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Biomedical subjects

G Goldenberg

Publications and source records attributed to G Goldenberg.

At least 19 recordsLinked to original sources
PubMed2005

'Fiber 7' supplement as an alternative to laxatives in a nursing home.

BACKGROUND: Chronic constipation is a common and bothersome problem in elderly nursing home patients. Although fibre has a known role in the treatment of constipation, laxatives are still widely used in nursing home patients. OBJECTIVE: To determine whether the addition of a fibre supplement to oral diet can reduce the use of laxatives in a long-term care facility. PARTICIPANTS AND METHODS: Oral diet of 92 nursing home residents (all older than 65) on chronic laxatives (docusate, milk of magnesia with Cascara, psyllium) was supplemented with 'Fiber 7', a natural powder fibre (7 g per meal twice a day). During the next 2.5 years discontinuation of laxatives was attempted. RESULTS: Laxatives were successfully discontinued in 63 of the 92 patients (68.5%, 95% confidence interval 59-78%). The fibre supplement was well tolerated. The cost of care was decreased by dollar 3.5 per patient every month or by dollar 220/month for the 63 patients. CONCLUSIONS: Use of 'Fiber 7' allowed discontinuation of laxatives in 63 of 92 nursing home residents. The fibre supplement was a safe and convenient alternative to laxatives and decreased the cost of medical care.

Aged↗
PubMed2004

The effect of tactile feedback on pantomime of tool use in apraxia.

OBJECTIVE: To investigate whether apraxic patients' better performance with real tools compared to miming is due to the tactile feedback provided by holding the tool. METHODS: Ten patients with aphasia and apraxia from left hemisphere damage were asked to demonstrate the use of 12 tools and objects under three conditions: miming with empty hands, miming with an implement shaped like the handle of the tool, and using the real tool with its corresponding object. RESULTS: Whereas real tool use was much better than pantomime in all patients, tactile feedback from the isolated handle facilitated miming only in some and deteriorated it in others so that across the group there was no significant improvement. CONCLUSIONS: The better performance of real than of pretended tool use does not depend on tactile feedback per se, but on the mechanical affordances and constraints of tools and objects transmitted by this feedback in real use. Tactile feedback deprived of these contents and restricted to the shape of the handle does not substantially help produce the appropriate action.

Adult↗
PubMed2003

The dependence of ipsilesional aiming deficits on task demands, lesioned hemisphere, and apraxia.

Neuroimaging studies as well as neurophysiological and lesion data indicate that the ipsilateral hemisphere plays a role in controlling the active limb. However, the nature and the conditions of this ipsilateral control are not well understood. We measured aiming movements with the ipsilesional limb toward targets with different characteristics which were made by patients with unilateral left brain damage (LBD) or right brain damage (RBD). The movement kinematics were analysed. Performance measures of the pointing movements were impaired in LBD patients, whereas RBD patients performed normally. LBD patients had obvious deficits during all tasks; however, they were exacerbated when high accuracy was required, and when an exocentric target had to be reached without visual feedback. Thus, the motor-dominant hemisphere plays a specific role in the programming and execution of ipsilateral aiming movements, and the importance of ipsilateral control increases with increasing task demands. To assess the relationship between pointing deficits and apraxia in LBD patients, the imitation of meaning gestures was tested. We replicated a recent study, showing that deviations of the final hand position from the demonstration were not correlated with abnormal kinematics of the corresponding arm movement when LBD patients performed this test. However, there were correlations between related kinematic measures during pointing and gesture imitation. These findings suggest a deficit of motor programming and execution after damage to the motor-dominant brain which is unrelated to the spatial errors characteristic of apraxia. This deficit affects different types of goal-directed aiming movements and its severity depends on task demands.

Adult↗
PubMed2002

Ipsilesional deficits during fast diadochokinetic hand movements following unilateral brain damage.

Impaired sensorimotor function of the hand ipsilateral to a unilateral brain lesion has been reported in a variety of motor tasks; however, elementary diadochokinetic movements, such as tapping with the index finger, seem to be preserved in chronic-lesion patients. Three different diadochokinetic movements (forearm diadochokinesis, hand tapping (HT) and finger tapping (FT)) were tested in patients with left brain damage (LBD) and right brain damage (RBD) and control subjects. Movements were measured three-dimensionally and the kinematics of joint angles were analyzed. While the patients' measures of movement speed and symmetry appeared normal, detailed kinematic analysis revealed clear deficits in several measures of movement variability, which reflected decreased regularity of the alternating movement cycles. This impairment was greater in LBD patients and tended to be greater during forearm diadochokinesis. The necessity of ipsilateral control in addition to dominant, contralateral control, especially during left hand and more complex or more proximal manual tasks may account for these findings. In addition, the role of apraxia (defined by impairments during the imitation of gestures) in the performance deficits of LBD patients was also assessed. Although, some performance decrements were associated with the presence of apraxia, these were different from the group findings and restricted to the two tapping tasks. Thus, although apraxia may have caused deficits in establishing dynamic representations of the elementary postures in conditions of high speed and low complexity, the disturbances during diadochokinetic movements must for the most part be attributed to more motor-related deficits of ipsilateral sensorimotor control, which are particularly apparent when the motor dominant left hemisphere is affected. The absence of clear correlations between performance deficits and lesion characteristics suggests that a distributed network is involved in this ipsilateral control.

Adult↗
PubMed2002

Neck muscle vibration induces lasting recovery in spatial neglect.

OBJECTIVES: To evaluate whether neck muscle vibration is an effective technique for neglect rehabilitation, with lasting beneficial effects. METHODS: The effects of differential treatment of visual exploration training alone or in combination with neck muscle vibration were evaluated in a crossover study of two matched groups of 10 patients suffering from left sided neglect. Each group received a sequence of 15 consecutive sessions of exploration training and combined treatment. The effects of treatment were assessed with respect to different aspects of the neglect disorder such as impaired perception of the egocentric midline, exploration deficits in visual and tactile modes, and visual size distortion. The transfer of treatment effects to activities of daily living was examined by a reading test and a questionnaire of neglect related everyday problems. All variables were measured six times: three baseline measurements, two post-treatment measurements, and one follow up after two months. RESULTS: The results showed superior effects of combination treatment. A specific and lasting reduction in the symptoms of neglect was achieved in the visual mode, which transferred to the tactile mode with a concomitant improvement in activities of daily living. The improvement was evident two months after the completion of treatment. In contrast, isolated exploration training resulted in only minor therapeutic benefits in visual exploration without any significant transfer effects to other tasks. CONCLUSIONS: Neck muscle vibration is a decisive factor in the rehabilitation of spatial neglect and induces lasting recovery when given as a supplement to conventional exploration training.

Activities of Daily Living↗
PubMed2001

Cortical correlates of gesture processing: clues to the cerebral mechanisms underlying apraxia during the imitation of meaningless gestures.

The clinical test of imitation of meaningless gestures is highly sensitive in revealing limb apraxia after dominant left brain damage. To relate lesion locations in apraxic patients to functional brain activation and to reveal the neuronal network subserving gesture representation, repeated H2(15O)-PET measurements were made in seven healthy subjects during a gesture discrimination task. Observing paired images of either meaningless hand or meaningless finger gestures, subjects had to indicate whether they were identical or different. As a control condition subjects simply had to indicate whether two portrayed persons were identical or not. Brain activity during the discrimination of hand gestures was strongly lateralized to the left hemisphere, a prominent peak activation being localized within the inferior parietal cortex (BA40). The discrimination of finger gestures induced a more symmetrical activation and rCBF peaks in the right intraparietal sulcus and in medial visual association areas (BA18/19). Two additional foci of prominent rCBF increase were found. One focus was located at the left lateral occipitotemporal junction (BA 19/37) and was related to both tasks; the other in the pre-SMA was particularly related to hand gestures. The pattern of task-dependent activation corresponds closely to the predictions made from the clinical findings, and underlines the left brain dominance for meaningless hand gestures and the critical involvement of the parietal cortex. The lateral visual association areas appear to support first stages of gesture representation, and the parietal cortex is part of the dorsal action stream. Finger gestures may require in addition precise visual analysis and spatial attention enabled by occipital and right intraparietal activity. Pre-SMA activity during the perception of hand gestures may reflect engagement of a network that is intimately related to gesture execution.

Adult↗
PubMed2001

Imitation and matching of hand and finger postures.

Converging evidence from patients with unilateral brain lesions, from a patient with callosal disconnection, and from functional imaging in healthy subjects suggests different competencies of both hemispheres for imitation and matching of hand and finger postures. Whereas the left hemisphere is fully competent for processing hand postures, an additional right hemisphere contribution is needed for finger postures. I propose that the left hemisphere is responsible for coding gestures with reference to knowledge about the structure of the human body, whereas a right hemisphere contribution is needed for visuospatial exploration and analysis of gestures. Single case studies of patients with visuoimitative apraxia and results of functional imaging suggest a prominent role for left area 40 for body-part coding. Additional activation of left MT/V5 in the functional neuroimaging study may be related to processing of the motion implied by the gesture which is presented as a static image.

Attention↗
PubMed2001

Imitation of gestures by disconnected hemispheres.

PU's corpus callosum was severed as a sequel of bleeding from an arteriovenous malformation. The lesion affects the truncus and the splenium and caused somatosensory and visual disconnection of the hemispheres. On clinical testing PU's left hand was apraxic for pantomime of object use but not for imitation. By contrast, when stimuli for imitation of meaningless hand and finger postures were presented tachistocopically to either the left or the right visual field, both hemispheres turned out to be apraxic in different ways. Imitation of hand postures was perfect for right-handed imitation of stimuli presented to the left hemisphere but defective in all other conditions. Imitation of finger postures was below the normal range in all conditions initially, but improved to normality for right-hand imitation of stimuli presented to the left hemisphere after repeated testing. After successful imitation of gestures presented to the left hemisphere PU commented that he imitated without really seeing the stimulus by "formulating the unseen", whereas after presentation to the right hemisphere he felt that he saw the stimulus but could not imitate. We propose that imitation of meaningless gestures affords a coding of gestures with reference to knowledge about body parts which can be applied only by the left hemisphere. Imitation of finger postures puts additional demands on fine grained visuospatial discrimination which necessitates a contribution by the right hemisphere.

Adult↗
PubMed2001

Stability of employment after brain injury: a 7-year follow-up study.

Forty-three patients with severe traumatic brain injury (n = 24), cerebrovascular diseases (n = 15), or other acquired brain damage (n = 4) were followed-up 7-8 years after neuropsychological rehabilitation including a vocational re-entry programme. Current vocational status and work history since rehabilitation were investigated by means of a structured interview. Before interview, the patients were classified on the basis of medical records into four groups: (A) patients with minor residual neuropsychological impairments, (B) patients with minor impairments but psychopathological symptoms, (C) patients with persistent neuropsychological impairments showing no psychopathological symptoms, and (D) patients with persistent impairments and psychopathological symptoms. For patients in group A, a good, and for those in group D, a poor long-term employment outcome was predicted, while no predictions were made for the intermediate groups. Of the 43 interviewed subjects, 16 (37%) reported a stable return to work at pre-morbid level and seven (16%) at a lower level. In eight patients (19%), persisting difficulties in maintaining work were documented. Twelve subjects (28%) had retired within a period of 2 years after work trial. The relationship between patient classification and long-term employment outcome was only weak. Four out of 11 patients with a good prognosis (group A) experienced vocational adjustment problems or had retired. Three out of 10 patients with a poor prognosis (group D) were able to continue successfully with their previous jobs. These cases are described in detail. The employment outcome of the intermediate groups was very heterogeneous. The results suggest that particular attention should be paid to the long-term consequences of a reduced capacity for work, even if minor in degree. The success of patients despite a poor prognosis illustrate unsolved problems in relation to the ecological validity of neuropsychological measures of executive dysfunctions.

Adolescent↗
PubMed2000

Cerebellar volume in humans related to magnitude of classical conditioning.

Neural circuits in the cerebellum are essential for eyeblink classical conditioning, and hippocampal activation is also present during acquisition. Anatomical (volumetric) brain MRI, delay eyeblink conditioning and neuropsychological tests were administered to eight healthy older subjects. The correlation between cerebellar volume (corrected for total cerebral volume) and conditioned response percentage was 0.81 (p < 0.02), but neither hippocampal nor total cerebral volume correlated with conditioning or any neuropsychological test scores. There was no relationship between age and cerebellar volume, but the correlation between hippocampal volume and age was -0.80 (p < 0.02). These volumetric results add to the increasing evidence in humans demonstrating a relationship between the integrity of the cerebellum and eyeblink classical conditioning.

Aged↗
PubMed1999

Effects of unilateral brain damage on grip selection, coordination, and kinematics of ipsilesional prehension.

To determine whether the left and right hemispheres play specific roles in goal-directed movements, prehension with the ipsilesional hand was tested in patients with unilateral brain damage. The task required that subjects rotate the hand while reaching for a bar that was presented in different orientations in the frontal plane, thus making high demands on visuospatial processing. The grasped bar had to be put into a hole: under one task condition the placement of the bar was specified, while under another it was not. The constrained task required that the subject anticipate the placing action when planning the initial prehensile movement. Grip selection, reaction times, kinematics of the transport movement, and coordination of hand rotation during transport were assessed in ipsilesional movements of 22 patients with either left or right brain damage (LBD and RBD) and in control subjects. Patients in both groups exhibited performance deficits; however, impairment characteristics differed profoundly between the groups. RBD patients showed prolonged reaction time and degraded kinematics in the unconstrained task, whereas LBD patients performed relatively well when only the orientation of the bar varied, but slowly and frequently incoordinated when the subsequent action was specified. Our findings emphasize the dominant role of the right hemisphere in processing visuospatial aspects of goal-directed movements, whereas the left hemisphere subserves non-spatial aspects of preplanning under increased task demands. Correlations of the patient's performance with results from clinical tests showed that neither deficits in visuospatial perception of RBD patients nor apraxia of LBD patients could account for the observed abnormalities in the use of the ipsilesional hand.

Adult↗
PubMed1999

Prehension with the ipsilesional hand after unilateral brain damage.

Sensorimotor deficits in the hand ipsilateral to a brain lesion have been reported in different motor tasks. We evaluated performance of the ipsilesional hand in 12 patients with either left (LBD) or right brain damage (RBD) by kinematic analysis in order to precisely characterize possible deficits in the two components of prehension (transport and grasp). Both patient groups exhibited performance deficits in the main kinematic parameters, e.g., reduced velocity of the transport component and prolonged movement time. However, while LBD patients showed a more general slowing, RBD patients prolonged in particular the last phase of the movement toward the object. We suggest that relevant visuospatial representations and the adequate mapping of motor processes may be impaired after RBD. In contrast, LBD caused a more unspecific disturbance pattern, supporting the view that the precise parameterization of motor programs is impaired. Maximum grip aperture was normal in both patient groups. However, since aperture could be biased by slowed movement, the notion that the grasp component was preserved remains speculative. The patient's ability to scale the maximum velocity of the transport component to adapt to changes in movement amplitude and to scale the maximum hand aperture of the grasp component to adapt to object size was preserved in both groups. Thus both hemispheres can have competence for this scaling mechanism.

Adult↗
PubMed1999

Matching and imitation of hand and finger postures in patients with damage in the left or right hemispheres.

To disentangle perceptual, conceptual and motor aspects of imitation of gestures, reproduction of meaningless postures of either the hand or the fingers was examined in two conditions. In the matching test a target gesture had to be identified among an array of four gestures performed by different persons and seen under different angles of views. For imitation, the same gestures had to be imitated. Thirty-five patients with LBD, 21 patients with RBD, and 17 healthy controls were examined. LBD patients had more difficulties with imitation than with matching while RBD patients had more difficulties with matching than with imitation. Regardless of whether imitation or matching was tested, LBD patients made more errors with hand than with finger postures whereas RBD patients made more errors with finger than with hand postures. This constellation of results is compatible with the assumption that errors are caused by faulty visuoperceptual processing in RBD, and by defective conceptual mediation in LBD. Defective motor execution does not appear to be a significant source of imitation errors in either group.

Adult↗
PubMed1999

Basal forebrain amnesia: does the nucleus accumbens contribute to human memory?

OBJECTIVE: To analyse amnesia caused by basal forebrain lesions. METHODS: A single case study of a patient with amnesia after bleeding into the anterior portion of the left basal ganglia. Neuropsychological examination included tests of attention, executive function, working memory, recall, and recognition of verbal and non-verbal material, and recall from remote semantic and autobiographical memory. The patient's MRI and those of other published cases of basal forebrain amnesia were reviewed to specify which structures within the basal forebrain are crucial for amnesia. RESULTS: Attention and executive function were largely intact. There was anterograde amnesia for verbal material which affected free recall and recognition. With both modes of testing the patient produced many false positive responses and intrusions when lists of unrelated words had been memorised. However, he confabulated neither on story recall nor in day to day memory, nor in recall from remote memory. The lesion affected mainly the nucleus accumbens, but encroached on the inferior limb of the capsula interna and the most ventral portion of the nucleus caudatus and globus pallidus, and there was evidence of some atrophy of the head of the caudate nucleus. The lesion spared the nucleus basalis Meynert, the diagnonal band, and the septum, which are the sites of cholinergic cell concentrations. CONCLUSIONS: It seems unlikely that false positive responses were caused by insufficient strategic control of memory retrieval. This speaks against a major role of the capsular lesion which might disconnect the prefrontal cortex from the thalamus. It is proposed that the lesion of the nucleus accumbens caused amnesia.

Amnesia↗
PubMed1998

The more you know the less you can tell: inhibitory effects of visuo-semantic activation on modality specific visual misnaming.

WH, a 77-years old right-handed psychoanalyst, displayed modality specific visual misnaming as a sequel of an embolic stroke in the left posterior cerebral artery. WH's errors in visual object naming consisted mainly of semantic paraphasias and perseverations. His verbalizations during testing sometimes manifested a conflict between correct responses and perseverations. Analysis of the stream of information from visual perception via semantics to phonology suggested incomplete access from vision to semantics as the source of errors. The disconnection did not affect verbo-visual matching, though he was unable to reject names that did not correspond to visual stimuli. Action naming was relatively spared, but naming of pictures of actions with objects was worse than naming of pictures of intransitive actions. Tactile naming worsened with simultaneous vision of objects. In visual object naming the error rate increased with increasing familiarity of objects. We propose that an interaction of excitation and inhibition within a single semantic system can explain the clinical phenomena of modality specific visual misnaming.

Aged↗
PubMed1998

Tool use and mechanical problem solving in apraxia.

Moorlaas (1928) proposed that apraxic patients can identify objects and can remember the purpose they have been made for but do not know the way in which they must be used to achieve that purpose. Knowledge about the use of objects and tools can have two sources: It can be based on retrieval of instructions of use from semantic memory or on a direct inference of function from structure. The ability to infer function from structure enables subjects to use unfamiliar tools and to detect alternative uses of familiar tools. It is the basis of mechanical problem solving. The purpose of the present study was to analyze retrieval of instruction of use, mechanical problem solving, and actual tool use in patients with apraxia due to circumscribed lesions of the left hemisphere. For assessing mechanical problem solving we developed a test of selection and application of novel tools. Access to instruction of use was tested by pantomime of tool use. Actual tool use was examined for the same familiar tools. Forty two patients with left brain damage (LBD) and aphasia, 22 patients with right brain damage (RBD) and 22 controls were examined. Only LBD patients differed from controls on all tests. RBD patients had difficulties with the use but not with the selection of novel tools. In LBD patients there was a significant correlation between pantomime of tool use and novel tool selection but there were single cases who scored in the defective range on one of these tests and normally on the other. Analysis of LBD patients' lesions suggested that frontal lobe damage does not disturb novel tool selection. Only LBD patients who failed on pantomime of object use and on novel tool selection committed errors in actual use of familiar tools. The finding that mechanical problem solving is invariably defective in apraxic patients who commit errors with familiar tools is in good accord with clinical observations, as the gravity of their errors goes beyond what one would expect as a mere sequel of loss of access to instruction of use.

Adult↗