The disability experience conference

1. The disability experience conference The Development of a Reliable Biomeasure for Detecting Self- Regulation Behaviors in Adults with TBI: A Pilot Study Ashlee B. McKeon, BPhil. University of Pittsburgh Rehabilitation Counseling

2. Background • Each year, 1.7 million people sustain a traumatic brain injury ([TBI]; Centers for Disease Control and Prevention, 2006) • One of the leading causes of death and disability • Silent epidemic- Public health concern • Anywhere from 76- 97% of individuals with a TBI experience self- regulation difficulties (Shereret al., 1998) • Hallmark deficit • Leads to barriers • Independence • Functioning in major life areas • Negative outcomes (Ylvisakeret al., 2007) • Decreased participation • Decreased quality of life (QoL) and life satisfaction • Impact on daily living is clear

3. Background (cont.) • Interventions typically delivery within clinic settings • Easily controlled; highly structured • Weaknesses: • May not be a natural representation of functioning • Not the true environment where dysfunction manifests • Lack of generalizability- not ecologically valid • Inconsistent research outcomes • Deficit resistance to interventions • Interventions can be effective, and potentially superior when delivered outside of the clinic (McCue, Fairman, & Pramuka, 2010) • Biofeedback has been shown to be highly efficacious across a wide range of disabilities for increasing self- regulatory ability (Association for Applied Psychophysiological and Biofeedback, 2011a) • Use of technology to train awareness of biological systems • Naturalistic delivery capability • Facilitates independence through fading of technology

4. Rationale • Clinic- based rehabilitation interventions may be inappropriate for TBI cohorts • Lack of self- awareness • Inability to generalize learned skills • Weaknesses of current interventions suggest a need for rehabilitation professionals to consider novel intervention options for individuals with TBI that are more ecologically valid • Natural occurrence of deficits • Assistance is most needed • Real- world interventions may yield greatest outcomes • Existing research is scarce, despite high rate of self- regulation deficits experienced • The proposed research is the first stage in developing a TBI- specific in- vivo intervention using biofeedback for increasing self- regulatory ability

5. Methods • Initial and critical development task • Identification of appropriate biomeasures and device • Scholarly paper results • Literature search • Device inclusion criteria • Pilot testing • Healthy controls; N= ≤ 10 • Clinic setting • Accurate detection of emotional dysregulation • Completion of challenging tasks elicit emotional response task breakdown • Continuous recording of biomeasures • Comparison to gold standard • Pilot data will guide future research efforts

6. ANTICIPATED results • Correlation of clinician judgment (behavioral dysregulation) with biomeasure recordings (physiological change) • Accurate detection of emotional dysregulation • Potential to intervene at the level of emotional response, before behavioral output • Eventually train individuals to self- manage • Development of a set of algorithms for accurate detection • If anticipated results are found, future research aims will be carried out using persons with TBI

7. future RESEARCH Efforts

8. discussion • This project will evaluate the ability for an innovative technology- based rehabilitation service delivery model to accurately detect emotional dysregulation in healthy volunteers • Pilot study participant benefits: • Enhanced awareness of situations that cause dysregulation • Increased knowledge of the link between physiological changes, emotions, and behaviors • It is expected future research task outcomes will yield additional benefits • Increased independence/ self- management skills • Increased QoL • Increased participation in major life areas • Decreased maladaptive behaviors • Increase self- management skills and enhance environmental participation

9. ACKNOWLEDGEMENTS • PhD clinical advisor: Dr. Michael McCue • PhD technical advisor: Dr. Dan Ding • University of Pittsburgh IGERT Team: Mary Goldberg, MS; Dan Ding, PhD; Rory Cooper, PhD • National Science Foundation • Grant #DGE 1144584 • Integrative Graduate Education & Research Traineeship (IGERT) fellowship

10. references • Association for Applied Psychophysiology and Biofeedback. (2011a). About biofeedback. Retrieved from http://www.aapb.org/i4a/pages/index.cfm?pageid=3463 • Association for Applied Psychophysiology and Biofeedback. (2011b). Disorders and treatment. Retrieved from http://www.aapb.org/i4a/pages/index.cfm?pageid=3404 • Brain Injury Association of America. (2011). About brain injury. Retrieved from http://www.biausa.org/about-brain-injury.htm • Centers for Disease Control and Prevention. (2006). Traumatic brain injury in the united states: Emergency department visits, hospitalizations, and deaths, 2002-2006. Retrieved fromhttp://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf • Gartha, I. (1976). What is biofeedback? Canadian Family Physician, 22(1), 105- 106. • Henry, J., Phillips, L., Crawford, J., Ietswaart, M., & Summers, F. (2006). Theory of mind following traumatic brain injury: The role of emotion recognition and executive dysfunction. Neuropsychologia, 44(1), 1623- 1628. • Heron, K., & Smyth. (2010). Ecologically momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15(1), 1-39.

11. References (cont.) • Levine, B., Deirdre, D., Schwartz, M., Boutet, I., Stuss, D. (2000). Assessment of strategic self- regulation in traumatic brain injury: Its relationship to injury severity and psychosocial outcome. Neuropsychology, 14(4), 491- 500. • McCue, M., Fairman, A., & Pramuka, M. (2010). Enhancing quality of life through telerehabilitation. Physical Medicine and Rehabilitation Clinics in North America, 21(1), 195- 205. • Ownsworth, T., McFarland, K., & Young, R. (2002). The investigation of factors underlying deficits in self- awareness and self- regulation. Brain Injury, 16(4), 291- 309. • Sherer, M., Bergloff, P., Levin, E., High, W., Oden, K., & Nick, T. (1998). Impaired awareness and employment outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13(1), 52- 61. • Ylvisaker, M., Turkstra, L., Coehlo, C., Yorkston, K., Kennedy, M., Sohlberg, M., & Avery, J. (2007). Behavioural interventions for children and adults with behaviour disorders after tbi: A systematic review of the evidence. Brain Injury, 21(8), 769- 805. • Yucha, C., & Gilbert, C. (2004). Evidence- based practice in biofeedback and neurofeedback. Retrieved from http://www.aapb.org/files/public/Yucha-Gilbert_EvidenceBased2004.pdf