Leighton Chan's research while affiliated with Bethesda Neuroscience Clinic and other places
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Publications (243)
Objective:
In patients with systemic lupus erythematosus (SLE), fatigue is a debilitating symptom with poorly understood pathophysiology. Cardiorespiratory dysfunction has been hypothesised as a contributor to SLE-fatigue. The purpose of this exploratory study was to examine changes in cardiorespiratory function, following an exercise training pro...
Background:
Susceptibility-weighted imaging (SWI) provides superior image contrast of cerebral microhemorrhages (CMBs). It is based on a three-dimensional (3D) gradient echo (GRE) sequence with a relatively long imaging time.
Purpose:
To evaluate whether an accelerated 3D segmented echo planar imaging SWI is comparable to GRE SWI in detecting CM...
Objective:
To describe headache characteristics over time in patients with traumatic brain injury (TBI).
Setting:
Patients enrolled and followed at the National Institutes of Health Clinical Center between 2011 and 2020.
Participants:
There were 147 patients with TBI, with 74 mild TBI (mTBI), 49 moderate (modTBI), 24 severe (sTBI), and 20 indi...
The disability determination process of the Social Security Administration's (SSA's) disability program requires assessing work-related functioning for individual claimants alleging disability due to mental impairment. This task is particularly challenging because the determination process involves the review of a large file of information, includi...
Manual classification of functional resting state networks (RSNs) derived from Independent Component Analysis (ICA) decomposition can be labor intensive and requires expertise, particularly in large multi-subject analyses. Hence, a fully automatic algorithm that can reliably classify these RSNs is desirable. In this paper, we present a deep learnin...
Background: Invaluable information on patient functioning and the complex interactions that define it is recorded in free text portions of the Electronic Health Record (EHR). Leveraging this information to improve clinical decision-making and conduct research requires natural language processing (NLP) technologies to identify and organize the infor...
Background: Invaluable information on patient functioning and the complex interactions that define it is recorded in free text portions of the Electronic Health Record (EHR). Leveraging this information to improve clinical decision-making and conduct research requires natural language processing (NLP) technologies to identify and organize the infor...
UNSTRUCTURED
Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the...
Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity o...
Traumatic brain injury (TBI) is linked to long-term symptoms in a sub-set of patients who sustain an injury, but this risk is not universal, leading us and others to question the nature of individual variability in recovery trajectories. Extracellular vesicles (EVs) are a promising, novel avenue to identify blood-based biomarkers for TBI. Here, our...
Many patients with traumatic brain injury (TBI) have persistent cognitive deficits, including decreased attention and working memory. This preliminary study examined fMRI data from a clinical trial implementing a 4-week virtual reality driving intervention to assess how sustained training can improve deficits related to traumatic brain injury. Prev...
Background
Secondary use of Electronic Health Records (EHRs) has mostly focused on health conditions (diseases and drugs). Function is an important health indicator in addition to morbidity and mortality. Nevertheless, function has been overlooked in accessing patients’ health status. The World Health Organization (WHO)’s International Classificati...
Recognizing a need for more guidance on the SARS-CoV-2 (COVID-19) pandemic, members of the Archives of Physical Medicine and Rehabilitation Editorial Board invited several clinicians with early experience managing the disease to collaborate on a document to help guide rehabilitation clinicians in the community. This consensus document is written in...
Counselor‐client agreement on the work capacity of clients living with serious mental illnesses informs the counseling relationship and facilitates accurate assessments of client eligibility for public programs. In this exploratory mixed‐methods study, we assessed counselor‐client agreement on clients’ work capacity in 61 established therapeutic dy...
Introduction
Individuals who have experienced a traumatic brain injury (TBI) often have residual balance problems. It remains unclear whether these balance problems are driven by vestibular dysfunction or gait automaticity deficits, particularly in the chronic stages of TBI recovery, since most studies include only acute/sub‐acute cases.
Objective...
Objective
To determine if neurofilament light (NfL), glial fibrillary acidic protein (GFAp), tau, and ubiquitin C-terminal hydrolase-L1 (UCH-L1) measured in serum relate to traumatic brain injury (TBI) diagnosis, injury severity, brain volume, and diffusion tensor imaging (DTI) measures of traumatic axonal injury (TAI) in patients with TBI.
Method...
Objective
To determine if serum neurofilament light (NfL) correlates with cerebrospinal fluid (CSF) NfL, TBI diagnosis, injury severity, brain volume, and diffusion tensor imaging (DTI) estimates of traumatic axonal injury (TAI).
Methods
Participants were prospectively enrolled in Sweden and the United States between 2011-2019. The Swedish cohort...
Patients with pulmonary hypertension (PH) and interstitial lung disease (ILD) typically display a blunted ventilatory function including gas-exchange abnormalities, restrictive lung disorders, decreased lung compliance. With the common experience of dyspnea, the capacity to perform exercise is often severely limited in patients with PH and ILD, whi...
Objective
To present recent evidence on the prevalence, incidence, costs, activity limitations, and work limitations of common conditions requiring rehabilitation.
Methods
This was a systematic review. Medline (PubMed), SCOPUS, Web of Science, and the grey literature were searched for relevant articles about amputation, osteoarthritis, rheumatoid...
Objective: The primary objective of this study was to track the incidence and progression of traumatic microbleeds (TMBs) for up to five years following traumatic brain injury (TBI).
Methods: Thirty patients with mild, moderate, or severe TBI received initial MRI within 48 h of injury and continued in a longitudinal study for up to five years. The...
Background:
Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual's interaction with the world, includi...
Multiple organizations around the world have issued evidence‐based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health‐related outcomes (eg, fatigue, anxiety...
Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The Test of Premorbid Functioning (ToPF), a word reading test co-normed with the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV), was examined as a tool for estimating premorbid intelligence in persons with a history of TBI....
Purpose
This paper aims to estimate the performance of the social security administration (SSA) in dealing with disability benefits applications in American.
Design/methodology/approach
The authors propose a multi-stage data envelopment analysis (DEA) method to analyze the efficiency of 167 hearing offices (HOs) to find the best performed HOs and...
To assess the longitudinal changes in brain volumes, attention/processing speed, executive functioning, language, working memory, and delayed memory up to five years after recent TBI.
OBJECTIVE:
Neuropsychological assessment plays a key role in characterizing and detecting cognitive impairment after traumatic brain injury (TBI). The Rey Tangled Line Test (RTLT), an understudied neuropsychological assessment thought to be capable of detecting visual processing deficits, was examined to determine which cognitive abilities may cont...
Accuracy in measuring function related to one's ability to work is central to public confidence in a work disability benefits system. In the United States, national disability programs are challenged to adjudicate millions of work disability claims each year in a timely and accurate manner. The Work Disability Functional Assessment Battery (WD-FAB)...
Background:
Pulmonary arterial hypertension (PAH) is a chronic debilitating illness. The effects of vigorous aerobic exercise training (AET) on heart function in PAH are poorly understood.
Methods:
Eighteen women with PAH (aged 56.2 ± 8.8 yr, body mass index: 28.8 ± 7.3 kg/m) underwent 10 wk of vigorous AET. Cardiac function was observed at rest...
The occurrence of persistent postconcussive symptoms (PCS) associated with traumatic brain injury (TBI) is an increasing cause of disability and lost productivity. The reasons for these persistent symptoms in a percentage of even mild TBI are poorly understood. The existence of comorbid conditions such as post-traumatic stress disorder or other tra...
Objective:
To assess psychometric properties of the improved Work Disability Functional Assessment Battery (WD-FAB 2.0).
Design:
Longitudinal study.
Setting:
Community.
Participants:
Three samples of working-age (21-66) adults (N=1006): (1) unable to work because of a physical condition (n=375); (2) unable to work because of a mental health...
Objective:
To further improve measurement of work-related physical and mental health by updating the Work Disability Assessment Battery (WD-FAB).
Methods:
Cross-sectional study with 1024 disability claimants and 1000 working age (21 to 66 years) adults in the United States. Developed new items to replenish the WD-FAB and analyzed using factor an...
Background
Assessing functioning and disability among individuals with mental and behavioral health disorders has historically relied on deriving accurate psychiatric diagnoses and assessing symptoms. However, growing empirical evidence suggests that this approach is inadequate to determine real world performance, particularly with respect to work....
Comprehensive, efficient assessment of work-related activity limitations is imperative to government disability programs and clinicians working with patients experiencing work limitations. This article describes the development and initial validation of a newly developed instrument: the Work Disability Functional Assessment Battery (WD-FAB). The WD...
Objective: The high prevalence of fatigue among persons with traumatic brain injury (TBI) may be related to poor cardiorespiratory fitness observed in this population. Oxygen uptake on-kinetics is a method of assessing cardiorespiratory fitness and may be used to examine performance fatigability (decline in performance during a given activity) in p...
Cancer rehabilitation research has accelerated as great attention has focused on improving survivorship care. Recent expert consensus has attempted to prioritize research needs and suggests greater focus on studying physical functioning of survivors. However, no analysis of the publication landscape has substantiated these proposed needs. This manu...
Objective:
To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation: the Physical Work Performance Evaluation (PWPE).
Design:
Cross-sectional.
Setting:
Outpatient rehabilitation.
Pa...
Traumatic brain injury (TBI) is caused by a sudden trauma to the head that may result in hematomas and contusions and can lead to stroke or chronic disability. An accurate quantification of the lesion volumes and their locations is essential to understand the pathophysiology of TBI and its progression. In this paper, we propose a fully convolutiona...
Purpose To improve the mental health component of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration’s (SSA) disability determination process. Specifically our goal was to expand the WD-FAB scales of mood & emotions, resilience, social interactions, and behavioral control to improve the d...
Background
There is a concerted effort underway to evaluate and reform our nation’s approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities.
Objective
This literature review characterizes the current state of knowledge on the measurement of chronic disease and disab...
Increasingly, health-care research may involve the analysis of "secondary data" referring to data collected by someone other than the user. Secondary data sources can be research or survey based but often they are the by-products of health-care providers' nonresearch activities. This includes administrative (billing) as well as clinical activities....
The importance of functional status information (FSI) has become increasingly evident in recent years [1, 2]. However, implementation, application, and normalization of FSI in health care and Electronic Health Records (EHRs) have been largely underexplored. The World Health Organization's International Classification of Functioning, Disability and...
Evaluating the accuracy (ie, estimating the sensitivity and specificity) of new diagnostic tests without the presence of a gold standard is of practical meaning and has been the subject of intensive study for several decades. Existing methods use 2 or more diagnostic tests under several basic assumptions and then estimate the accuracy parameters vi...
People who have cancer diagnoses often need care throughout their lives through all stages of their illness. These stages include diagnosis, primary treatment, survivorship, and end of life. The management of people with cancer, now a common and chronic illness with long-term survival improving, is complex, challenging, and rapidly changing. Rehabi...
Background:
Among working age adults in the United States, there is a large, heterogeneous population that requires ongoing and elevated levels of healthcare and related services. At present, there are conflicting approaches to the definition and measurement of this population in health services research.
Objective:
An expert panel was convened...
Objective:
Examine the association of cognitive reserve (CR) factors (estimated premorbid intelligence quotient [IQ], years of education, and occupational attainment) and traumatic brain injury (TBI) severity with functional and neuropsychological outcomes 1 to 5 years following TBI.
Participants:
Patients with mild (N = 58), moderate (N = 25),...
Background Context
Common data elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. Although CDEs have been developed for a number of disorders, to date CDEs for lumbar spinal stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, t...
One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The Nation...
One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The Nation...
Purpose To expand content of the physical function domain of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration’s (SSA) disability determination process. Methods
Newly developed questions were administered to 3532 recent SSA applicants for work disability benefits and 2025 US adults. Fact...
The basket trial is a recent development in the clinical trial practice. It conducts the test of the same treatment on several different related diseases in a single trial, and has the advantage of reduced cost and enhanced efficiency. A natural question is how to assess the performance of the group sequential basket trial against the classical gro...
The article proposes a unified least squares method to estimate the receiver operating characteristic (ROC) parameters for continuous and ordinal diagnostic tests, such as cancer biomarkers. The method is based on a linear model framework using the empirically estimated sensitivities and specificities as input “data.” It gives consistent estimates...
BJOT, like many major occupational therapy and rehabilitation journals, has already adopted guidelines for reporting. Since 2015, when the journal moved to SAGE for publication, BJOT has conformed to the ICMJE requirement (International Committee of Medical Journal Editors[ICMJE], n.d.) that clinical trials are registered in a WHO-approved public t...
Background:
Exercise training is associated with elevations in mood in patients with various chronic illnesses and disabilities. However, little is known regarding the effect of exercise training on short and long-term mood changes in those with traumatic brain injury (TBI).
Objective:
The purpose of this study was to examine the time course of...
Date Presented 4/10/2016
This research describes the development of the Work Disability Functional Assessment Battery (WD–FAB). The WD–FAB characterizes a person’s functioning along six key dimensions. The WD–FAB may be useful among occupational therapists focusing on work rehabilitation and disability evaluation.
Primary Author and Speaker: Elizab...
Study design:
Retrospective, observational study.
Objective:
To determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.
Summary of background data:
Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of...
The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability impact a majority of patients during and after disease treatment. Rehabilitation health ca...
Post-traumatic stress disorder (PTSD) is commonly associated with mild traumatic brain injury (mTBI). To better understand their relationship, we examined neuroanatomical structures and neuropsychological performance in a sample of individuals with mTBI, with and without PTSD symptoms. Thirty-nine subjects with mTBI were dichotomized into those wit...
25 adults were selected for inclusion in this study from a larger natural history study of TBI. Participants were classified as having a non-penetrating TBI as defined by the VA/DoD severity rating scale. This classification system was modified in that participants who met criteria for mild TBI but had positive MRI findings were classified as “comp...