Donald Kewman - Academia.edu (original) (raw)

Papers by Donald Kewman

American Journal of Physical Medicine & Rehabilitation, Dec 1, 2005

When we look at the big picture, we might be surprised by the health and enablement achieved duri... more When we look at the big picture, we might be surprised by the health and enablement achieved during the second half of the 20th century by many members of our nation's disability community. The scope of the changes, when laid alongside the socioecological reality of 50 yrs ago, is a tribute to our nation in the 20th century. America dealt with the knowledge base of rehabilitation, the skills to cope with chronicity and disability, society's readiness for fundamental changes in its vision and statutes, and the economic impact of disability on individual communities and the entire nation. However, rehabilitation was not an early entrant to the fold of clinical departments in most American medical schools. Rehabilitation is a medical specialty that responds to people with disabilities, frequently conspicuous disabilities. Like other visible minorities, people with disabilities are marginalized and further disabled by society's discrimination. There are ancient myths about the crippled and maimed who were feared and shunned by the larger societythe hunchback of Notre Dame and the Phantom of the Opera, for example. Medicine is drawn to the attractive fields that dwell in the land of high technology. Rehabilitation, on the other hand, seemed mired down with its patients who were considered second rate, or worse. All that is changing, and we are privileged to be part of the changes. The winds of modernity have reshaped the model of health care. For example, in the last century, the physician-nurse team has grown to become a more interdisciplinary one. We have moved beyond the dictum that diagnosis informs cure to an increased understanding that whole-person diagnosis informs adaptive strategies for long-term altered function. We have evolved from heaping the costs of disability on the person with the disability to realizing that society has a role in accommodating and empowering the person as he or she, together with the family, faces disablement and financial catastrophe. In short, we are maturing as a nation.

American Psychological Association eBooks, 2010

Psychological Reports, Dec 1, 1982

The usefulness of the Minnesota Multiphasic Personalicy Inventory (MMPI) for predicting treatment... more The usefulness of the Minnesota Multiphasic Personalicy Inventory (MMPI) for predicting treatment response to electrical spinal epidural stimulation was examined in 11 patients with chronic pain and 11 patients wich movement disorders. The movement-disordered group had generally lower MMPI scores than :he group with chronic pain and higher subjective ratings of improvement. However, physicians' ratings for the group as a whole showed that scores on Hr and Hy, while. elevated, tended to be relatively lower for patients who were treatment resistant than for those rated as successes. Higher elevations on D were associated with treatment failure. The "conversion 'A. H. Roberts, The pain clinic and ain treatment program procedure manual. (2nd ed.) Minneapolis, M N : University o f Minnesota, Department of Physical Medicine and Rehabilitation, May, 1977.

PubMed, Jul 1, 1986

A procedure was developed for retraining color and form identification in a multiply handicapped ... more A procedure was developed for retraining color and form identification in a multiply handicapped cortically blind adolescent girl who had sustained anoxic brain damage. Treatment involved systematic presentation of four different colored shapes with verbal feedback on performance. The trainer used a multiple choice procedure and traced the edge of the stimulus with a pointer. The patient attained near perfect performance with the four colored shapes in less than 10 sessions, while identification of visual and tactile stimulus materials not used in training remained essentially unchanged. Results suggest a specific effect of training on performance.

Brain Injury, 1988

In a simulated functional task involving comprehension of a spoken passage, the performance of 20... more In a simulated functional task involving comprehension of a spoken passage, the performance of 20 traumatically brain-injured and 14 non-brain-injured control patients was compared under conditions which included the presence and absence of competing vocal stimuli. The subjects heard 10 target paragraphs which were approximately 1 minute in length. Five of these paragraphs were transmitted without any interference, while the other five were presented with distraction caused by a second voice reading a different paragraph with equal volume and intensity. Based on the answers to subsequent multiple-choice questions, the traumatically brain-injured subjects had significantly more difficulty comprehending the target passages in the presence of the interfering or competing passages compared to control subjects. The results of this study suggest the need for specific rehabilitation programmes to aid brain-injured persons in improving their auditory comprehension in everyday situations where distracting or competing auditory stimuli are present.

PubMed, Oct 1, 1981

This study investigated the effects of brain damage on perceptual/cognitive skills and driving. T... more This study investigated the effects of brain damage on perceptual/cognitive skills and driving. The subjects included 23 persons with brain damage, 18 persons with spinal-cord damage, and 10 able-bodied persons. Each subject was evaluated using a battery of perceptual and cognitive tests, a set of driving tasks in a parking lot, and actual in-traffic driving over a fixed route. The results indicate that (1) while persons with brain damage, as a group, exhibited impaired perceptual/cognitive skills and also impaired driving, those who scored well on certain perceptual/cognitive tests tended to show good driving performance as well, (2) different perceptual/cognitive tests are good predictors of driving performance by persons with and without brain damage, and (3) the driving problems exhibited by some of the persons with brain damage likely result, in part, from the deficits in their perceptual and cognitive skills.

International Journal of Psychiatry in Medicine, Sep 1, 1991

To assess the incidende and relationship of cognitive/intellectual impairments to pain problems, ... more To assess the incidende and relationship of cognitive/intellectual impairments to pain problems, seventy-three adults with musculoskeletal pain seen in a PM&R outpatient clinic were screened using the Neurobehavioral Cognitive Status Examination (NCSE). Subjective pain complaints were assessed using portions of the McGill Pain Questionnaire. Patients with prior diagnoses of neurocognitive problems or those who had taken narcotic analgesics in the last 24 hours were excluded. Results showed that 32 percent of subjects had impaired performance in at least one cognitive domain. Individuals with poorer performance on the NCSE had higher levels of reported pain or disability and psychological distress. Possible factors contributing to poor performance on cognitive tasks include psychological disorders or distress, undiagnosed organic brain dysfunction, social/psychological factors such as education, or a combination of these. Results suggest the need for further research to understand the relationship of poor performance on cognitive tasks to the etiology, maintenance and rehabilitation of pain problems.

Archives of Clinical Neuropsychology, 1996

However, clinical lore posits poorer backward vs. forward performance compared to normals due to ... more However, clinical lore posits poorer backward vs. forward performance compared to normals due to the greater attentional demands of the backward task. This study examined qualitative aspects of Digit Span performance including forward/backward span discrepancies and error patterns in children with traumatic brain injury (n = 20) and normais (n = 19). The hypothesis of greater forward/backward discrepancy with traumatic brain injury was not supported. Children with traumatic brain injury make a significantly greater number of preceiling errors than normal& consistent with other findings of increased performance variability. Preceiling errors are errors that occur in trials prior to the two failed trials, resulting in discontinuation of the task. In addition, cognitive correlates of error types, such as WlSC-R factor scores, were significantly different between groups. The results of this study suggest that a more detailed analysis of performance on attentional tasks previously described as resilient to brain injury may shed further light on the nature of acquired attentional deficits.

Archives of Physical Medicine and Rehabilitation, Nov 1, 1999

Objective: To describe the relationship of multiple biographic, injury-related, and educational f... more Objective: To describe the relationship of multiple biographic, injury-related, and educational factors with employment outcomes after spinal cord injury (SCI). Design: Cross-sectional. Setting: Data were collected through 18 model SCI systems, a nationwide network of hospitals that treat approximately 14% of all SCIs in the United States.

Clinical Psychology Review, 1993

We evaluate the hypothesis that the power of nonspecific ejects may account for as much as two th... more We evaluate the hypothesis that the power of nonspecific ejects may account for as much as two thirds of successful treatment outcomes when both the healer and the patient believe in the efficacy of a treatment. Five medical and surgical treatments, once considered to be eJiicacious by their proponents but no longer considered effective based upon later controlled trials, were selected according to strict inclusion criteria. A search of the English literature was condtutedfor all studies published for each treatment area. The results of these studies were categorized, where possible, into excellent, good, and poor outcomes. For these five treatments combined, 40% excellent, 30% good, and 30% poor results were reported by proponents. We conclude that, under conditions of heightened expectations, the power of nonspeczfic eflects far exceeds that commonly reported in the literature. The implications of these results in evaluating the relative eflicacy of biological and psychosocial treatments is discussed. The issue of specific and nonspecific effects in psychiatric and psychological interventions continues to be a matter of intense interest and debate. Controversies involve both biological (Fisher & Greenberg, 1989a; Margraf et al., 1991) and psychosocial (Beutler,

Rehabilitation Psychology, 1998

The Grand Rounds section of Rehabilitation Psychology presents a clinical case or treatment issue... more The Grand Rounds section of Rehabilitation Psychology presents a clinical case or treatment issue to advance knowledge of rehabilitation psychology. I encourage authors to submit articles to me in the following general format: introduction, including a statement of the issue being addressed by the case study, followed by a presentation of the case study material, and finishing with a discussion of the implications of the case study for advancing knowledge and methodology in the field of rehabilitation psychology.

This study investigated the relation of perceptual/cognitive skills and driving. The subjects inc... more This study investigated the relation of perceptual/cognitive skills and driving. The subjects included 23 persons with brain damage, 8 persons with spinal-cord damage, and 10 able-bodied controls. Each subject was evaluated using a battery of perceptual and cognitive tests, a set of driving tasks in a parking lot, and actual in-traffic driving. The main findings are as follows: (a) Driving performance was significantly correlated with perceptual and cognitive skills. The highest correlations were obtained for Picture Completion Test (r = .71,), Picture Arrangement Test (r = .58), and Motor Free Visual Perception Test (r = .57). (2) The persons with brain damage performed significantly worse than the control subjects or people with spinal-cord damage on a range of perceptual and cognitive tests. (3) The persons with brain damage exhibited impaired driving performance in relation to the control subjects or people with spinal-cord damage. (4) The correlation between, a subjective evaluation of driving potential by a driver trainer and an evaluation of selected driving actions proved to be rather high (r = .81). (5) The obtained high correlations between several perceptual/cognitive tests and driving suggest that these tests (if properly validated) could be used in a screening battery to detect potentially serious driving-related problems. (6) Statistical procedures indicate that the data are consistent with the following hypothesis: Brain damage affects perceptual and cognitive skills (Including those evaluated by Symbol Digit Modalities Test, Picture Completion, and Picture Arrangement), which in turn affect driving performance. (A)

... adolescents. Sexual function in people with disability and chronic illness: A health professi... more ... adolescents. Sexual function in people with disability and chronic illness: A health professional's guide. Kewman, Donald; Warschausky, Seth; Engel, Lisa; Warzak, William. Sipski, Marca L. (Ed); Alexander, Craig J. (Ed), (1997). Sexual ...

Biofeedback and self-regulation, Sep 1, 1983

Clinical appfications of biofeedback have proliferated and considerable lore surrounding the appl... more Clinical appfications of biofeedback have proliferated and considerable lore surrounding the application of these techniques has evolved. Many assertions about the effectiveness of biofeedback training are based on findings of the least well-controlled studies, while many of the better controlled studies have failed to show that biofeedback directly mediates target symptoms or is superior to other treatments. Steiner and Dince (1981) suggest that the failure of these controlled studies is primarily attributable to methodological deficiencies. We believe that the question of whether or not there is a specific effect of biofeedback training is still frequently confused with the question of whether or not the treatment package as a whole has therapeutic value. Biofeedback is often therapeutic; however, evidence is often lacking that its effectiveness is due to biofeedbacktrained changes in a target physiological process.

Archives of Physical Medicine and Rehabilitation, 1993

1993 ACRM ABSTRACTS of these patients had another neurological disease and 3 had another medical ... more 1993 ACRM ABSTRACTS of these patients had another neurological disease and 3 had another medical diagnosis. Twenty patients (33%) had EMG evidence of polio in an extremity felt to be uninvolved. Twenty-nine patients (48%) had an additional neurological lesion, including carpal tunnel syndrome (40%). peripheral neuropathy (5%). radiculopathy (7%), tibia1 neuropathy above the ankle (2%) and ulnar neuropathy (5%). We have found this standardized electrodiagnostic protocol useful in excluding other diagnoses, identifying subclinical polio and detecting concurrent potentially treatable causes of weakness. We believe a routine four extremity EMG/NCS is a necessary adjunct in the evaluation of the post-polio patient.

Archives of Physical Medicine and Rehabilitation, 1994

Journal of Pediatric Orthopaedics, 1996

Lower extremity lawn-mower injuries in children result in significant morbidity with a significan... more Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.