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Age of presentation in developmental disability.

It has not been determined whether severity of handicap or other associated factors are more important in determining the age of presentation for developmental disabilities. The relationship between age at presentation and referral source, presenting complaint, diagnosis, and associated factors (medical illness, motor signs, or behavioral disturbances) was examined in 738 consecutive children referred for developmental evaluation during 1982-1983. The nature of the complaint or diagnosis (motor, language, behavioral, or educational) was a far better predictor of age of presentation than the severity of the disorder. The degree of mental retardation did not affect age of presentation. Behavior problems did not affect the age of presentation for school failure or learning disability, but were associated with later presentation for motor delay, language delay, communication disorder, and within all IQ groups. The association of topography of handicap rather than severity with age of presentation should be considered when establishing or evaluating efforts at early identification of developmental disability.

Black or African American↗

[Somatoform depressive disorders].

The Tetra-dimensional Model of Depression has several advantages for diagnosis and therapy in relation to other models. Therefore, somatoform depressive symptoms are described here following this model. In the depressive mood, pain and paraesthesiae are the most important somatic symptoms. In the anergy, chronic fatigue, irritable bowel and sexual inhibition. In the communication disorder, vertigo and limitation of facial expressivity. In the rhytmopathy, insomnia and bulimia. In order to detect the depression in a clinical picture integrated by functional somatic symptoms we haven seven kinds of features: personal and family history, clinic and evolutive aspects of somatic symptoms, the search of psychic symptoms, the therapeutic reaction and the type of the personality.

Depression↗

The language of dissociation.

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.

Child↗

Amusia after right frontal resection for epilepsy with singing seizures: case report and review of the literature.

Although many authors consider aprosodia and amusia to be synonymous, they actually represent two distinct communication disorders. Amusia refers to a profound deficit involving musical abilities, whereas aprosodia refers to deficits regarding the emotional content of speech. Many authors have presumed a similar etiology and localization for these conditions and assumed that these disorders would not occur independently. We report the case of a 31-year-old choir director who developed amusia without aprosodia after a right frontal lobe resection for intractable seizures. His ictal onset manifested with rhythmic slapping of his thighs while communicating with melodic speech. Video EEG monitoring documented right hemispheric discharges that occurred simultaneously with this ictal behavior. While a right frontal lobe resection made him seizure-free, his postoperative amusia was so profound that he could no longer continue his occupation as a choir director. This case suggests that the right frontal cortex has different sites for musical ability distinct from the centers regarding prosody. Patients scheduled to undergo right frontal lobectomy ought to be counseled regarding the potential loss of musical abilities.

Adult↗

Clinical note: acquired pragmatic impairments and aphasia.

Recent advances in the field of communication sciences have led to the description of acquired communication disorders affecting pragmatic skills in patients with brain damage. The present article discusses the impact of such findings on the clinical concept of aphasia. Through reference to a number of articles contained in this Special Issue, it must be reiterated that pragmatic and other linguistic components of communication abilites are two sides of a same coin-that of language-and intimately interrelated. It is also argued that the difference between traditional (e.g., syntax) and pragmatic components of language cannot be explained in simple terms such as the former being subserved only by linguistic processes and the latter by other cognitive processes. Pragmatic components are thus to be considered as part of language. The evolution of the concept of language has a direct impact on the clinical concept of aphasia. Indeed, if aphasia corresponds to an acquired impairment of language, then pragmatic impairments must be considered part of aphasia. The inclusion of pragmatic impairments in the concept of aphasia does not hold only when they occur within the frame of classic types of aphasia, but also when they occur in isolation. Consequently, a new type of aphasia-pragmatic aphasia-should be considered and defined in order to describe the clinical condition of those individuals suffering from acquired pragmatic disorders as those reported among right-hemisphere-damaged right-handers. It is concluded that the recent evolution around the concept of language should be followed by an evolution of the concept of aphasia per se.

Aphasia↗

Problems of the communicatively disadvantaged. An overview.

The article traces the attitude of various cultures through the centuries toward the hearing and speech handicapped. It outlines the early efforts to develop rehabilitative techniques for such handicaps, and describes a number of the pioneers in the field of education for the "deaf and dumb." The emergence of the opposing philosophies for training the hearing handicapped, the oral school and the signing school, and the influence these two had on the development of education for the deaf is described. The part played by basic research and the development of new instrumentation during the past 50 years in the solution of many of the problems of disordered communication is reviewed. Finally, the philosophic aims are described that led to the establishment of the Boys Town Institute for communicatively handicapped children.

Academies and Institutes↗

Perception of facial expression and facial identity in subjects with social developmental disorders.

BACKGROUND: It has been hypothesized that the social dysfunction in social developmental disorders (SDDs), such as autism, Asperger disorder, and the socioemotional processing disorder, impairs the acquisition of normal face-processing skills. The authors investigated whether this purported perceptual deficit was generalized to both facial expression and facial identity or whether these different types of facial perception were dissociated in SDDs. METHODS: They studied 26 adults with a variety of SDD diagnoses, assessing their ability to discriminate famous from anonymous faces, their perception of emotional expression from facial and nonfacial cues, and the relationship between these abilities. They also compared the performance of two defined subgroups of subjects with SDDs on expression analysis: one with normal and one with impaired recognition of facial identity. RESULTS: While perception of facial expression was related to the perception of nonfacial expression, the perception of facial identity was not related to either facial or nonfacial expression. Likewise, subjects with SDDs with impaired facial identity processing perceived facial expression as well as those with normal facial identity processing. CONCLUSION: The processing of facial identity and that of facial expression are dissociable in social developmental disorders. Deficits in perceiving facial expression may be related to emotional processing more than face processing. Dissociations between the perception of facial identity and facial emotion are consistent with current cognitive models of face processing. The results argue against hypotheses that the social dysfunction in social developmental disorder causes a generalized failure to acquire face-processing skills.

Adolescent↗

Hearing loss in a memory disorders clinic. A specially vulnerable population.

OBJECTIVES: To determine the prevalence and characteristics of hearing loss in patients undergoing examination because of a memory disorder, to determine whether currently used screening tools were adequate for use in this specific population, and to determine if patients with Alzheimer disease reliably report hearing problems. DESIGN: Case-control study. PATIENTS: A consecutive sample of 52 patients: 30 patients who met the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer disease (group 1) and 22 patients with other forms of cognitive impairment (group 2). METHODS: Patients underwent a hearing screening that included a case history, a visual inspection of the external ear canal and tympanic membrane, and pure tone audiometry. Patients and their caregivers completed a questionnaire intended to assess hearing impairment and perceived disability. OUTCOME MEASURES: Pass or fail on pure tone audiometry and pass or fail on a hearing impairment questionnaire. RESULTS: Of the 52 patients, 49 had significant hearing loss. No difference was found in the failure rate between patients in groups 1 and 2. In group 1, a significant discrepancy was found between the patient's self-report and that of their caregivers, whereas in group 2, the self-report was reliable. The prevalence of hearing loss in this population greatly exceeds the prevalence in healthy aged controls. CONCLUSION: The extraordinarily high prevalence of hearing loss in this selected population suggests that a hearing evaluation should be part of any assessment of cognitive function.

Aged↗

Rehabilitation in brain disorders. 3. Intervention strategies.

This self-directed learning module highlights advances in the principles of management of brain disorders. It is part of the chapter on rehabilitation in brain disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The chapter is composed of four articles, and each builds on principles established in the others. This article covers rehabilitation philosophy, management of cognitive remediation, and behavioral management, with attention to communication disorders, social factors, vocational/educational/avocational issues, treatment of motor deficits, dysphagia, sensory dysfunction, sexual dysfunction, and substance abuse. Advances that are covered in this section include pharmacologic and rehabilitative interventions for acute, chronic, and progressive brain injuries and diseases. The learner is directed to articles 1, 2, and 4 in this chapter for supporting information.

Brain Diseases↗

Meaning matters: a clinician's/student's guide to general sign theory and its applicability in clinical settings.

UNLABELLED: The pragmatic mapping process and its variants have proven effective in second language learning and teaching. The goal of this paper is to show that the same process applies in teaching and intervention with disordered populations. A secondary goal, ultimately more important, is to give clinicians, teachers, and other educators a tool-kit, or a framework, from which they can evaluate and implement interventions. What is offered is an introduction to a general theory of signs and some examples of how it can be applied in treating communication disorders. LEARNING OUTCOMES: (1) Readers will be able to relate the three theoretical consistency requirements to language teaching and intervention. (2) Readers will be introduced to a general theory of signs that provides a basis for evaluating and implementing interventions.

Humans↗

Helping clients with presbycusis.

Hearing impairment is the most common chronic disability in the United States. The National Institute on Deafness and Other Communication Disorders (NIDCD) reports that more than 28 million Americans have impaired hearing. Hearing loss can be temporary or permanent, depending on what function of the auditory system is not working right.

Age Distribution↗

[Epidemiology of developmental disorders in children in Tel Aviv].

We assessed the prevalence of developmental disorders, the need for intervention, potential for rehabilitation, and also characterized the risk factors, from files of 1,944 children referred during 1981-1990. The study group consisted of 4.3% of the children born in Tel Aviv during this period. Referral was highest between the ages 3-4 years and the causes for referral were language, speech and communication disorders (38%), global developmental delay (20%), motor disorders (16%), and behavioral and emotional problems (15%). Developmental disorders were more prevalent in boys (M/F ratio 1.8:1). 84% had at least 1 risk factor, either pre/perinatal, social or genetic. 66% had a social risk factor requiring involvement of a community social worker, or a parent with a chronic disease. The principal genetic risk factors were a developmental problem in a sibling, and parental consanguinity. The most common perinatal risk factors were birth weight under 2500 grams, hyperbilirubinemia of the newborn and severe asphyxia. Prognosis was good: 83% had normal intelligence and only 10% had severe disability. Upon discharge from the development center at the age of 5 years only 18% required special schooling, but 63% were referred for continuation of rehabilitation services. This study provides multi-disciplinary information that allows planning of requirements for diagnostic, therapeutic and rehabilitation services in the human, logistic and economic fields.

Child↗

Incidence of very mild to severe dementia and Alzheimer's disease in Denmark: the Odense Study.

OBJECTIVE: Calculation of incidence of dementia and AD, including cases in the earliest phases of the diseases. BACKGROUND: Establishment of incidence estimates is important for the future planning of the health care system, and incidence studies can offer insights into risk factors. METHODS: A total of 5,237 persons age 65 to 84 years were randomly drawn among people living in the municipality of Odense, Denmark. Of this sample 3,086 persons were eligible for the incidence study. All participants were examined with CAMCOG, the cognitive section of The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), and the follow-up period was 2 years. Using multiple linear regression, the CAMCOG cutoff score was individualized to detect even minor cognitive decline with optimal precision. Possibly demented persons were further examined with the remaining part of the CAMDEX and neuropsychological tests. AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD, and vascular dementia and dementia of other types were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for dementia. Finally, the severity of dementia was determined according to the Clinical Dementia Rating scale. RESULTS: The incidence rate for very mild to severe dementia was 29.5 per 1,000 person-years and 20.9 for AD, and the rates were similar for men and women. CONCLUSION: Application of an individualized cutoff for the screening instrument resulted in detection of a substantial number of cases with very mild dementia, which subsequently resulted in higher incidence rates than those reported in most other studies.

Age Distribution↗

Why comprehensive epilepsy programs?

Epilepsy is a common disorder, affecting more than two million people in the United States. For the majority of these people, medications control seizures and permit them to lead nearly normal lives. But the Commission for the Control of Epilepsy and its Consequences estimates that at least 200,000 Americans suffer seizures more than once a month. The National Institute of Neurological and Communicative Disorders and Stroke has established comprehensive Epilepsy Programs to stimulate clinical research on all aspects of epilepsy, including prevention, diagnosis, and more effective management.

Epilepsy↗

International Classification of Diseases, tenth revision: neurological adaptation (ICD-10 NA): extrapyramidal and movement disorders.

A classification of diseases is important in epidemiologic studies, indexing of clinical disorders, communication, and education. Since the 10th revision of the International Classification of Diseases (ICD-10) in 1992, a specialty-based neurological adaptation (ICD-10NA) has been developed to reflect the specific needs of individual subspecialties. Although the revision was constrained by the need to maintain compatibility with previous classifications, the new ICD-10NA of Extrapyramidal and Movement Disorders aims to provide an updated and comprehensive categorization of movement disorders.

Basal Ganglia Diseases↗

Autism, primary pragmatic difficulties, and specific language impairment: can we distinguish them using psycholinguistic markers?

Three groups of children with communication disorders were examined using a series of psycholinguistic markers to explore whether the tasks could identify children with impairments other than specific language impairment (SLI), and to examine whether the different groups within this clinical population could be distinguished reliably from one another. The groups comprised children with autistic spectrum disorders (ASD; n = 13, all males; mean age 10 years 10 months, range 10 years 2 months to 12 years 6 months); children with primary pragmatic language impairment (PLI) but who did not have definite ASD diagnoses (n = 25, 22 males, three females; mean age 11 years 3 months, range 10 years 2 months to 12 years 5 months); and children with specific language impairment (SLI) without marked pragmatic language difficulties (n = 29, 25 males, 4 females; mean age 10 years 10 months, range 10 years 2 months to 11 years 9 months). Clinical markers examined were: the Children's Non-Word Repetition (CNRep), the Past Tense Task (PTT), and the Clinical Evaluation of Language Fundamentals, Recalling Sentences. First, it was found that the a priori groupings were not sufficiently defined and that four groups were actually present. The PLI group was in fact two separate samples: those with PLI pure and those with some autistic-like behaviours (referred to here as PLI plus, following Bishop 1998). Second, group comparisons indicated that CNRep was significantly lower for children with SLI than all other groups (although this measure was not such a good discriminator using a specificity analysis). Third, the markers were able to discriminate between all types of communication impairment in normal control participants (n = 100; 51 females, 49 males; mean age 11 years, range 10 years 5 months to 11 years 6 months) with sensitivity levels of at least 75% and specificity of 80%. Recalling Sentences was the most efficient marker for all groups. Finally, analysis showed that children with PLI plus could be accurately distinguished from all others, scoring most favourably overall on communication markers and on performance IQ scores.

Autistic Disorder↗

Classification of vascular dementia in the Cardiovascular Health Study Cognition Study.

OBJECTIVE: To describe the diagnostic classification of subjects with incident vascular dementia (VaD) participating in the Cardiovascular Health Study (CHS) Cognition Study. METHODS: The CHS classified 480 incident cases between 1994 and 1999 among 3,608 CHS participants who had brain MRI in 1992 through 1994 and in 1997 through 1998. The patients were diagnosed before and after reviewing the brain MRI. RESULTS: The pre-MRI classification showed that 52 participants had VaD and 76 had both Alzheimer disease (AD) and VaD. The post-MRI classification showed that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria classified 61 subjects as having VaD, the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria classified 43 subjects as having probable VaD and 10 as possible VaD, and the State of California Alzheimer's Disease Diagnostic and Treatment Center (ADDTC) criteria classified 117 as having probable VaD and 96 as possible. The combination of the ADDTC and National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria was used to examine the spectrum of vascular disease in dementia. The dementia was attributable to only vascular factors in 56 cases (probable VaD); VaD coexisted with AD in 61 cases, although the VaD component was the leading cause of dementia (probable VaD with AD); AD was the leading cause of dementia in 61 cases (possible VaD and probable AD); and in 29 cases, it was not clear that either AD or VaD was the primary diagnosis (possible AD and possible VaD). CONCLUSIONS: None of the clinical criteria for VaD identified the same group of subjects. The diagnosis of vascular dementia is difficult in epidemiologic studies because poststroke dementia can be due to Alzheimer disease (AD) and evidence of vascular disease can be found in the MRI of dementia cases without clinical strokes. Whether the clinical progression is related to AD pathology or vascular disease is difficult to establish.

Aged↗

Plasma and red blood cell thiamine deficiency in patients with dementia of the Alzheimer's type.

OBJECTIVES: To determine the prevalence of plasma thiamine deficiency in patients referred to a memory disorder clinic and to compare plasma thiamine levels with red blood cell (RBC) thiamine levels. To determine if patients with senile dementia of the Alzheimer's type (SDAT) differ from those without SDAT in either plasma or RBC thiamine levels. DESIGN: Case-control study. SETTING: Ambulatory care referral center. PATIENTS: Consecutive sample of 34 patients; 17 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and 17 patients with other forms of dementia. METHODS: Plasma and RBC thiamine levels were determined in all patients with the use of a microbiologic assay known for its specificity to biological forms of thiamine. Vitamin supplementation was determined by chart review. OUTCOME MEASURES: Plasma and RBC thiamine levels. RESULTS: Patients with SDAT were found to have significantly lower plasma thiamine levels than patients without SDAT. Low plasma thiamine levels were detected in a significantly larger proportion of patients with SDAT than in patients without SDAT. Red blood cell thiamine levels did not correlate with the clinical diagnosis of SDAT. Vitamin supplementation did not correlate with diagnosis and plasma or RBC thiamine levels. CONCLUSIONS: A significant proportion of patients with SDAT may have a thiamine deficiency, which may have an impact on cognitive function. Currently used assays may not be adequate to assess thiamine status.

Aged↗