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Papers by stephen trapp

Child: Care, Health and Development, 2014

Background This qualitative, exploratory study examines the content of communication between heal... more Background This qualitative, exploratory study examines the content of communication between healthcare providers (HCP) and childhood cancer patients (CCP) during a medical appointment to evaluate the extent to which cancer survivorship issues (medical and psychosocial) are discussed. Methods The content of the communication for 16 CCP ages 10-22 and their HCP were examined via audio recorded medical appointments occurring within 6 months of the end of active cancer treatment. The data were analysed using template analysis, a constructivist-interpretivist qualitative approach. Results HCP addressed more medically focused than psychosocially focused issues related to survivorship. Conclusions Most discussions of survivorship are medically focused, potentially leaving patients with little information about future psychosocial functioning. Recommendations for future research on enhancing discussions about psychosocial issues are presented. This research has the potential to inform future interventions to enhance patient-provider communication on survivorship issues. Over 14 000 children and adolescents are diagnosed with cancer yearly in the United States (Howlader et al. 2012). Approximately 83% achieve long-term remission (Siegel et al. 2012). With over 325 000 paediatric cancer survivors in the United States (Mariotto et al. 2009), attention to adjustment in survivorship is warranted. Although many childhood cancer patients (CCP) adjust well, functioning can be compromised by interruptions in development, family stressors and treatmentrelated distress (

Supportive Care in Cancer, 2012

Purpose The coping styles of five adult men within the context of a cancer-related social support... more Purpose The coping styles of five adult men within the context of a cancer-related social support group and their preferences regarding group support were examined. Methods Considering the paucity of literature on male coping processes within a cancer-related social support group, qualitative methods were employed. Specifically, template analysis was used to analyze the range and quality of coping styles. Results In contrast to the commonly cited solitary and emotionally restricted coping qualities associated with the male gender role, an emphasis on seeking connection and emotional support in their coping efforts was discovered. Preferences of group qualities (e.g., participant characteristics and session topics) that emerged included an interest in connection, mixed sex groups, and groups composed of mixed diagnoses. Conclusions The findings of this study can contribute to the development of interventions aimed at increasing the effectiveness of male coping in group-focused supportive services in cancer care.

The belief that distress can lead to positive change has been a perennial topic in literature ove... more The belief that distress can lead to positive change has been a perennial topic in literature over time and remains a present concept in modern psychosocial discourse (Tedeschi & Calhoun, 1995). Despite this long-standing belief that positive change derived from involvement in a highly stressful event, scientific inquiry into this area did not emerge until the 1980's when it was operationalized as constructs such as benefitfinding and, later, as Posttraumatic Growth (Taylor, 1983; Tedeschi & Calhoun, 2004). Areas of trauma-related growth have been observed in five domains: greater appreciation of life and changed sense of priorities; warmer, more intimate relationships with others; a greater sense of personal strength; recognition of new possibilities or paths for one's life; and spiritual development. This experience of trauma-related growth is not unusual in individuals with a chronic illness. Furthermore, as it is not uncommon for cancer survivors to experience symptoms o...

Social Psychology of Education, 2021

In a pair of studies, the present research examined mindfulness as a mediator through which perce... more In a pair of studies, the present research examined mindfulness as a mediator through which perceived support for the basic psychological needs of autonomy and competence facilitate adaptive outcomes in a university classroom setting. In Study 1 (N = 199), dispositional mindfulness mediated the relation between perceived support for autonomy and competence in daily life and generalized test anxiety in college students. In Study 2 (N = 328), perceived support for autonomy and competence in the classroom predicted higher test performance and instructor evaluations among college students. Notably, perceived support for autonomy and competence in the classroom predicted increased state mindfulness minutes before a final exam, which in turn was associated with less test anxiety and better test performance, even after controlling for past academic achievement. In summary, instructor support of students' basic needs for autonomy and competence in the classroom context predicted heightened states of mindful awareness prior to a final exam, which explained improvements in academic performance among students. This research represents a first step toward identifying situational factors that facilitate mindful awareness in academic contexts.

Emotion, 2021

Motor responses are more efficient when there is a match (or congruency) between the motivational... more Motor responses are more efficient when there is a match (or congruency) between the motivational properties of an emotional state and the distance altering characteristics of the movement being executed to the emotion-eliciting stimulus. However, the role of spatial context in shaping motivational orientations to approach and avoid, particularly during whole-body movement tasks, remains less understood. We sought to narrow this knowledge gap by investigating whether an emotion (fear) relived from a previous experience affected movement initiation based on whether motor responses were implicitly coded as approach (i.e., incongruent) or avoidance (i.e., congruent) as per the location of the imagined threat stimulus. Participants (N = 29) completed a tone-initiated forward gait initiation task after recalling a previous fearful experience in which the stimulus from their memory was located either in front (incongruent) or behind (congruent) them. Facilitation versus inhibition of motor responses was indexed by reaction time (RT), displacement and velocity of postural movements prior to stepping, and step kinematics. Analyses revealed that participants initiating forward gait after recalling a fearful experience in which the fearful stimulus was congruent to the movement direction expedited RTs, greater displacement and velocity of anticipatory postural responses, and greater step length and velocity. Results provide support for the theoretical position that motivational orientations to approach and avoid are contextualized based on affective congruency, which includes the spatial orientation of real or imagined emotional stimuli. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Estimated rates of obesity are notably high in the United States and pose a significant public he... more Estimated rates of obesity are notably high in the United States and pose a significant public health concern. A number of deleterious physical and psychosocial conditions are associated with pediatric obesity and the cost of its treatment is considerable. Accordingly, the number of weight management treatments has increased to meet this growing public health challenge. Unfortunately, insufficient participation in weight management treatment, namely low adherence and high attrition, often impede the effectiveness of these programs. Although the

Outdoor recreation improves the quality of life for individuals with tetraplegia, however, a rang... more Outdoor recreation improves the quality of life for individuals with tetraplegia, however, a range of barriers exist in accessing these sports. This chapter describes the iterative design and field evaluation of the Tetra-Ski, a novel power-assisted ski chair for individuals who use a power wheelchair. Users control the Tetra-Ski with a joystick or sip-and-puff controller either independently or collaboratively with a tethered skier through a Shared-Control scheme. A field study of the Tetra-Ski demonstrated the usability of the system. The chapter also reflects on the Shared-Control approach to controlling Tetra-Ski, which effectively supported the unique abilities of different users. These findings inform the future application of this Shared-Control approach for use with other assistive technology and less-dependent forms of outdoor recreation. Finally, we describe some of the challenges we have faced developing and deploying a sports activity (skiing) for individuals with tetrap...

Therapeutic Recreation Journal, 2021

Virtual reality (VR) interventions can be motivating for clients when presented as treatment in h... more Virtual reality (VR) interventions can be motivating for clients when presented as treatment in healthcare settings. Researchers know little, however, about the elements of specific VR games that contribute to this motivation. This study aimed to describe differences among a sample of commercially available VR games using the four subscales of the Leisure Motivation Scale (LMS). The research team used a mixed-methods design, and compiled an expert panel of recreational therapists (N = 5) who evaluated eight VR games using Q-sort methodology. Semi-structured interviews generated additional data for the evaluation. Results indicated participants viewed certain VR games as containing elements more closely aligned with each of the LMS subscales of intellectual, social, competence-mastery, and stimulus avoidance than others. These findings represent a critical step in developing guidelines for the purposeful selection of VR games as treatment interventions in recreational therapy practic...

Proceedings of the 2020 ACM Designing Interactive Systems Conference, 2020

Effective design is essential to creating adaptive outdoor activities. Ability-Based Design (ABD)... more Effective design is essential to creating adaptive outdoor activities. Ability-Based Design (ABD) is an approach to accessible design in the HCI literature that we found to be most appealing for this endeavour. ABD focuses on making systems adaptable to users' needs and abilities rather than making the user conform to system requirements. We explore principles of ABD in the context of two adaptive outdoor experiences: Tetra-Ski and Tetra-Sail. We found that while the general approach of ABD is useful in this context, some of the basic tenants of ABD can be confounded by: (1) activity risk, (2) dynamic sport environments, and (3) the role of psychological fow during the activity. To accommodate these restrictions on ABD principles and provide a usable experience we developed Shared-Control as a collaborative approach to implementation. This paper explores using Shared-Control and ABD principles in the context of these two adaptive recreation systems for individuals with acquired tetraplegia. This perspective reveals tensions between ABD guidelines and designing for adaptive outdoor activities. We refect on these tensions, potential additions to ABD, and our own usage of Shared-Control as a mechanism for adhering to ABD principles in this context.

The 21st International ACM SIGACCESS Conference on Computers and Accessibility, 2019

Outdoor recreation improves quality of life for individuals with tetraplegia, however providing s... more Outdoor recreation improves quality of life for individuals with tetraplegia, however providing safe opportunities to engage in these sports has many challenges. We describe the iterative design and field evaluation of Tetra-Ski, a novel power-assisted ski chair. Users control Tetra-Ski with a joystick or Sip-and-Puff controller either independently or collaboratively with a tethered skier through our novel shared-control scheme. We also developed a training simulator to help prepare users prior to their skiing experience. A field study with eight participants and interviews with three trainers who used Tetra-Ski showed that Tetra-Ski is usable, enjoyable, and that the experience has a positive psychosocial effect on users. Furthermore, the shared-control scheme developed for Tetra-Ski proved crucial for supporting the unique abilities of different users, suggesting that a shared-control approach could enable broader access to less-dependent forms of outdoor recreation in the future.

Archives of Physical Medicine and Rehabilitation, 2020

Background: While chronic pulmonary hypertension is a known manifestation of cocaine intoxication... more Background: While chronic pulmonary hypertension is a known manifestation of cocaine intoxication, acute reversible pulmonary hypertension with right ventricular dysfunction has been rarely reported and poses diagnostic challenges.

Health & Social Care in the Community, 2019

Parkinson's disease is a chronic and progressive neurodegenerative disorder characterized by a co... more Parkinson's disease is a chronic and progressive neurodegenerative disorder characterized by a complex of physical symptoms, such as slow and rigid motoric movements, loss of balance, cognitive impairment, and psychological distress (Wong, Gilmour, & Ramage-Morin, 2014). Over time, those who develop the disease lose aspects of their independence and the ability to care for themselves, often requiring an informal caregiver (Leiknes, Lien, & Severinsson, 2015). Informal caregivers in Western countries provide extensive care for individuals with Parkinson's disease during early stages of the disease but may decide to relinquish care when the disease progresses to later stages (Abendroth, Lutz, & Young, 2012). In non-Western and developing countries, informal caregivers are often the primary caregivers throughout disease progression due to resource constraints and/or cultural aversions to institutionalization of family members (Mahoney, Cloutterbuck, Neary, & Zhan, 2005; Mausbach et al., 2004). For example, in Mexico, family caregiving is typically a highly valued cultural role and one offered through the trajectory of a patient's illness course (Vroman & Morency, 2011). Caregiving for someone with Parkinson's disease is associated with a range of physical and psychological stressors (Martínez-Martín et al.,

Archives of Physical Medicine and Rehabilitation, 2018

Research Objectives: To determine the association between caregiver factors and outpatient health... more Research Objectives: To determine the association between caregiver factors and outpatient healthcare utilization by stroke patients over 1-year post-stroke. Design: Observational study. Setting: Outpatient rehabilitation (OTR), specialist outpatient clinics (SOC), primary care (PC). Participants: Stroke patients 40 years and above with recent stroke diagnosis, along with their caregivers were recruited from all tertiary hospitals in Singapore, after index stroke. Caregiver was an immediate or extended family member or friend providing care or assistance of any kind. Interventions: Not applicable. Main Outcome Measure(s): (1) Any OTR utilization during 1-3 months post-stroke, (2) SOC and PC visits during 1-3 and 3-12 months post-stroke. Results: Among the patient-caregiver dyads analyzed (NZ256), for every 1 unit increase in caregiver reported patient behavior score (disruptive), the odds of using OTR decreased by 15%. Dyads with caregivers having positive care management strategies were more likely to visit OTR (Odds Ratio: 1.04, 95% confidence interval [CI], 1.01 e 1.07). Those with coresiding caregivers were expected to have a rate of 1.59 times greater for SOC visits (95% CI, 1.05 e 2.40). For every 1 unit increase in caregiver burden, the incidence rate ratio (IRR) for PC visits decreased by a factor of 0.98 (95% CI, 0.96 e 0.99). For every 1 unit increase in caregiver reported patient behavior score (memory problems), the IRR for PC visits decreased by 5%. Conclusions: Potential implications are promoting positive care management strategies among caregivers, directing efforts to reduce caregiving burden by addressing unmet needs and training caregivers to anticipate and manage patient behavioral problems post-stroke. Future research efforts should extend the current analysis to acute services and adopt a dyadic approach, giving due importance to caregiver and clinical factors. Author(s) Disclosures: None.

Archives of Physical Medicine and Rehabilitation, 2019

Objective: To investigate the feasibility of using virtual reality to enhance mechanical ventilat... more Objective: To investigate the feasibility of using virtual reality to enhance mechanical ventilator weaning among individuals with spinal cord injury.

International Psychogeriatrics, 2018

ABSTRACTBackground:Informal caregivers of individuals with Parkinson’s disease face a range of re... more ABSTRACTBackground:Informal caregivers of individuals with Parkinson’s disease face a range of responsibilities that increase as the disease progresses. As a result of these stressors, caregivers are vulnerable to decreased health-related quality of life (HRQOL). Guided by the stress process model of caregiving, the present study examined the relations between family cohesion, perceived burden, and mental and physical HRQOL among Parkinson’s disease caregivers in Mexico. It was hypothesized that perceived burden would mediate the relations of family cohesion and mental and physical HRQOL.Methods:Ninety-five family caregivers of individuals with Parkinson’s disease in Mexico City, Mexico, participated in the study. Multiple regression was utilized to conduct mediation analyses.Results:Results indicated that burden fully mediated the relation between family cohesion and mental HRQOL, and family cohesion was not associated with physical HRQOL.Conclusions:Findings extend the stress proc...

The International Journal of Psychiatry in Medicine, 2018

Objective This study examined the mediating role of caregiver distress on family factors and care... more Objective This study examined the mediating role of caregiver distress on family factors and caregiver life satisfaction among an understudied population of Parkinson’s disease caregiver in Mexico. Methods A cross-sectional design was used to examine psychosocial factors pertinent to caregiver of individuals with Parkinson’s disease ( n = 95). Guided by a caregiver stress process model, relations among family factors (e.g., cohesion, flexibility, quality of functioning), gender, distress, and satisfaction with life among caregiver were examined. Mediation analyses were performed to test the role of caregiver distress on the associations between family factors, gender, and caregiver satisfaction with life. Results Mediation models demonstrated that caregiver distress fully mediated the relation between quality of family functioning and caregiver satisfaction with life and partially mediated the association between family flexibility and caregiver satisfaction with life. Caregiver gen...

Technology & Innovation, 2018

Group dynamics : theory, research, and practice : the official journal of Division 49, Group Psychology and Group Psychotherapy of the American Psychological Association, 2018

Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for vet... more Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Group therapy can be an effective and efficient means of treating PTSD, yet the literature exploring treatment outcomes for racial minorities is mixed and limited. The present study was an evaluation across racial groups of the PTSD Recovery Program, a manualized group therapy implemented at a Veterans Affairs hospital. Data were collected from male veterans ( = 450) who identified as non-Hispanic White or non-Hispanic African American and participated in a 10-week, combat-related, group therapy program between 2010 and 2014. Participants completed the Posttraumatic Stress Disorder Checklist-Military version (PCL-M) measure at pre-treatment and post-treatment. The Program led to a statistically significant reduction in PCL-M scores (Cohen's = .64). Symptom reduction occurred regardless of race, with no racial differences in improvement. Racial and ethnic composition of groups ...

Archives of Physical Medicine and Rehabilitation, 2017

(95%), median age of 31 years and primarily moderate to severe TBI (Median GCS Z 9; PTA Duration ... more (95%), median age of 31 years and primarily moderate to severe TBI (Median GCS Z 9; PTA Duration of 45 days). Interventions: N/A. Main Outcome Measure(s): BMI at one year post-injury. Results: The median BMI increased from 23.4 during inpatient rehabilitation to 27.5 at one-year post injury. Univariate linear regression revealed baseline BMI (< .001) and worsening respiratory indices (i.e., overall apnea-hypopnea index [AHI; < .001], number of times of desaturation [Desaturation Index; < .001], degree of desaturation [NADIR; < .001], and percent of sleep time below 90% desaturation (< .001) on polysomnography) had significant associations with of higher BMI at one-year injury. Sleep quality and architecture were not significant factors. After adjustment for baseline BMI, sleep and respiratory indices no longer had significant associations with one-year BMI. Conclusion/Discussion: This exploratory study found significant univariate associations between sleep apnea severity and weight gain at one-year post injury. AHRQ has identified the long-term health effects of sleep apnea as a high priority future research need. Given the high incidence and negative health consequences of obesity in TBI, early identification and successful treatment of sleep apnea may be a mechanism for improving the chronic health issues in TBI such as obesity. Future research with larger samples is needed to further explore the relationship between sleep and health in TBI.