ICRP-IEB (PD version)

S OF RELEVANT STUDIES Sample 1: ICRP version 1 Lyons, K.D., & Tickle-Degnen, L. (2005). Reliability and validity of a videotape method to describeexpressive behavior in Parkinson’s disease. American Journal of Occupational Therapy, 59, 41-49. The ability to effectively communicate thoughts, feelings, and identity to others is an important aspectof occupational performance. The symptoms of Parkinson‘s disease can impair a person‘s ability toverbally and nonverbally communicate with others. In order to better understand issues ofcommunication functioning for this population, research tools to describe expressive andcommunicative behavior during occupation and social interaction are needed. In this study, six personswith Parkinson‘s disease participated in individual, videotaped interviews focused on problem solvingduring daily activities. Three trained graduate students viewed edited clips from the videotapes andcompleted a rating scale of expressive behavior designed by the authors. Data support the reliabilityand construct validity of the behavioral rating scale, suggesting that measures of expressive behaviorof persons with Parkinson‘s disease can be effectively derived using short segments of videotapedactivity. Tickle-Degnen, L., & Lyons, K.D. (2004). Practitioners’ impressions of patients with Parkinson’s disease:The social ecology of the expressive mask. Social Science & Medicine, 58, 603-614. The expressive mask of Parkinson‘s disease, a reduced spontaneity, intensity, and fluidity of facial,bodily, and vocal expression, jeopardizes interpersonal interaction and quality of life. Observers havedifficulty perceiving the ̳ ̳real‘‘ person behind the mask, leading to failed communication andmisunderstanding. A social ecological explanation of this difficulty is that observers have learned intheir daily social lives, and quite appropriately so, that expressive behavior reveals meaningfulinformation about character. The premise of this study was that health practitioners, especially novices,would bring into the clinic their everyday perceptual tendencies related to deciphering character. Thestudy examined 30 novice and 50 expert practitioners‘ impressions of the personality of six patientswith Parkinson‘s disease who were videotaped during a healthcare interview. It was found thatpractitioners, especially novices, appeared to be overly sensitive to expressive masking when formingimpressions about patient extraversion. They incorrectly perceived patients with more masking to beless extraverted than patients with less masking. Novice practitioners were particularly inaccurate intheir impressions of neuroticism compared to experts. Novices incorrectly perceived patients withmore masking as being more neurotic, whereas experts tended to be sensitive to valid cues ofneuroticism. Practitioners‘ impressions of patient conscientiousness were not sensitive to masking andwere highly accurate. ICRP-IEB (PD version-3) Updated as of July 12, 201030Sample 2: ICRP version 2 Lyons, K.D., Tickle-Degnen, L., Henry, A., & Cohn, E. (2004a). Behavioral cues of personality inParkinson’s disease. Disability & Rehabilitation, 26, 463-470. Purpose: To determine if there were observable cues of personality to be found in the appearance andexpressive behaviour of six men and six women with Parkinson‘s disease.Method: Participants completed a personality measure and engaged in an individual, videotapedinterview. Four trained raters measured the expressive behaviour demonstrated in the videotapes. Acorrelational design was used to explore associations between self-reported personality and measuresof expressive behaviour.Results: In this sample, more eyebrow furrowing indicated significantly higher levels of Neuroticismand less formal dress indicated significantly higher levels of Openness to Experience. Theseassociations remained large and significant after controlling for the effect of disease severity. Conclusions: Whereas previous research has focused on the detrimental effect of Parkinson‘s diseasesymptoms on first impressions, this study explored the potential for accurate first impressions ofpersonality by identifying observable cues of personality. Findings suggest that in early stages ofParkinson‘s disease there may be plausible and intuitive cues of personality present in expressivebehaviour. Lyons, K.D., Tickle-Degnen, L., Henry, A., & Cohn, E. (2004b). Impressions of personality in Parkinson’sdisease: Can rehabilitation practitioners see beyond the symptoms? Rehabilitation Psychology, 49, 328-333. Objective: To explore rehabilitation practitioners‘ use of observable cues of personality to formaccurate impressions of persons with Parkinson‘s disease. Participants: Ninety-nine practitioners from disciplines of occupational, physical, and speech therapyand nursing and medicine.Procedure: Participants viewed excerpts of videotaped interviews of 6 men and 6 women with mild-to-moderate Parkinson‘s disease and formed impressions of the targets‘ personality.Main Outcome Measure: NEO Five Factor Inventory personality test.Analysis: Brunswik lens model correlational analysis of the associations between expressive behaviorand personality judgments. Results: Practitioners were accurate in judging Openness to Experience, Agreeableness, andConscientiousness but were unable to detect interparticipant differences in levels of Extraversion andNeuroticism. Conclusion: Accuracy in judging some traits suggests that future research may identify interventions,such as sensitizing practitioners to valid behavioral cues or modifying contextual features, to maximizea practitioner‘s ability to understand a client‘s personality. ICRP-IEB (PD version-3) Updated as of July 12, 201031Sample 2: ICRP version 2 (Continued) Lyons, K.D., Tickle-Degnen, L., & DeGroat, E.J. (2005). Inferring personality traits of clients withParkinson’s disease from their descriptions of favourite activities. Clinical Rehabilitation, 19, 799-809. Objective: To explore the extent to which practitioners effectively use cues from clients‘ verbaldescriptions of their favourite activities to form accurate impressions of the personality of clients withParkinson‘s disease.Participants: Ninety-nine practitioners from disciplines of occupational, physical and speech therapy,nursing or medicine.Procedure: Six men and six women with Parkinson‘s disease completed a self-report measure ofpersonality and were individually interviewed regarding their favourite activities. The practitionersviewed 2-min segments of those videotaped interviews and provided judgements of the clients‘personality. Measure: The NEO-Five Factor Inventory and a coding scheme to describe characteristics of clients‘favourite activities.Analysis: Clients‘ self-reported personality was correlated with the activity characteristics to identifythe degree to which each characteristic was a cue of personality. Practitioners‘ judgements ofpersonality were correlated with the activity characteristics to identify how heavily the practitionersweighted each cue. These two sets of weightings were compared using Pearson‘s correlations todetermine whether practitioners used an appropriate cue strategy related to the activity descriptions.Results: Practitioners appropriately used the personality cues found in the clients‘ favourite activitydescriptions to assess the traits of Openness to Experience, Agreeableness and Conscientiousness (r=/0.66, r =/0.60, and r =/0.55, respectively, all pstrategies for the traits of Neuroticism and Extraversion. Conclusion: Clients with Parkinson‘s disease appear to express their personality in their descriptions offavourite activities, and practitioners appear to make use of these expressive verbal cues effectively forsome aspects of personality. DeGroat, E., Lyons, K.D., & Tickle-Degnen, L. (2006). Verbal content during favorite activity interviewas a window into the identity of people with Parkinson’s disease. Occupational Therapy Journal ofResearch: Occupation, Participation, & Health, 26(2), 56-68. The purpose of this study was to document the degree to which a brief segment of an occupationaltherapy interview about favorite activities served as a window into personal identity and experience inclients with Parkinson‘s disease. Two-minute segments of videotaped interviews of 12 participantswith Parkinson‘s disease were transcribed and analyzed. A verbal content measure was developed, itsreliability tested, and its items correlated with participants‘ self-rated personality and mood. Overall,the inter-rater reliability for this verbal content measure was acceptably high, and many expectedassociations between participant verbal content and participant identity as related to personality andmood were found. The results tentatively suggest that the client‘s discussion of favorite activityparticipation, as well as the tone and frequency of the client‘s verbal communication, can provideinsight into the identity of the client, and this information is available to the practitioner even forclients who have difficulty expressing their identities nonverbally. This exploratory study establishes afoundation for further research in the area of identity expression through verbal content in individualswith diminished nonverbal expressiveness. ICRP-IEB (PD version-3) Updated as of July 12, 201032Sample 3: ICRP version 3 Tickle-Degnen, L., Ellis, T.D., Saint-Hilaire, M., Thomas, C., & Wagenaar, R.C. (2010). Self-managementrehabilitation and health-related quality of life in Parkinson’s disease: A randomized controlled trial.Movement Disorders, 25, 194-204. This study’s baseline videotaped interviews provided the database for Sample 3 studies. The purpose of this randomized controlled trial was to determine if increasing hours of self-management rehabilitation had increasing benefits for health-related quality of life (HRQOL) inParkinson‘s disease beyond best medical treatment, if effects persisted at two and six months follow-up, and if targeted compared to non-targeted HRQOL domains responded more to rehabilitation.Participants on best medication therapy were randomized to one of three conditions for six weeksintervention: 0 hrs of rehabilitation; 18 hrs of clinic group rehabilitation plus 9 hrs of attention controlsocial sessions; and 27 hrs of rehabilitation, with 18 in clinic group rehabilitation and 9 hrs ofrehabilitation designed to transfer clinic training into home and community routines. Results (N = 116)showed that at six weeks there was a beneficial effect of increased rehabilitation hours on HRQOLmeasured with the Parkinson‘s Disease Questionnaire-39 summary index (eta = .23, CI = .05 .40, p=.01). Benefits persisted at follow-up. The difference between 18 and 27 hrs was not significant.Clinically relevant improvement occurred at a greater rate for 18 and 27 hrs (54% improved) than for 0hrs (18% improved), a significant 36% difference in rates (95% CI = 20% to 52% difference). Effectswere largest in two targeted domains: communication and mobility. More concerns with mobility andactivities of daily living at baseline predicted more benefit from rehabilitation. Huang, P-C., Tickle-Degnen, L, & Ma, H-I. (2006, unpublished manuscript). American and Taiwaneseinter-rater reliability of ratings of Taiwanese and American parkinsonian nonverbal behavior. TuftsUniversity. Objective. The objective of this study was to test the cross-cultural interrater reliability of rating scalesdesigned to assess the nonverbal behavior of Taiwanese and American women and men withParkinson‘s disease (PD). The rating scales were derived from those tested previously with Americanraters and people with PD, and which had demonstrated reliability and validity with single ethnicitygroup.Method. Taiwanese (n=6) and American (n=6) raters rated a video-only, 2-minute segment from eachof the videotaped interviews of 8 people with Parkinson‘s disease. The stimulus tape consisted of fourwomen (n=2 Taiwanese and n=2 American) and four men (n=2 Taiwanese and n=2 American) withParkinson‘s disease who ranged in age from 51 to 72. The raters used eight or nine 5-point scales torate interviewee behavior. Interrater reliability coefficients were examined for consistency across raterethnicity, interviewee ethnicity and interviewee gender. Results. The overall interrater reliability of the scales was acceptable across cultures: .58 for a singlerater, and .86 for the average of at least 6 raters. No statistically significant differences in interratercorrelation coefficients were found across the different groups. Conclusion: The study results suggest that raters can reliably detect differences in the intensity andfrequency of the behavior of this client population across ethnicity and gender. ICRP-IEB (PD version-3) Updated as of July 12, 201033Sample 3: ICRP version 3 (continued) Takahashi, K. (2008). Behavior in Parkinson’s disease as related to self-efficacy and outcome expectancy.Unpublished doctoral dissertation, Boston University. Occupational therapy seeks to effectively change clients‘ behavior to result in better quality oflife by both focusing on tasks that clients find purposeful and meaningful and by enhancing clients‘sense of competence. Self-regulatory system theory (Bandura, 1977) similarly demonstrates thatbehaviors are best predicted by the combined influence of self-efficacy and outcome expectancy whichresults in four different motivational states: apathy, hopelessness, protest, and hopefulness. In clinicalcontexts, therapists evaluate clients‘ states by observing clients‘ nonverbal and verbal behavior.However, people with Parkinson‘s disease are often misunderstood about their motivation because oftheir motor symptoms. This dissertation focused on whether people with Parkinson‘s disease displaybehavior that discriminates four categories of motivation, and how context influences their behavior.Men and women with Parkinson‘s disease (N =106) discussed two topics (enjoyable activityversus frustrating activity) during an assessment with a female or male interviewer, and fromvideotaped clips four types of observer-rated motivation (apathy, hopelessness, protest, andhopefulness) as well as 12 verbal and 18 nonverbal discrete behaviors were measured. Nonverbalbehavior was shown to contribute greater to the observers‘ judgment than verbal behavior. Because ofthe impairment of nonverbal behavior in Parkinson‘s disease, observers must be cautious in makinginferences about motivation from nonverbal behavior alone. Displays of apathy and hopelessness wereindicated by less eye movement, smiling, talkativeness, and body movement. Displayed protest wasindicated by more frowning and hopefulness by more smiles. Verbal behaviors were also found toindicate each observed motivation.Interview context (topic, gender of interviewer and participants) was found to influencebehavior in people with Parkinson‘s disease. During the enjoyable compared to frustrating activitytopic, participants smiled more, were generally more facially expressive and used more positive words.With respect to gender effects, participants were less talkative about their negative feelings, seemedmore apathetic, with the same versus opposite gender interviewer (especially male with maleinterviewer). Therapists are encouraged to take interview context into consideration when assessingthe motivation of clients with Parkinson‘s disease. The results suggested that a clinical observationalprocedure for motivation is possible and necessary for people with Parkinson disease. Takahashi, K., Tickle-Degnen, L., Coster, W. J., & Latham, N. (2010). Expressive behavior in Parkinson’sdisease as a function of interview context. American Journal of Occupational Therapy, 64, 483-494. Objective. Parkinson‘s disease affects the ability to express motivation through face, body, and voice;contextual factors may facilitate or inhibit expressive behavior. The purpose of this study was todetermine whether qualities of the interview context are associated with client motivational behavior inParkinson‘s disease. Method. Men and women with Parkinson‘s disease (N = 106) discussed 2 topics (enjoyable activity vs.frustrating activity) during an assessment with a female or male interviewer. From videotaped clips,displays of 4 categories of motivation and 12 verbal and 18 nonverbal behavioral patterns were rated. Results. During the discussion of enjoyable activities, participants used more positive words, smiledmore, and were more facially expressive. Participants were less talkative about their negative feelingsand appeared to be more apathetic with the same-gender interviewer. Conclusion. Occupational therapy practitioners should vary the emotional tone of their questions toimprove the validity of motivation assessments. ICRP-IEB (PD version-3) Updated as of July 12, 201034Huang, P-C. (2009). Social behavior, gender and quality of life in Parkinson’s disease. Unpublisheddoctoral dissertation. Boston University. Recent studies have found that women and men have different experiences living withParkinson's disease (PD) and create different impressions when they have reduced facial expressivity.Previous research also suggests that reduced facial expressiveness, called facial masking, is a commonsymptom in people with PD. Because social relations typically are facilitated through facialexpressiveness, masking may create negative interpersonal impressions. This study examined thequestions: (1) Are there gender differences in quality of life in people with PD? (2) Are thereassociations between facial expressiveness and capacity to show rapport in people with PD? (3) Arethere associations between social behavior (facial expressiveness and rapport) and social well-being?(4) Is there a moderating role of gender?Videotaped interview and data of 104 participants (31 women) were analyzed. Our findingsshowed that women reported more problems in stigmatization, and men reported more problems inactivities of daily life. Both women and men who showed less facial expressiveness were less likely toshow rapport during the interview. Women's higher levels of facial expressivity and rapport behaviorwould occur with fewer problems in social support and communication. These associations remainedsignificant after controlling for covariates including age, living status, marital status, PD duration, PDstage, cognitive status, depression symptoms, and extraversion. The magnitudes of zero-ordercorrelations were generally greater in women compared to men. However, the gender differences thatexisted in zero-order correlations were not supported when controlling for the covariates.The findings demonstrate the need to broaden our knowledge on how certain symptoms mayrelate to people's social roles. The possible moderation of gender should be explored in future studies.Health-care providers should be aware of the potential relationship between facial expressiveness andrapport, and the implications for family, community, and therapeutic relationships. Huang, P-C., Tickle-Degnen, L., Coster, W., & Orsmond, G. (2009, unpublished manuscript). Facialexpressiveness, rapport and gender in Parkinson’s disease. Boston University. Previous research has suggested that reduced facial expressiveness, called facial masking, is acommon symptom in people with Parkinson‘s disease (PD). Because social relations typicallyare facilitated through facial expressiveness, facial masking may create negative interpersonalimpressions. Recent studies have found that women and men have different experiences livingwith PD and create different impressions when they have reduced facial expressivity. This studyexamined the questions: (1) Is there an association between facial expressiveness and capacity toshow rapport in people with PD? And (2) Is there a moderating role of gender? Videotapedinterviews and data of 104 participants (31 women) were analyzed. Both women and men whoshowed less facial expressiveness were less likely to show rapport during the interview. Thisassociation remained significant after controlling for age, living status, marital status, PDduration, PD stage, cognitive status, depression symptoms, and extraversion. Gender differencesthat existed in zero-order correlations were not supported when controlling for these variables.Health-care providers should be aware of the potential relationship between facial expressivenessand rapport, and the implications for family, community, and therapeutic relationships. ICRP-IEB (PD version-3) Updated as of July 12, 201035Sample 4: ICRP version 3 Tickle-Degnen, L., Zebrowitz, L.A., & Ma, H-I. (2010, unpublished manuscript). Gender, culture andhealth care stigma in parkinsonism. Tufts University. The motor symptom of facial masking in Parkinson‘s disease ( ̳poker face‘) involves a reduction in theautomatic and controlled emotional and social response of facial musculature. People with the diseasemay appear apathetic, asocial and cognitively compromised. Previous studies demonstrate thatpractitioners respond negatively to Parkinson‘s induced masking and by over-utilizing facialexpressivity in their impressions draw inaccurate conclusions about psycho-social attributes. Socio-cultural norms about facial expressivity vary according to gender and culture, yet little research hasstudied the effect of socio-cultural factors on practitioners‘ predispositions toward patients who vary infacial expressivity. This study evaluated the effect of parkinsonian masking, gender and culture onpractitioners‘ first impressions of patient psychological attributes. Practitioners (N=284) in Americaand Taiwan judged 12 Caucasian American and 12 Asian Taiwanese women and men patients in videoclips from interviews. Half of each patient group had a moderate degree of facial masking and theother half had near-normal expressivity. Practitioners in both countries judged patients with highermasking to be more depressed and less sociable, less socially supportive, and less cognitivelycompetent than patients with lower masking (P‘s < .0001) despite no difference in tested patientpsychological attributes. The negative effect of higher masking was stronger for women than menpatients, particularly among American patients. Higher masking in American patients wasdisadvantageous for impressions of sociability, while in Taiwanese patients for impressions of socialsupportiveness and cognitive competence. American practitioners were more sensitive to maskingwhen judging sociability and Taiwanese practitioners were more sensitive to masking when judgingcognitive competence. Findings suggest that gender norms related to facial expressiveness interactwith cultural values to influence practitioners‘ impressions of patients with Parkinson‘s disease.Women patients with Parkinson‘s disease appear to be more vulnerable to health care stigmatizationthan men at initial impression, particularly for culturally valued psycho-social attributes. Hemmesch, A.R., Tickle-Degnen, L., & Zebrowitz, L.A. (2009). The influence of facial masking andgender on age peers' impressions of older adults with Parkinson' disease. Psychology & Aging, 24, 542-549. Parkinson‘s disease (PD) involves facial masking, which may impair social interaction. Older adultobservers who viewed segments of videotaped interviews of individuals with PD expressed lessinterest in relationships with women with higher masking and judged them as less supportive. Maskingdid not affect ratings of men in these domains, possibly because higher masking violates gender normsfor expressivity in women but not in men. Observers formed less accurate ratings of the socialsupportiveness and social strain of women than men, and higher masking decreased accuracy forratings of strain. Results suggest that some of the problems with social relationships in PD may be dueto inaccurate impressions and reduced desire to interact with individuals with higher masking,especially women. Bogart, K. R. (2010, unpublished manuscript). A cross-cultural lens analysis of rehabilitation practitioners’perceptions of people with Parkinson’s disease. Tufts University Objective: Research has shown rehabilitation practitioners form inaccurate judgments about thepersonalities of targets with Parkinson‘s disease (PD). However, little is known about the influence ofculture on practitioner impressions. The purpose of this study was to examine three possiblemechanisms for the influence of culture on practitioners‘ accuracy of personality judgments relative to ICRP-IEB (PD version-3) Updated as of July 12, 201036the self-reports of people with PD: universality of trait encoding and decoding, ingroup recognitionadvantage, and variation in trait importance. Participants: 284 rehabilitation practitioners from the United States (US) and Taiwan (TW) and 24targets with PD from the US and TW.Procedure: Participants with PD completed a personality inventory and a videotaped interview.Practitioners judged personality from 80 s. clips of the interviews. Trained research assistants codedtargets‘ expressive behavior. Analysis: Brunswik lens model analysis of the associations between self-reported personality,expressive behavior, and practitioners‘ judgments of target personality across cultures.Results: Cross-cultural differences in achievement were found for 4 of the Big Five personality traits.The pattern of cultural differences in judgment accuracy suggests differences in trait importance, notingroup bias, affected trait perception accuracy. An ingroup recognition bias was not supportedbecause practitioners did not recognize traits of same-culture targets more accurately. Extraversion wasrecognized at levels above chance and accurately recognized equally across cultures, suggesting thatthis personality attribute is universally encoded and decoded. Practitioners across all cultures madepersonality judgments based on the mask, particularly for extraversion.