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Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and clinical considerations.

Part I of this series discussed our observations of Ground Zero of the World Trade Center (WTC) immediately after the attack on September 11, 2001, as well as the stress-response of police officers on site. This paper offers a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.

Aircraft↗

A biologically inspired neural network for dynamic programming.

An artificial neural network with a two-layer feedback topology and generalized recurrent neurons, for solving nonlinear discrete dynamic optimization problems, is developed. A direct method to assign the weights of neural networks is presented. The method is based on Bellmann's Optimality Principle and on the interchange of information which occurs during the synaptic chemical processing among neurons. The neural network based algorithm is an advantageous approach for dynamic programming due to the inherent parallelism of the neural networks; further it reduces the severity of computational problems that can occur in methods like conventional methods. Some illustrative application examples are presented to show how this approach works out including the shortest path and fuzzy decision making problems.

Algorithms↗

Intuition in nursing relationships: the result of 'skills' or 'qualities'?

Maintaining the scientific orientation of health and nursing care systems has resulted in a lack of focus on nurses' intuitive knowledge base. Consequently, confusion exists as to whether intuition in nursing is the result of acquired skills, or is dependent upon the inherent qualities of the individual. In deconstructing the apparently intuitive process of building rapport, neuro-linguistic programming (NLP) can offer insight, suggesting that rapport building depends on learnt skills that have moved into unconscious competence. The examination of nurses' intuitive knowledge, in order to identify underlying skills, needs to be just as rigorous as the acquisition of scientific knowledge. Examining intuitive knowledge can be achieved within a framework of reflective practice to counter the inherent dangers of an increasingly scientific approach operating within a caring profession.

Clinical Competence↗

Our personal space.

Neuro Linguistic Programming (NLP) as a model of human behaviour is presented. Its basic tenets and the factors that give rise to the physiological and emotional response to an external event are described. A number of psychotherapeutic interventions are also described, along with the influence of NLP on sporting and academic success. Finally, an exploration of these ideas for the purpose of contributing to personal well-being is given.

Achievement↗

Lateralization of cognitive processes in the brain.

The lateralization of cognitive processes in the brain is discussed. The traditional view of a language-visuo/spatial dichotomy of function between the hemispheres has been replaced by more subtle distinctions. The use of magnetic resonance imaging (MRI) to study brain morphology has resulted in a renewed focus on the relationship between structural and functional asymmetry. Focus has been on the role played by the planum temporale area in the posterior part of the superior temporal gyrus for language asymmetry, and the possible significance of the larger left planum. The dichotic listening technique is used to illustrate the difference between bottom-up, or stimulus-driven laterality versus top-down, or instruction-driven laterality. It is suggested that the hemispheric dominance observed at any time is the sum result of the dynamic interaction between bottom-up and top-down processing tendencies. Stimulus-driven laterality dominance is always monitored and modulated through top-down cognitive processes, like shifting of attention and changes in arousal. A model of top-down modulation of bottom-up laterality is presented with special reference to the understanding of psychiatric disorders.

Adult↗

The cognitive neuroscience of signed language.

The present article is an assessment of the current state of knowledge in the field of cognitive neuroscience of signed language. Reviewed lesion data show that the left hemisphere is dominant for perception and production of signed language in aphasics, in a fashion similar to spoken language aphasia. Several neuropsychological dissociations support this claim: Non-linguistic visuospatial functions can be dissociated from spatial functions and general motor deficits can be dissociated from execution of signs. Reviewed imaging data corroborate the lesion data in that the importance of the left hemisphere is re-confirmed. The data also establish the role of the right hemisphere in signed language processing. Alternative hypotheses regarding what aspects of signed language processing are handled by the right hemisphere are currently tested. The second section of the paper starts by addressing the role that early acquisition of signed and spoken language play for the neurofunctional activation patterns in the brain. Compensatory cognitive and communicative enhancements have also been documented as a function of early sign language use, suggesting an interesting interaction between language and cognition. Recent behavioural data on sign processing in working memory--a cognitive system important for language perception and production suggest e.g. phonological loop effects analogous to those obtained for speech processing. Neuroimaging studies will have to address this potential communality.

Functional Laterality↗

Is there a natural order for expressing semantic relations?

All languages rely to some extent on word order to signal relational information. Why? We address this question by exploring communicative and cognitive factors that could lead to a reliance on word order. In Study 1, adults were asked to describe scenes to another using their hands and not their mouths. The question was whether this home-made "language" would contain gesture sentences with consistent order. In addition, we asked whether reliance on order would be influenced by three communicative factors (whether the communication partner is permitted to give feedback; whether the information to be communicated is present in the context that recipient and gesturer share; whether the gesturer assumes the role of gesture receiver as well as gesture producer). We found that, not only was consistent ordering of semantic elements robust across the range of communication situations, but the same non-English order appeared in all contexts. Study 2 explored whether this non-English order is found only when a person attempts to share information with another. Adults were asked to reconstruct scenes in a non-communicative context using pictures drawn on transparencies. The adults picked up the pictures for their reconstructions in a consistent order, and that order was the same non-English order found in Study 1. Finding consistent ordering patterns in a non-communicative context suggests that word order is not driven solely by the demands of communicating information to another, but may reflect a more general property of human thought.

Adult↗

Challenging the widespread assumption that connectionism and distributed representations go hand-in-hand.

One of the central claims associated with the parallel distributed processing approach popularized by D.E. Rumelhart, J.L. McClelland and the PDP Research Group is that knowledge is coded in a distributed fashion. Localist representations within this perspective are widely rejected. It is important to note, however, that connectionist networks can learn localist representations and many connectionist models depend on localist coding for their functioning. Accordingly, a commitment to distributed representations should be considered a specific theoretical claim regarding the structure of knowledge rather than a core principle, as often assumed. In this paper, it is argued that there are fundamental computational and empirical challenges that have not yet been addressed by distributed connectionist theories that are readily accommodated within localist approaches. This is highlighted in the context of modeling word and nonword naming, the domain in which some of the strongest claims have been made. It is shown that current PDP models provide a poor account of naming monosyllable items, and that distributed representations make it difficult for these models to scale up to more complex language phenomena. At the same time, models that learn localist representations are shown to hold promise in supporting many of the core reading and language functions on which PDP models fail. It is concluded that the common rejection of localist coding schemes within connectionist architectures is premature.

Cognitive Science↗

The recognition of gender-marked nouns and verbs in Polish-speaking aphasic patients.

In the present study, we investigated the on-line recognition of gender-marked lexical items by three aphasic patients and eighteen matched control participants, all native speakers of Polish. Polish is unique in that it allows investigating grammatical gender across the major categories of nouns and verbs. Patients and their controls were tested using a simple visual lexical decision paradigm in which gender, number and grammatical category were manipulated. Results show that, while response latencies were markedly slower for aphasic patients, gender did not yield differential results in either grammatical category, for both patients and control participants. Plural forms, on the other hand, showed significantly slower response latencies than singular forms in both brain-damaged and unimpaired participants, but only for nouns. We interpret these findings in terms of the inherent vs. contextual, i.e. underspecified, nature of gender and number in the two grammatical categories. This study suggests that while gender can be impaired in off-line performance in aphasia, on-line recognition patterns parallel the performance of non-brain-damaged individuals, confirming the preservation of access procedures in automatic word recognition.

Aged↗

Thematic relations in adults' concepts.

Concepts can be organized by their members' similarities, forming a kind (e.g., animal), or by their external relations within scenes or events (e.g., cake and candles). This latter type of relation, known as the thematic relation, is frequently found to be the basis of children's but not adults' classification. However, 10 experiments found that when thematic relations are meaningful and salient, they have significant influence on adults' category construction (sorting), inductive reasoning, and verification of category membership. The authors conclude that concepts function closely with knowledge of scenes and events and that this knowledge has a role in adults' conceptual representations.

Adult↗

Models of phonology in the education of speech-language pathologists.

We discuss developments in theoretical phonology and, in particular, at the divide between theories aiming to be adequate accounts of the data, as opposed to those claiming psycholinguistic validity. It would seem that the latter might have greater utility for thye speech-language pathologist. However, we need to know the dominant models of clinical phonology, in both clinical education and practise, before we can promote other theoretical approaches. This article describes preliminary results from a questionnaire designed to discover what models of phonology are taught in institutions training speech-language pathologists in the United States. Results support anecdotal evidence that only a limited number of approaches (phonemic, distinctive features, and processes) are taught in many instances. They also demonstrate that some correspondents were unable to distinguish aspects of theoretical phonology from similar sounding (but radically different) models of intervention. This ties in with the results showing that some instructors of phonology courses have little or no background in the subject.

Humans↗

Development of the pediatric test of brain injury.

OBJECTIVE: The Pediatric Test of Traumatic Brain Injury (PTBI) (currently in its research edition) is a tool for assessing the cognitive-linguistic skills of school-aged children and adolescents in acute care and rehabilitation settings after traumatic brain injury. Development of the PTBI was motivated by the fact that, to date, no standardized test has been available to assess the full range of cognitive-linguistic impairments associated with pediatric brain injury. In this article we describe how the research edition of the PTBI was developed, provide rationale for the areas of assessment, discuss a plan for standardization, and illustrate its use with three children with TBI. DESIGN: The PTBI was constructed to sample the attention, memory, language, reading, writing, metalinguistic, and metacognitive skills that are particularly at risk in pediatric brain injury and that are relevant to the general education curriculum. MATERIAL: The test material for the PTBI was selected on the basis of clinical and experimental evidence that children and adolescents with TBI demonstrate a wide range of cognitive and language deficits. These first appear in the early stages of recovery and often persist but change over time. CONCLUSION: Our goal is to standardize the PTBI so it can be used to establish baseline behaviors and track cognitive-linguistic recovery.

Accidents, Traffic↗

Neurolinguistic development in deaf children: the effect of early language experience.

Recent investigations have indicated a relationship between the development of cerebral lateralization for processing language and the level of development of linguistic skills in hearing children. The research on cerebral lateralization for language processing in deaf persons is compatible with this view. We have argued that the absence of appropriate input during a critical time window creates a risk for deaf children that the initial bias for left-hemisphere specialization will be distorted or disappear. Two experiments were conducted to test this hypothesis The results of these investigations showed that children educated early and intensively with cued speech or with sign language display more evidence of left-hemisphere specialization for the processing of their native language than do those who have been exposed later and less intensively to those languages.

Adult↗

[Self-esteem of nursing undergraduate students].

UNLABELLED: This study evaluates the self-esteem of undergraduate students of nursing, that through a workshop developed mechanisms for improving their self-esteem, considering that this is the most propitious time for students to multiply health care actions. METHODOLOGY: the research was carried out with 156 undergraduate students of the third year. Socio-drama techniques of Neurolinguistics were used and the evaluation was done according to Minayo. It was possible to observe that students usually confuse self-esteem and self-image, and that both are stereotyped for for men and women. As nurses are always worried about the client/patient's life quality, they neglect themselves. In this case, the Workshops were essential for the students to rescue interior knowledge about themselves, and to realize that in order to take good care of clients/patients, they must be physically and psychologically healthy.

Adult↗

Dystypia: isolated typing impairment without aphasia, apraxia or visuospatial impairment.

We report a 60-year-old right-handed Japanese man who showed an isolated persistent typing impairment without aphasia, agraphia, apraxia or any other neuropsychological deficit. We coined the term 'dystypia' for this peculiar neuropsychological manifestation. The symptom was caused by an infarction in the left frontal lobe involving the foot of the second frontal convolution and the frontal operculum. The patient's typing impairment was not attributable to a disturbance of the linguistic process, since he had no aphasia or agraphia. The impairment was not attributable to the impairment of the motor execution process either, since he had no apraxia. Thus, his typing impairment was deduced to be based on a disturbance of the intermediate process where the linguistic phonological information is converted into the corresponding performance. We hypothesized that there is a specific process for typing which branches from the motor programming process presented in neurolinguistic models. The foot of the left second frontal convolution and the operculum may play an important role in the manifestation of 'dystypia'.

Agraphia↗

Response of an agrammatic patient to a syntax stimulation program for aphasia.

A Syntax Stimulation Program (SSP) based on the findings of neurolinguistic studies of agrammatic aphasic patients was used to treat one patient with a three year history of severe agrammatism. The SSP is designed to elicit eight different sentence constructions at two levels of difficulty using a story completion technique. The patient received pre-, mid- and post-treatment testing with the Northwestern Syntax Screening Test (NSST) and the cookie theft picture description of the Boston Diagnostic Aphasia Examination (BDAE). With 10 1/2 weeks of treatment, the patient's NSST expressive scores improved from 0 to 21, and his BDAE picture description showed increased phrase length and use of grammatical constructions. In addition, with this special treatment, the patient was able to produce grammatical speech in spontaneous conversation. Thus, the SSP appears to have therapeutic merit in training syntactic skills in presumably stable agrammatic patients.

Adult↗

Automated classification of phonological errors in aphasic language.

Using heuristically guided state space search, a prototype program has been developed to simulate and classify phonemic errors occurring in the speech of neurologically impaired patients. Simulations are based on an interchangeable rule/operator set of elementary errors which represent a theory of phonemic processing faults. This work is significant because it introduces and evaluates a novel approach to error simulation and classification, provides a prototype simulation tool for neurolinguistic research, and forms the initial phase of a larger research effort involving computer modelling of neurolinguistic processes.

Aphasia↗