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PubMedDate not supplied

A comparison of developmental versus functional assessment in the rehabilitation of young children.

BACKGROUND: The purpose of this study was to explore the differences in and potential uses of information derived from developmental vs. functional assessment during the acute rehabilitation of very young children with acquired brain injury. Both methods of assessment are typically used during hospitalization in order to assist in developing individualized goals and outcome measures. With the trend of shortened hospital stays, effective assessment for determining optimal treatment goals and outcomes becomes increasingly important. The results from a developmental and a functional assessment obtained on 23 inpatient children below 6 years of age who had experienced either an acquired brain injury or encephalitis were compared. The data was collected through a retrospective chart review spanning 4 years. METHODS AND OUTCOME MEASURES: Each child received a cognitive and a language test using either the Early Learning Accomplishment Profile (E-LAP) or the Learning Accomplishment Profile Diagnostic (LAP-D) for the developmental assessment measure. The Functional Independence Measure for Children (WeeFIM) was used as a functional assessment. Summary statistics and frequencies were calculated for variables including age and diagnosis. Partial Pearson correlations and 95% confidence intervals were calculated between the functional and developmental assessments, adjusting for the amount of time between administrations of the two exams. Pearson correlations were computed between length of hospital stay and performance on the developmental and functional quotients. RESULTS: Moderate, statistically significant Pearson partial correlations were found between the E-LAP/LAP-D cognitive quotient and the WeeFIM cognitive quotient (r = 0.42, 95% CI (0, 0.72)), the E-LAP/LAP-D language quotient and the WeeFIM cognitive quotient (r = 0.55, 95% CI (0.17, 0.79)) and the E-LAP/LAP-D cognitive quotient and the WeeFIM total quotient (r = 0.50, 95% CI (0.10, 0.76)). An inverse correlation was found between the length of stay and the E-LAP/ LAP-D cognitive quotient (r = -0.68, 95% CI (-0.86, -0.34)) as well as the E-LAP/LAP-D language quotient (r = -0.61, 95% CI (-0.83, -0.23)). CONCLUSIONS: The moderate but limited correlations between developmental and functional assessments may be attributed to differences in the two forms of assessment including the test items, their administration and scoring. While both forms of assessment were thought to be useful for developing individualized treatment goals and measuring outcomes, there were advantages and disadvantages to each.

Activities of Daily Living↗

PubMedDate not supplied

A preliminary 31P MRS study of autism: evidence for undersynthesis and increased degradation of brain membranes.

In this pilot study, brain high energy phosphate and membrane phospholipid metabolism were investigated in the dorsal prefrontal cortex of 11 high-functioning autistic adolescent and young adult men (the age range is 12-36 years) and 11 age-, gender-, IQ, race- and socioeconomic status-matched normal controls using in vivo 31P nuclear magnetic resonance spectroscopy (MRS). The autistic group had decreased levels of phosphocreatine and esterified ends (alpha ATP + alpha ADP + dinucleotides + diphosphosugars) compared to the controls. When the metabolite levels were compared within each subject group with neuropsychologic and language test scores, a common pattern of correlations was observed across measures in the autistic group, but not in the control group. As test performance declined in the autistic subjects, levels of the most labile high energy phosphate compound and of membrane building blocks decreased, and levels of membrane breakdown products increased. No significant correlations were present with age in either group or with IQ in the control group, suggesting that these findings were not the consequence of age or IQ effects. This pilot study provides tentative evidence of alterations in brain energy and phospholipid metabolism in autism that correlate with the neuropsychologic and language deficits. The findings are consistent with a hypermetabolic energy state and undersynthesis of brain membranes and may relate to the neurophysiologic and neuropathologic abnormalities in autism.

Adolescent↗

PubMed1987

[Recovery in aphasia (Part 3)--Study by multivariate analysis].

In order to elucidate the factors which have influence on the prognosis of aphasia, correlation between recovery rate of aphasia and the five factors, i.e. initial evaluation of speech test, age, educational level, time between onset and institution of therapy and size of abnormal findings in CT (computed tomography), was studied in 76 right-handed aphasic patients, using multivariate analysis. Cluster analysis and factor analysis were used for analysis of five factors and multiple regression analysis was used for estimation of recovery rate of aphasia. The method of calculation of recovery rate of aphasia is the same to our previous report. The results obtained were as follows: As to analysis of factors, first similarity group among initial evaluation of speech test, recovery rate of aphasia and educational level and second similarity group among time between onset and institution of therapy, size of abnormal findings in CT and age were observed. As to the estimation of recovery rate of aphasia, multiple correlation coefficient of regression analysis using five factors were 0.758, 0.444, 0.627, 0.620, 0.810 and 0.375 respectively in total score, hearing, speaking, reading, writing and calculation on standard language test of aphasia. As to the weight or partial correlation coefficient of regression analysis to the five factors, initial evaluation of speech test, time between onset and institution of therapy and educational level were 129.46, -49.93 and 45.65 respectively and the one of the size of abnormal findings in CT was not high. Stepwise multiple regression analysis of five factors were made.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed2000

Visual cognitive tests, central auditory function and auditory communication.

A cognitive, text-based test battery, presented as text on a computer screen (TIPS), was used to assess properties of central cognitive processing relevant for visual and audiovisual speech comprehension. TIPS was compared and contrasted with another, purely auditory, battery, ACE, aimed at assessing afferent (A), central (C) and efferent (E) auditory communicative functions. The results show that there is no overlap with the 'A' component, but some overlap between TIPS parameters and the 'C' component, especially when the auditory-language tests are used in the C estimate. However, the TIPS parameters show high correlations with the 'E' component (i.e. measuring output and phonological parameters), suggesting that the efferent component may be composed of an interesting central feature. TIPS parameters do not fare as well in the predictions of the auditory ecological test performances, but the ACE parameters do, especially when organized according to a cognitive complexity parameter. In order to optimize the conceptual and practical benefit of the TIPS and ACE concepts, TIPS needs to be adapted auditorily and ACE tests need to be audiovisual. These developments will become important for ecological audiology.

Adult↗

PubMed2003

The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.

Aged↗

PubMed2003

The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

Aged↗

PubMed1998

Visible changes in lesion borders on CT scan after five years poststroke, and long-term recovery in aphasia.

This study examined 12 aphasia patients at approximately 1 year poststroke (Time 1) and again at 5-12 years poststroke (Time 2) with language testing and CT scan. Significant increases in naming scores, and phrase length in nonfluent speech were observed after 5 years poststroke. Significant expansion in visible lesion borders (lesion size) was observed after 5 years poststroke; an increase in lesion size of > 1% was present in 9/12 cases (75%). Not one case had a second stroke. Thus, it appears that even though lesion expansion may occur after 5 years poststroke, as long as this expansion is unilateral and gradual, it has no adverse effect on language, and in fact, continued recovery in naming and nonfluent speech may also occur. Long-term recovery patterns in aphasia which may be associated with brain reorganization deserve further study, especially with functional brain imaging techniques.

Aged↗

PubMed1997

Pregnancy outcome and neurodevelopment of children exposed in utero to psychoactive drugs: the Motherisk experience.

This paper presents an overview of the Motherisk Program data on pregnancy outcome and neurodevelopment of children exposed in utero to selected psychoactive drugs. First, the use of cocaine during pregnancy has been associated with increased risk of spontaneous abortions, abruptio placenta, premature labor, and stillbirth. Twenty-three adopted children exposed in utero to cocaine demonstrated an 8-fold increase in risk for microcephaly compared with controls. Global intelligence quotients (IQ) did not differ between the 2 groups, but the cocaine-exposed children achieved significantly lower scores on the Reynell language test. Second, the long-term neurobehavioral effects of fetal alcohol syndrome (FAS) were studied in 384 children to show that alcohol-induced brain insults, which consist of attention and memory deficits together, and poor adaptability and organization are not attenuated with age. Third, the rates of major malformations in children exposed in utero to fluoxetine, tricyclic antidepressants, and nonteratogenic drugs did not differ or exceed the expected rates in the general population. A 2nd phase of this study established the safety of antidepressants during pregnancy by demonstrating that the mean IQ and language scores are comparable in the 3 groups. A level 2 ultrasonography is recommended in cases of in utero exposure to lithium and carbamazepine because of an increased risk of cardiac malformations and spina bifida, respectively.

Developmental Disabilities↗

PubMed2006

Functional imaging before and after constraint-induced language therapy for aphasia using magnetoencephalography.

Five patients with chronic aphasia underwent functional imaging using magnetoencephalography (MEG) before and after constraint-induced language therapy (CILT). Patients who responded well to CILT exhibited a greater degree of late MEG activation in posterior language areas of the left hemisphere and homotopic areas of the right hemisphere prior to therapy than those who did not respond well. Response to CILT, however, was positively correlated with the degree of pre-therapy MEG activity within posterior areas of the right hemisphere only on an individual basis.

Aged↗

PubMed1980

The family-oriented home visiting program: a longitudinal study.

Designed and tested a home-based intervention program for low-income mothers with toddler and at least one other child under five. Sex of toddlers and race (black or white) about equally divided. Nine months of weekly home visits were specifically planned for each mother to enhance her effectiveness as an educational change agent. Treatment was planned to promote skills and understandings applicable over range of ages. Pretests, immediate posttests, and posttests one and two years later were administered to 27 experimental families and to a randomly assigned control group of 20. At .05 level of significance or beyond, experimentals excelled controls on receptive language test (toddler), on the Caldwell HOME (mother was indirectly rated as an educational change agent), and on a measure of teaching style (mother). They were also significantly superior on the Binet (toddler) at second posttest. No differences found with older siblings on Slosson Intelligence Test. Differences at third posttest were at least as great as earlier ones on mother measures. Relationships among child and mother measures are discussed.

Child Behavior Disorders↗

PubMedDate not supplied

[Deep cerebral lesions: neuro-rehabilitative aspects].

All 21 patients under rehabilitative care, who were followed by the authors, suffered from language and motor deficits, the latter being part of a deficient hemi-syndrome caused by deep vascular cerebral lesions, in both thalamic (8 patients) and basal ganglia (13 patients) sites. All subjects, on entry and 3 months after treatment, underwent a language test, routine tests, De Renzi-Vignolo's Token test and neuromotor evaluation, to study muscle tone, the presence of pathological synergies, sensitivity, active motility and functionality. On entry, patients with thalamic lesions had fewer problems than those with lesions of the basal ganglia at both symbolic and neuromotor levels. A better recovery of the functional capacities in the treatment period was thus achieved.

Aged↗

PubMed1996

High-level linguistic disturbances subsequent to childhood closed head injury.

High-level language functioning was assessed in a group of 11 children with severe closed head injury (CHI). Performance was examined on measures of figurative language, oral expression, inferencing, and interpretation of ambiguous sentences, and was compared with that of a control group matched for age, gender, and handedness. The children with CHI demonstrated inferior performance on the oral expression, ambiguous sentences, and figurative language tests; however, performance on the inferencing task appeared intact. These findings are discussed with respect to the underlying nature of the observed impairments. Both linguistic and cognitive factors are considered. It is concluded that a complex interaction of cognitive and linguistic impairments experienced by children with CHI may underlie the performance deficits identified in the current study.

Child↗

PubMed1994

[Symbolic process in intellectual activities of so-called psychotic adolescents].

Based on his experience as psychopedagogue in a special education facility for adolescents with psychopathological disturbances, the author develops the idea that the learning difficulties cannot be reduced to intellectual deficits due to constitutional causes or traumatic experiences. The observation and analysis of the difficulties suggest that symbolization processes are deeply involved. This research is based on the assumption that symbolization processes of so-called psychotic adolescents can be assessed through various psychological techniques: the Borel-Maisonny language test, tests derived from those of Meljac on the knowledge and spontaneous use of numbers, and the EDEI (Differential scales of intellectual efficiency) by Perron-Borelli. Symbolization is defined in reference to theoretical approaches along three differentiated modes: the long option, the confused option and the short option. Different modalities of symbolization, the conceptual, the referential and the confused, are described and analyzed throughout the performances of the subjects, utilizing a differential and clinical method.

Adolescent↗

PubMed1995

Tone perception of Mandarin-speaking postlingually deaf implantees using the Nucleus 22-Channel Cochlear Mini System.

Because Mandarin Chinese is a tonal language, testing the patient's ability to distinguish among four tones is of paramount importance. This paper evaluates the efficacy of the Nucleus 22-Channel Mini System for Mandarin Chinese by comparing the postoperative tone perception test results with the results of the closed-set monosyllable, trochee, and spondee (MTS) test, and the open-set phonetically balanced (PB) word and sentence comprehension tests, which also incorporate tonal features, for eight Mandarin-speaking postlingually deaf patients implanted with this device. Except for one patient, the data clearly indicate that patients who had increased scores on tone perception after implantation also had improvements on other test batteries. Results also substantiate our previous observation that the Nucleus 22-channel cochlear implant enables profoundly and totally deaf patients to distinguish four separate tones in Mandarin Chinese. This would seem to support our earlier speculation that the acoustic cues of fundamental frequency of the four Mandarin tones are extracted by the Multipeak coding strategy of the 22-channel device and transferred to the cochlea, where they are perceived as rate pitch.

Adult↗

PubMed1998

[Variability of the Boston test for the diagnosis of aphasia in active working adults].

INTRODUCTION: The aim of this study was to analyze the influence of age, gender, socioeconomic status (SES), academic achievement (education), and type of occupation, on the performance of the Boston Diagnostic Aphasia Examination (BDAE) Spanish version. MATERIAL AND METHODS: The BDAE was administered to a group of 156, 19 to 60 years old, occupationally active normal subjects. RESULTS: A descriptive analysis showed that some subjects (1 to 3%) scored in the pathological range of the centiles and profiles of the BDAE. A MANOVA (p < 0.05) demonstrated a significant effect of education over most of the BDAE subtests. Females outperformed males on some reading and writing subtests. SES had an effect over body part identification and naming. Significant differences were observed between younger and middle age groups in confrontation naming, oral and word picture reading. The older group scored significantly lower than the younger group in serial writing and sentences to dictation. No differences were observed between the older and the middle groups. Only oral spelling was affected by the type of occupation but a significant interaction of occupation and level of education was found. CONCLUSIONS: Language tests are influenced by demographic variables, particularly education. Normal variability on the BDAE should be considered when dealing with clinical populations.

Adolescent↗

PubMed1994

Cerebral blood flow in subcortical global aphasia. Perisylvian cortical hypoperfusion as a crucial role.

BACKGROUND AND PURPOSE: Global aphasia after subcortical stroke is very rare, and its pathophysiology remains unsolved. To clarify the mechanism underlying subcortical global aphasia, we investigated lesion sites and cerebral blood flow in patients with subcortical global aphasia and nonaphasic patients with subcortical stroke. METHODS: We examined four patients with global aphasia and four nonaphasic patients. Language testing was performed more than 4 weeks after the onset. Measurement of cerebral blood flow was done between 35 and 75 days after stroke by using single-photon emission computed tomography (SPECT) with N-isopropyl-p[123I]iodoamphetamine as a tracer and three-dimensional surface display generated from SPECT. RESULTS: All aphasic patients had subcortical lesions in the putamen, posterior internal capsule, temporal isthmus, and periventricular white matter in the left hemisphere. No cortical lesions were found on either magnetic resonance imaging or computed tomographic scanning. The nonaphasic patients had smaller periventricular white matter lesions and no temporal isthmus lesions. All aphasic patients showed cortical hypoperfusion mainly in the perisylvian areas, including Broca's and Wernicke's areas. In contrast, cortical cerebral blood flow of the nonaphasic patients was decreased in smaller areas and spared the perisylvian language areas. CONCLUSIONS: These results suggest that cortical hypoperfusion in the perisylvian language areas, presumably due to undercutting of the white matter, is crucial for the development of subcortical global aphasia.

Aged↗

PubMed1989

Empirical classification of speech/language impairment in children. I. Identification of speech/language categories.

Cluster analysis was employed to classify speech/language impairment in a sample of 347 children 5 years of age. Based on scores on a variety of speech and language tests, four groups of children with similar linguistic profiles were identified. These groups were labeled high overall, low overall, poor auditory comprehension, and poor articulation. Differences among these groups according to cognitive, developmental, demographic, and audiometry variables were examined. The low overall group was most disadvantaged on all measures, the high overall group was most advantaged, and the poor articulation and poor auditory comprehension groups were intermediate. The implications of these findings for the development of a theory of the relationship between speech/language and psychiatric disorders are discussed.

Articulation Disorders↗

PubMed1991

An aphasia group intensive efficacy study.

The response of five adults with chronic aphasia to a 4-week intensive treatment course is presented. Using four language tests, pre-intervention stability was demonstrated over the month preceding the treatment programme. Following the intervention period, two subjects showed improvement in one test, and more widespread changes occurred in three subjects. On further assessment 1 month after treatment had finished, one of the two subjects who had made least progress performed better than at the end of the course, and one had returned to pre-treatment level. Although there were indications of regression in two of the three other subjects, this was not to pre-treatment level. Only one subject maintained the gains made fully. Given the short duration of the course, the changes in performance noted suggest that, providing transport is available, intensive treatment of aphasia should be available to patients with sufficient motivation and stamina.

Aged↗