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PubMed2000

Screening for developmental language disability in 3-year-old children. Experiences from a field study in a Swedish municipality.

This study evaluates a screening instrument for identification of severe developmental language disability (DLD) in 3-year-old children, which is used as a routine assessment at several child health centres (CHCs) in Sweden. The results are reported in terms of clinical outcome (false- and true-positive rates), kind and extent of DLD, signs of comorbidity and relation between nurses' and parents' observations. More than 60 CHC nurses, all with experience of the screening instrument, assessed in all 2359 3-year-old children (98% of the whole population) by direct observation of their language comprehension, language production and level of co-operation. In addition to the screening parents answered a questionnaire. Children who failed the screening had their hearing assessed and were clinically examined by trained speech and language therapists. Forty-four (34 boys and ten girls) of the 65 referred children were clinically examined. Apart from two false-positive cases most of them were diagnosed as generally and severely language disabled. According to the nurses' observations attention deficit was common among the referred boys, which was later confirmed by the speech therapist in two-thirds of them. Agreement between nurses and parents was poor and only half of the parents were concerned about their child's language development. In the light of this result, continued application of the screening and the use of parent questionnaires is discussed.

Child, Preschool↗
PubMed1990

[Registration of detailed data in the medical record or how to translate "impressions" into measurable observations].

Every medical case record represents a mass of data (texts, pictures, figures, etc.) in an unstructured form. The physician needs to retrieve this data via several access routes: temporal (dependent on date or sequences of events), type of data (diagnostic, treatment, clinical signs, laboratory findings, image descriptors, all with their interrelationships), or depending on the severity of the disease, etc. Retrieval of this data fulfils several functions: circulation of a case record among specialists, assistance in summarizing a long and complex clinical course, comparison of patients, research, and teaching. Three projects are described which have the same aim: structuring of the case record in order to retrieve detailed data on patients as individuals and describe clinical courses on the basis of measurable observations. This structure must be understandable to a computer (directly or indirectly) so that searches and comparisons can be performed automatically. The first project, entitled "indexed paragraph prototype" reproduces the structure of the problem-oriented case record and is designed to input the Medical Outpatients Department's follow-up notes into the computer. The second, "automatic language analysis", aims to exploit two characteristics of medical language, its omnipresence in the case record and its reliability, in view of its status as the spontaneous vehicle of communication between physicians. The third, "collection of clinical signs during consultation", is based on a prospective collection of all elements of clinical observation, structured temporally consultation by consultation. The purpose of precise collection of detailed and measurable observations in individual patients is to identify those among the clinical signs which display the greatest power of discrimination, i.e. those which best serve to predict the case's evolution.

Abstracting and Indexing↗
PubMed1997

Isolation of a right hemisphere cognitive system in a patient with anarchic (alien) hand sign.

We report evidence of isolated conceptual knowledge in the right hemisphere of a woman with chronic anarchic hand sign after ischemic infarction of the central four-fifths of the corpus callosum. Limited visual information was available to the right hemisphere, access to medial temporal structures subserving memory was disrupted and disconnection from left hemisphere language structures was complete. Still, the right hemisphere could build mental representations of objects via tactile input and use them in cross-modal matching. These representations were not accessed consistently in auditory comprehension or naming tasks. This functional specificity and its pathoanatomical correlates demonstrate that the study of anarchic hand sign can illuminate not just motor control issues but may inform our understanding of the representation and lateralization of conceptual knowledge as well.

Brain Diseases↗
PubMed1991

Classifying by dimensions and reading: a comparison of the auditory and visual modalities.

Children have difficulty learning to read alphabetic writing systems, in part, because they have difficulty segmenting spoken language into phonemes. Young children also have difficulty attending to the individual dimensions of visual objects. Thus, children's early difficulty in reading may be one sign of a general inability to selectively attend to the parts of any perceptual wholes. To explore this notion, children in kindergarten through fourth grade (Experiments 1, 3, and 4) and adults (Experiment 2) classified triads of spoken syllables and triads of visual objects. Classifying speech by common parts was positively related to reading and spelling ability (Experiments 1 and 4), but usually not to classifying visual stimuli by common parts under free classification instructions (Experiments 1 through 3). However, classification was more consistent across the visual and auditory modalities when the children were told to classify based on a shared constituent (Experiment 4). Regardless of instructions, performance on the visual tasks did not usually relate to reading and spelling skill. The ability to attend selectively to phonemes seems to be a "special" skill--one which may require specific experiences with language, such as those involved in learning to read an alphabetic writing system.

Attention↗
PubMed2006

Thought disorder in schizophrenia is associated with both executive dysfunction and circumscribed impairments in semantic function.

BACKGROUND: Formal thought disorder (FTD) has long been regarded as a key sign of schizophrenia but little is known about its origins or aetiology. One suggestion is that it is directly related to disordered language functioning; a second is that it is a reflection of poor neurocognitive functioning. A current model posits that it is related to a combination of executive dysfunction and impaired semantic processing. METHOD: To examine these alternative ideas, a heterogeneous group of 30 patients, all carrying a diagnosis of schizophrenia, and 18 non-patient controls completed a series of neurocognitive and psycholinguistic tests, and a clinical review that, inter alia, permitted assessment of thought disorder (TD) using the Thought, Language and Communication Scale (TLC). RESULTS: Patients generally performed at a lower level on most components of the test battery, but there was little evidence of a relationship between TD and syntactic psycholinguistic function. However, schizophrenic patients manifesting higher levels of TD performed at a lower level on tests sensitive to executive dysfunction and semantic impairments. CONCLUSIONS: The origins of TD seem more closely linked to deficits in executive functioning and semantic processing than to impairments in other language functions or general cognition.

Adolescent↗
PubMed1975

Verbal coding strategies used by hearing-impaired individuals.

A paired-associate verbal learning task was used to determine the type of perceptual coding strategies hearing-impaired persons use in auditory perceptual processing of language. Four lists of word pairs were devised, whereby the word pairs in each list were characterized as sharing either similar sign-similar meaning, dissimilar sign-similar meaning, similar sign-dissimilar meaning, or dissimilar sign-dissimilar meaning. Severely hearing-impaired subjects were required to replace the missing word associated with the word pairs. The results showed that, while the subjects were able to code the verbal material on both a sign basis and a semantic basis, the semantic coding strategy appeared to be more efficient than the sign coding strategy. The findings are related to earlier investigations and are explained according to a theoretical model of perception.

Adolescent↗
PubMed2006

Recurrence of hypertrophic spinal pachymeningitis. Report of two cases and review of the literature.

Hypertrophic spinal pachymeningitis (HSP) is a comparatively rare disease characterized by hypertrophic inflammation of the dura mater and clinical symptoms that progress from local pain to myelopathy. The authors report two cases of recurrent HSP and review the English- and Japanese-language literature focusing on the recurrence of HSP. In the first case, a man who presented at 67 years of age with lower-extremity numbness, gait disturbance, and bladder dysfunction experienced two recurrences of HSP during the 11 years of follow up after his initial laminectomy. Both recurrences were successfully treated with laminoplasty and duraplasty. Three years after his last surgical procedure, he was still able to walk with the aid of a walker. In the second case, a man who presented at 62 years of age with lower-extremity numbness and gait disturbance was initially treated successfully with steroid pulse therapy. Approximately 8 months after his initial presentation, his symptoms recurred. He underwent laminoplasty and duraplasty. At the 2.5-year follow-up examination, he had only mild neurological deficits and was still able to walk unaided. To explore possible causes of recurrence, the authors searched the English- and Japanese-language literature for cases of HSP. Of the 96 cases identified, 11 were recurrent. Data on the presence or absence of inflammatory signs were available for 84 patients. A chi-square analysis revealed a significantly increased rate of recurrence for patients who had at least one positive inflammatory sign before surgery (six [20%] recurrent cases of 30) compared with those who had no positive inflammatory signs before surgery (two [3.7%] recurrent cases of 54) (p < 0.05). The authors conclude that HSP recurrence occurs because of active inflammation of the dura before surgery and the influence of chronic inflammation, including residual arachnoiditis.

Aged↗
PubMedDate not supplied

Longitudinal progression of subclinical structural brain disease in normal aging.

OBJECTIVE: The authors describe four types of brain structural change in "normal aging:" cortical atrophy, central atrophy, deep white-matter hyperintensities (DWMH), and periventricular hyperintensities (PVH). Cross-sectional investigations have reported that greater volumes of these forms of "subclinical structural brain disease" (SSBD) were found with increasing age. Greater volumes were also associated with poorer cognition, even though subjects performed within the normal range. The natural history of these forms of SSBD and their functional impact are not well established. METHODS: Twenty-nine normal subjects, ages 60-89, were examined longitudinally by volumetric magnetic resonance imagery, with two assessments performed at least 2 years apart; 26 also completed neuropsychological testing to evaluate processing speed, executive functions, language, and other cognitive functions. Associations between structure and function were evaluated with regression models. RESULTS: For most subjects, the volumes for signs of all types of SSBD were found to have increased; for many subjects, increases were small, and a few showed no change or small decreases. PVH and DWMH increases were predicted by baseline cerebrovascular risk factors. Cognitive test performance changed little over time for these normal subjects. CONCLUSIONS: SSBD volumes increased for most subjects over time, with small average increases for most types. Pretreatment cerebrovascular risk factors were associated with greater increases of PVH and DWMH, suggesting that progression of these types of SSBD may be amenable to intervention.

Aged↗
PubMed1979

Spoken words and manual signs as encoding categories in short-term memory for mentally retarded children.

The release from proactive inhibition paradigm was used to test differential encoding of manual signs and spoken words by six severely retarded children. Scores for shift conditions were significantly different from scores for nonshift conditions on the last trial, indicating that manual signs were encoded differently from spoken words for short-term memory storage. Implications of separate encoding categories for the investigation of language processes were discussed.

Adolescent↗
PubMed1993

Evaluating and selecting an information system, Part 2.

Final steps in the evaluation and selection of a computerized information system for the pharmacy department are described. Once the computerization committees have been established, the needs assessment has been conducted, and vendors have responded to the request for proposal, the vendors and their products are subjected to quantitative and qualitative evaluations. The quantitative evaluation involves factors that can be counted, weighted, or tabulated and involves little professional judgment. Vendors can be quantitatively evaluated on the basis of the utility and features of the proposal, the fields to which the product applies, financial strength, product maturity, number of installations, regional presence, user group, software releases and upgrades, personnel, technology, and system costs. The qualitative evaluation requires judgment and intuition and is best performed by pharmacists. Vendors can be qualitatively evaluated on the basis of references, site visits, personnel, demonstrations and presentations, history and plans, user group, product literature, implementation plans, technology, and personalities. The steering committee makes the final selection of a system, and a contract is written that safeguards the hospital's interests. The contract should include performance criteria, promises made orally by salespersons, protection against software and other defects, a phased-in payment schedule, and language covering hardware, support and maintenance, default, and liability. Resources should be budgeted for implementation and stress testing after the contract is signed. Costly errors in selecting a pharmacy information system can be avoided by thoroughly evaluating vendors and writing a contract that protects the hospital.

Clinical Pharmacy Information Systems↗
PubMed1987

Use of the alternating treatments design as a strategy for empirically determining language training approaches with mentally retarded children.

The present study was conducted as a practical demonstration of the potential utility of the alternating treatments design (ATD) in determining the most efficacious language training approach with mentally retarded children. Two subjects were chosen who used single words to communicate but who did not combine words to form sentences. Two sentence triads consisting of four words each and rated as equivalent in difficulty were trained. Each triad had one sentence trained using oral speech methods, a second trained using total communication methods, and a third sentence trained using a "modified" total communication approach. Each training procedure involved chaining sentence parts, reinforcement, and prompting. Oral methods involved presenting vocal stimuli and requiring vocal responses. Total communication methods involved presenting vocal and signed stimuli and requiring vocal and signed responses. The "modified" total communication approach also involved presenting vocal and signed stimuli, but required only vocal responses. For the initial sentence triad with each child, an alternating treatments design was used to determine the relative efficacy of the three language training methods. This approach was repeated with a second sentence triad for each child using a multiprobe technique within a multiple baseline design. Results were consistent within each subject but differed across subjects, with one child benefitting most from total communication methods and the other benefitting most from oral speech methods. Results were discussed in terms of the utility of the alternating treatments design as a potentially useful aid to traditional decision-making in the selection of language training strategies commonly employed with mentally retarded children.

Adolescent↗
PubMed2003

Usher syndrome and cochlear implantation.

OBJECTIVE: To evaluate the symptoms leading to diagnosis and the quality of rehabilitation after cochlear implantation in Usher syndrome. STUDY DESIGN: Retrospective cohort study. SETTING: ENT department of a tertiary referral hospital. PATIENTS: Among 210 patients given an implantation in the Ear, Nose, and Throat department, 185 were congenitally deaf and 13 had Usher syndrome (7.0%). Five had a family history of Usher, and eight were sporadic cases. Eleven cases were Usher type I, one was Usher type III, and one was not classified. The age at implantation ranged from 18 months to 44 years (mean, 6 years 1 month). The mean follow-up was 52 months (range, 9 months to 9 years). MAIN OUTCOME MEASURES: All patients had audiophonological and clinical examination, computed tomography scan of the temporal bones, ophthalmologic examination with fundoscopy, and an electroretinogram. Cerebral magnetic resonance imaging and vestibular examination were performed in 9 of 13 and 10 of 13 cases, respectively. Logopedic outcome measured preimplant and postimplant closed- and open-set word recognition and oral expression at follow-up. RESULTS: The most frequent initial sign of Usher syndrome was delayed walking, with a mean age of 20 months. Among the 172 other congenitally deaf children with implants, when deafness was not associated with other neurologic disorders, the mean age at walking was 14 months (p < 0.001). The fundoscopy was always abnormal after the age of 5 years, and the electroretinogram was abnormal in all cases. Vestibular function was abnormal in all but one case (nonclassified). The computed tomography scan and the magnetic resonance imaging were always normal. Logopedic results with cochlear implants showed good perception skills in all but one case. The best perceptive results were obtained in children implanted before the age of 9 years. Oral language had significantly progressed in 9 of 13 at follow-up. There was no relation between the visual acuity and the logopedic results. CONCLUSION: The earliest clinical sign associated with deafness evoking Usher syndrome is late walking. The electroretinogram is the only reliable examination to enable the diagnosis. When severe profound deafness is associated with late walking, the electroretinogram should be systematically proposed. Logopedic results are linked to precocity of implantation, and early Usher's diagnosis contributes to optimize speech therapy.

Age Factors↗
PubMed2005

Lateralizing signs during seizures in focal epilepsy.

This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as Todd's palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.

Automatism↗
PubMed2005

Cognitive development in low risk preterm infants at 3-4 years of life.

BACKGROUND: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. OBJECTIVE: To establish in a prospective study whether a characteristic neuropsychological profile exists in ex-preterm children who do not exhibit neurodevelopmental deficits on routine clinical examination. METHODS: Thirty intellectually normal children born preterm (30-34 weeks gestation) without major neurological disabilities and a control group of term children matched for age, sex, and parental educational and occupational status were assessed at 3-4 years of age to obtain a complete neuropsychological profile. Intellectual ability, language comprehension and expression, perceptual and visual motor function, working memory, and attention and behavioural problems were investigated. RESULTS: Even in the absence of major neurological signs, children born preterm achieved lower mean scores than controls on the Stanford-Binet intelligence scale (110.8 v 121, p<0.001), visual perception test (33.8 v 42.7, p<0.001), visual motor integration test (42.6 v 47.4, p = 0.049), memory for location test (8.4 v 9.5, p = 0.007), sustained attention test (41.6 v 51.5, p = 0.009), and the picture vocabulary test (33.3 v 44.7, p = 0.021). CONCLUSIONS: Neuropsychological abnormalities can be detected early in childhood in apparently normal ex-preterm children and are consistent with a growing body of evidence that prematurity may be associated with long term neuropsychological morbidity in childhood and adolescence.

Attention↗
PubMed2005

Frontotemporal dementia--a brief review.

Frontotemporal dementia (FTD) is the second most common type of presenile dementia and the forth most common type of senile dementia, but probably the most costly due to its florid symptom characteristics. Clinically, it often presents with changes of personality, restlessness, disinhibition, and impulsiveness and the clinical features can be complicated by neurological signs, such as motor neuron signs, parkinsonism, and gait disturbances. Syndromatically, FTD can be subdivided into a group with predominating behavioural disturbances (frontal variant) and another with predominating language deterioration (temporal variant). Based on the underlying pathological changes, FTD is nosologically divided into disorders such as Pick's disease, frontotemporal lobar degeneration, corticobasal degeneration, progressive supranuclear palsy, and frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17). The cause in sporadic FTD is most often unknown, but in FTDP-17, one of the hereditary FTDs, there is a causative mutation in the tau gene. The frequency of tau-gene mutations is low in sporadic FTD and present in about 10-40% of hereditary FTD. Other types of hereditary FTD have been described, such as FTD caused by mutations in chromosome 3, chromosome 9, and a FTD syndrome can also be caused by mutations in the presenilin-1 gene. Since there is no curative, treatment of prevailing symptoms is the given alternative. Serotonergic acting drugs have been shown to alleviate behavioural symptoms.

Chromosomes, Human, Pair 17↗
PubMed2005

Beyond emotion archetypes: databases for emotion modelling using neural networks.

There has been rapid development in conceptions of the kind of database that is needed for emotion research. Familiar archetypes are still influential, but the state of the art has moved beyond them. There is concern to capture emotion as it occurs in action and interaction ('pervasive emotion') as well as in short episodes dominated by emotion, and therefore in a range of contexts, which shape the way it is expressed. Context links to modality-different contexts favour different modalities. The strategy of using acted data is not suited to those aims, and has been supplemented by work on both fully natural emotion and emotion induced by various technique that allow more controlled records. Applications for that kind of work go far beyond the 'trouble shooting' that has been the focus for application: 'really natural language processing' is a key goal. The descriptions included in such a database ideally cover quality, emotional content, emotion-related signals and signs, and context. Several schemes are emerging as candidates for describing pervasive emotion. The major contemporary databases are listed, emphasising those which are naturalistic or induced, multimodal, and influential.

Computer Simulation↗
PubMed2002

Minor neurological signs and developmental performance in high risk children at preschool age.

The aim of this study was to establish correlations between minor neurological findings and developmental performance. A cohort of 72 preschool children was studied (38 females, 34 males; mean age 3 years 8 months, SD 1 year 2 months, range 2 to 5 years) who were considered to be at high risk due to placental insufficiency. The cohort was divided into four categories of neurological status: (1) minimal cerebral palsy (MCP) with independent walking before age 2 years; (2) Amiel-Tison triad (ATT) including imbalance of passive axial tone, phasic stretch reflex in triceps surae, and cranial signs, particularly on the squamous suture; (3) intermediate with one or two of the three ATT signs; and (4) absence of neurological findings. Six subscales of the Griffiths Mental Developmental Scales assessing locomotion, eye-hand coordination, interpersonal skills, language, performance, and practical reasoning were administered. Significant differences were found according to neurological status in three specific domains of development: coordination (F=2.84, p=0.04), language (F=3.65, p=0.02), and practical reasoning (F=3.62, p=0.02). In addition, significant differences were also found in language (L) and practical reasoning (R) performances according to the side of the abnormal stretch reflex: bilateral stretches (L=87.8; R=75.3) or an isolated right stretch (L=95.3; R=83.6) are more strongly associated with impaired developmental performances than an isolated left stretch (L=101.3; R=88.2) with F=2.94; p=0.04 for language and F=3.00, p=0.04 for practical reasoning. We concluded that a short neurological examination, easily performed by pediatricians and family practitioners, can identify permanent markers of minor brain damage occurring before, during, or soon after birth and so anticipate consequences.

Canada↗
PubMed1997

Dysgraphia and terminal delirium.

Delirium is a frequently encountered clinical condition in palliative medicine, but it is often unrecognized and misdiagnosed. The cardinal sign of delirium is that of impaired consciousness. Writing skills are reported to be a delicate indicator of consciousness impairment, and a too infrequently utilized clinical sign of delirium. Ten delirious hospice patients completed the Frenchay Aphasia Screening Test which showed that writing was the most impaired of the language dysfunctions assessed. The simple clinical task of a request to write 'name and address' revealed overt dysgraphic errors among delirious patients. This examination is clinically acceptable to hospice practice and may be an adequate and accurate bedside test of delirium.

Acute Disease↗

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