BIOMEASURE FOR SELF- REGULATION IN TBI1
Development of a Reliable Biomeasure for Detecting Self- Regulation Behaviors in Adults with TBI: A Pilot Study
Ashlee B. McKeon
University of Pittsburgh
Introduction
Each year in the United States 1.7 million people sustain a traumatic brain injury (TBI), making TBI one of the leading causes of death and disability (Centers for Disease Control and Prevention, 2006). Difficulty self- regulating, or exercising control over one’s thoughts, emotions, and behaviors to fit within the context of the environment is a hallmark deficit experienced by anywhere between 76- 97% of adults with TBI (Sherer et al., 1998). This inability to self- manage, along with other executive functioning deficits serve as barriers to independence and functioning in multiple life areas including, social and vocational (Ylvisaker et al., 2007). These negative outcomes have been shown to contribute to decreases in both environmental participation and overall quality of life.
Despite the significant impact of self- regulation deficits on daily living, current interventions for TBI groups are typically delivered in clinic settings. This is interesting given that individuals with TBI tend to function poorly in situations that are unstructured—where a high degree of self- regulation is needed (Levine, Deirdre, Schwartz, Boutet, & Stuss, 2000). Intervention delivery within the easily controlled and highly structured clinic does not allow for natural representation of functioning or tap into the true environment where dysfunction manifests. Observation within the clinic does not necessarily paint a clear picture of functioning and oftentimes there is a lack of generalizability of learned skills to real- world settings. Research has shown rehabilitation interventions can be effective and even superior in terms of functional outcomes 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 through physiological state awareness (AAPB, 2011b; Yucha & Gilbert, 2004). The overall goal is to use technology to train an individual to recognize, monitor, and adapt their biological systems—in other words self- regulate at will (Association for Applied Psychophysiology and Biofeedback [AAPB], 2011a). The instrument serves as a cueing device that alerts the individual to attend to their body state when physiological changes are detected. Biofeedback has in- vivo delivery capabilityfor evaluating self- regulation behaviors linked to physiological changes and emotional states.
Rationale
The majority of research on self- regulation uses clinic- based interventions that may not be appropriate for TBI cohorts due to a lack of self- awareness and an inability to generalize learning across contexts. Research on naturalistic interventions for this disability group is scarce and there is currently no body of literature focusing on biofeedback- based ecological momentary assessment/ intervention (EMA/ EMI) for TBI. Interventions that will produce the greatest outcomes may be through real- world application. Due to the weaknesses of current interventions, it is time for rehabilitation professionals to consider novel interventions that are ecologically valid and generalizable to real- world context where deficits naturally occur and where assistance is most needed. The proposed study is the first stage in developing a TBI- specific EMA/ EMI using biofeedback.
Methods
The proposed development project is the initial and critical stage for future research aims to identify a reliable EMA using physiological body states to serve as a cue to invoke a full ecological momentary intervention EMI. Appropriate biomeasures will be identified from available literature. Commercially available devices will then be selected based on several necessary criteria including, ability to monitor the specific biomeasures isolated as well as capability for real- world application (portability).
Pilot testing will be done using healthy volunteers within a clinic setting to measure the sensitivity and specificity of each biomeasure for accurate detection of the presence or absence of behavior dysregulation. This testing will be done through having participants complete several challenging tasks designed to illicit negative emotional responses (i.e. frustration, agitation, and irritability) and result in task breakdown (i.e. failure to correctly complete task or task interruptions). Biomeasures will be continuously recorded through a portable device worn throughout task completion—measuring physiological states during any given moment. To determine the ability for the biomeasures to accurately detect emotional dysregulation, the current gold standard method of clinician behavioral observation will be used for comparison. Behaviors are the most overt, objective, and researched component of self-regulation, when compared to highly subjective cognitions and emotions.
Anticipated Results & Future Research Aims
Ultimately, biomeasures that correlate to a high degree with clinician judgment for behavioral dysregulation within the clinic will provide insight to the ability for these same biomeasures to also detect simultaneous emotional dysregulation. If anticipated results are achieved using healthy volunteers,additional research aims will be carried out using adults with TBI. These future research aims will include: replication of pilot studyprotocol within the clinic; feasibility for accurate emotional dysregulation detection in the natural environment; and the ability for biofeedback to deploy a full EMI when emotional dysregulation is detected.
Discussion
This project will evaluate the ability for an innovative technology- based rehabilitation service delivery model to accurately detect emotional dysregulation in healthy volunteers. It is expected pilot study findings will guide future research tasks aimed at increasing self- management skills and enhancingenvironmental participation for adults with TBI. Participants will benefit frompilot studyresearch through (1) enhanced awareness of situations that cause emotional and behavioral dysregulation and (2) increased knowledge of the link between physiological changes, emotions, and behaviors. It is expected future research efforts will yield additional benefits.
BIOMEASURE FOR SELF- REGULATION IN TBI1
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