These data contradict the common notion that litigation promotes malingering. This study also confirms the efficacy of radiofrequency medial branch neurotomy in the treatment of traumatic cervical facet arthropathy.

Accidents, Traffic↗
PubMed2006

Is pain ever "normal"?

This article analyzes the Pain Terminology adopted by the International Association for the Study of Pain (IASP), noting that most of their pain categories are defined in terms of a reference standard of "normal" pain. Given the lack of any officially adopted operational definition of the word "normal," we argue that the use of this word expresses and maintains a paradigm that drives many clinicians' reasoning about their patients' pain. We offer evidence that this uninterrogated paradigm is being tacitly used to differentiate legitimate pain reports from malingering and drug seeking. We consider this unsubstantiated "folk" sense of "normal" in light of evidence-based, rationalized prototypes based on statistical analysis of empirical evidence. We conclude that evidence for consistency in the experience and expression of pain and for clinician accuracy in evaluating the veracity of that pain is lacking; therefore, the logical preconditions needed for a rationalized, evidence-based prototype of "normal" pain have yet to be met. We conclude that the use of "normal" as a reference standard leads to ineffective and inhumane management of patient pain and to the danger that third parties, such as insurance companies and drug enforcement agencies, will use this unsubstantiated reference standard to arbitrarily limit pain therapy options. The authors recommend that the word "normal" be expunged from the International Association for the Study of Pain, Pain Terminology.

Clinical Trials as Topic↗
PubMed2005

Practice parameter for the assessment and treatment of youth in juvenile detention and correctional facilities.

This practice parameter presents recommendations for the mental health assessment and treatment of youths in juvenile detention and correctional facilities. Mental and substance-related disorders are significant public health problems affecting youths in juvenile justice settings. Sufficient time is necessary to conduct a comprehensive diagnostic assessment, interview collateral historians, and review pertinent records to identify primary and comorbid conditions. Potential role conflicts (i.e., forensic evaluator versus clinical care provider) need to be clarified before beginning any evaluation or treatment program, and particular attention must be paid to the issue of patient confidentiality. Issues of special concern in correctional health care, such as self-mutilative behaviors, suicide attempts, malingering, mandated reporting, ethical issues, cultural competency, institutional policies affecting clinical care, and the role of the clinician, are reviewed.

Adolescent↗
PubMed2005

"Across the board" posturography abnormalities in vestibular injury.

OBJECTIVE: To analyze a newly defined group of Computerized Dynamic Posturography abnormalities and to determine if these patients' abnormalities are of vestibular origin. STUDY DESIGN: Analysis of results drawn from our larger study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. SETTING: A tertiary and quaternary care ambulatory referral centre. PATIENTS: Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work related injury. or litigation procedures. INTERVENTIONS: Standard vestibular assessment including Computerized Dynamic Posturography was carried out on all patients. MAIN OUTCOME MEASURES: CDP results of all patients were reanalyzed and all results were pulled which were abnormal on at least 5 of 6 sensory conditions. All results were analyzed using a quantitative method of detecting malingering and also using our newly developed nine point subjective/objective criteria scale. RESULTS: While the standardized formulae categorized most of these results as "aphysiologic," our nine-point protocol showed most of the patients to be legitimate. CONCLUSIONS: These results represent a legitimate subgroup of vestibular patients that we feel have been more or less unrecognized, many of whom are incapacitated by imbalance and disorientation. These results also are helpful in measuring safety of these patients in the workplace.

Craniocerebral Trauma↗
PubMed2006

Chronic dizziness: the interface between psychiatry and neuro-otology.

PURPOSE OF REVIEW: This paper reviews the often-enigmatic relationships between dizziness and psychiatric symptoms. Psychiatric causes of dizziness, neuro-otologic causes of anxiety, underrecognized co-morbid conditions, and medical illnesses that masquerade as 'psychogenic' dizziness are examined. Key clinical features and data from recent treatment trials are presented with potential pathophysiologic mechanisms. RECENT FINDINGS: Investigations at the interface between psychiatry and neuro-otology have identified the distinguishing features of several clinical conditions that present with non-vertiginous dizziness, subjective imbalance, and psychiatric symptoms. The most common condition is chronic subjective dizziness; a refinement of earlier concepts of psychogenic dizziness, phobic postural vertigo, and space-motion phobia. Chronic subjective dizziness is consistent with advancing research on anxiety and somatoform disorders and offers greater insights into the relationships between neuro-otologic illnesses and anxiety. Migraine, post-concussional syndrome, and dysautonomias also cause persistent dizziness and may be misdiagnosed or malingering or psychogenic dizziness because they often present with comorbid psychiatric symptoms in the absence of identifiable vestibular deficits. SUMMARY: Recent research has defined the key features of several medical-psychiatric conditions that cause chronic dizziness, permitting greater diagnostic precision and insight into underlying pathophysiologic processes. Treatment studies have identified potentially effective interventions, which must be evaluated in controlled clinical trials.

Anxiety Disorders↗
PubMedDate not supplied

Functional amnesia: clinical description and neuropsychological profile of 10 cases.

We carried out the first neuropsychological study of a series of patients with functional amnesia. We evaluated 10 patients, first with a neurological examination and then with three tests of anterograde amnesia and four tests of retrograde amnesia. Excluding one patient who later admitted to malingering, all patients had a significant premorbid psychiatric history and one or more possible precipitating factors for their amnesia. Eight of the 10 patients still had persistent retrograde amnesia at our last contact with them (median = 14 mo after the onset of amnesia). On tests of anterograde amnesia, the patients performed normally as a group, though some patients scored poorly on tests of verbal memory. On tests of retrograde amnesia, all patients had difficulty re-collecting well-formed autobiographical memories of specific events from their past. In contrast, patients performed as well as controls at distinguishing the names of cities from fictitious city names. On remote memory tests for past public events and famous faces, different patients exhibited different but internally consistent patterns of impaired and spared performance. The variability in the clinical and neuropsychological findings among our patients may be understood by supposing that memory performance is poor in proportion to how directly a test appears to assess a patient's common sense concept of memory. The presentation of patients with functional amnesia is as variable as humankind's concept of what memory is and how it works.

Adult↗
PubMed1997

Driving skills after whiplash.

Previous studies have shown that some persons with longlasting problems after whiplash have changed eye movements. These changes have been related to disturbance of the posture control system. The question raised in the present study is whether such disturbances can influence daily life functions connected with balance, position and external movements, such as car driving. A group of 23 persons with disturbed eye movements due to whiplash injury, was tested in a driving simulator, together with a closely matched control group. The results revealed significant differences between the two groups with respect to response times to the traffic signs presented, identification of type of sign, as well as steering precision while the subjects' attention was directed to the process of identifying the signs. Alternative explanations such as driving experience, pain, medication or malingering are at least partly controlled for, but cannot completely be ruled out. A distorted posture control system leading to disturbance of eye movements seems to be the most likely primary causative factor, but these disturbances are most certainly complexly determined. Reduced attention capacity is considered to be a mediating secondary factor. Registration of eye movements may be a useful diagnostic tool to evaluate driving skill after whiplash.

Adult↗