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PubMed2006

Prism adaptation in the rehabilitation of patients with visuo-spatial cognitive disorders.

PURPOSE OF REVIEW: The traditional focus of neurorehabilitaion has been on the patients' attention on their deficit, such that they should become aware of their problems and gain intentional control of compensatory strategies (descending approach). We review prism adaptation as one of the approaches that emphasize ascending rather than descending strategies to the rehabilitation of visuo-spatial disorders. The clinical outcome of prism adaptation highlights the need for a theoretical reconsideration of some previous stances to neurological rehabilitation. RECENT FINDINGS: Recent years have given rise to a growing body of experimental studies showing that the descending strategy is not always optimal, especially when higher-level cognition is affected by the patients' condition. Ascending approaches have, for example, used visuo-manual adaptation for the rehabilitation of visuo-spatial deficits. A simple task of pointing to visual targets while wearing prismatic goggles can produce remarkable improvements of various aspects of unilateral neglect. SUMMARY: The neural mechanisms underpinning visuo-manual plasticity can be viewed as a powerful rehabilitation tool that produces straightforward effects not only on visual and motor parameters, but on visuo-spatial, attentional and higher cognitive neurological functions. The use of prism adaptation therapy in neglect and other visuo-spatial disorders has just started to reveal its potential, both at a practical and theoretical level.

Adaptation, Physiological↗
PubMed2006

Motion perception in migraineurs: abnormalities are not related to attention.

Migraine groups have impaired ability to identify global motion direction in noisy random dot stimuli, an observation that has been used as evidence for cortical hyperexcitability. Several studies have also suggested abnormalities in cognitive processing, particularly in the domains of attention, visuo-spatial processing and memory. This study aimed to determine whether poor performance by migraineurs in motion coherence tasks could be explained by non-visual cognitive factors such as attention. Twenty-nine migraineurs and 27 non-headache controls participated. Global motion coherence thresholds were measured along with measures of neuropsychological function, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The migraine group had significantly higher motion coherence thresholds than controls. No significant difference in attention or any other RBANS index score was found between groups. Index scores did not correlate with motion perception thresholds. This study does not support inattention or other cognitive abnormality as an explanation for motion perception anomalies in migraine.

Adult↗
PubMed1980

On tune deafness (dysmelodia): frequency, development, genetics and musical background.

With the aid of the Distorted Tunes Test a group of British adults could be established whose melodic aptitude was below a certain level and whom we called tune deaf. They are only a fraction of those popularly called tone deaf. The Distorted Tunes Test is only slightly correlated with pitch discrimination, short term tonal memory or number memory. In children ability to pass the Distorted Tunes Test develops at greatly varying speeds and to a varying degree, reaching stability in adolescence. Tune deafness has a familial distribution and segregates in a way suggesting an autosomal dominant trait with imperfect penetrance. Some degree of positive assortative mating has been established. Some people, unfamiliar with the British melodies which form the basis of the test, pass it. This indicates the existence of a partly innate and partly acquired competence to judge what is acceptable and what is not, within the tradition of Western popular or classical music. This seems to indicate the existence of some deep structure of tonality, comparable with Chomsky's deep language structure. Asians who have not been much exposed to this kind of music find the task very difficult.

Adolescent↗
PubMed1984

Extreme deprivation in early childhood--II. Theoretical issues and a comparative review.

Five previously published and one novel case history of children who suffered extreme deprivation in early childhood are reviewed. Aspects of cognitive, emotional and social development are subject to critical appraisal and three main issues, central to theories about the origins of developmental disorders, are addressed. Firstly, what minimal experiences during childhood are sufficient and necessary for normal psychological development? Secondly, are there critical periods in development during which inadequate exposure to certain experiences has long-lasting or permanent sequelae? Thirdly, what minimal compensatory influences are necessary to alleviate psychological handicaps resulting from an adverse early environment?

Adolescent↗
PubMed1989

Children with preschool minor neurodevelopmental disorders. V: Neurodevelopmental profiles at age 13.

A cohort of children diagnosed at age seven as suffering from deficits in attention, motor control and perception was compared at age 13 with a group of children without such problems. More than two-thirds of the index children no longer had any clearly detectable motor problems at 13, but they still had significantly prolonged complex reaction times. These results suggest that children with these deficits in the early school years have a fair biological prognosis by the early teen years.

Achievement↗
PubMed2006

Neuropsychological findings in idiopathic occipital lobe epilepsies.

PURPOSE: We reviewed the clinical charts of 22 patients (mean age 12 years) with idiopathic occipital lobe epilepsies (IOLE) to verify the presence of visuoperceptual difficulties. METHODS: All 22 patients underwent a standard neuropsychiatric examination and had a sleep electroencephalogram (EEG). Eleven had normal development and adequate scholastic achievements, so no formal testing was performed. Psychological assessment was carried out in the remaining 11 patients who had been referred because of learning and behavioral difficulties. RESULTS AND CONCLUSIONS: IQ was in the average/low-average range in most patients, with a cognitive profile characterized by relatively better verbal than performance abilities (8/11). There was a high incidence of scholastic disabilities (7/11); psychiatric disorders in the form of anxiety and depressive disorders were also frequent (6/11). In the six patients who had neuropsychological assessment with specific visuoperceptual testing, a deficit in facial discrimination was found in four patients, associated with a line orientation deficit in three. Although preliminary, and based on a tertiary-care clinical sample, these data suggest that children with IOLE, are at risk for lower intellectual performance, poor scholastic achievement and psychiatric disorders, as well as for specific deficits in the visuoperceptual domain, probably due to dysfunction of the occipitotemporal circuitries most often involved in seizure spread in epilepsies originating in the posterior brain.

Achievement↗
PubMed2005

Characteristics of Mini-Mental State Examination 1 year after stroke.

OBJECTIVES: The Mini-Mental State Examination (MMSE) is commonly used to evaluate cognition after stroke. The purpose of this study was to describe the properties of MMSE in relation to different stroke characteristics. MATERIALS AND METHODS: Subjects were survivors (n = 253) of a population-based cohort who had had a first-ever stroke 1 year earlier. At baseline, patients were evaluated with regard to stroke type, stroke severity, unilateral neglect, and prestroke dementia. The 1-year follow-up included an MMSE, a functional evaluation according to the modified Rankin Scale (MRS) and a question regarding subjective memory problems. RESULTS: The mean MMSE was 24.9. Patients with lacunar infarction scored 26.6. Impact of hemisphere localization was insignificant. Twenty-nine percent of the patients had cognitive impairment (cut-off <24). After adjustment for age and education, 16% had cognitive impairment; 41% of the patients had subjective memory problems. The kappa-value between subjective memory problems and dichotomized MMSE was 0.21. Patients with cognitive impairment scored at average 1.8 higher on the MRS. CONCLUSIONS: If cut-off is used, the MMSE should be adjusted for age and education; otherwise the prevalence of cognitive impairment may be overestimated. Cognitive impairment heavily influences functional outcome. Subjective memory problems correlate poorly with MMSE. The impact of hemisphere location may previously have been overestimated.

Age Factors↗
PubMed1995

Appearance, body image and distress in facial dysmorphophobia.

Compared with surgical patients awaiting rhinoplasty and control subjects, dysmorphophobic patients were more dissatisfied with facial appearance, more anxious, more depressed, more neurotic and less extrovert. Morphanalysis, an objective measure of facial appearance, was applied to the first 11 dysmorphophobic and first 11 surgical subjects. The dysmorphophobic group had a variety of abnormal features that were not identified by medical practitioners or the patient. These subtle anomalies were often unrelated to the focus of dissatisfaction which was usually normal. A panel of lay judges rated the appearance of the dysmorphophobic group as being intermediate between the control and surgical groups but not significantly different from either.

Adolescent↗
PubMed1999

Morbid objectivization in psychopathology.

The fundamental problems of schizophrenia are wrongly formulated unless one takes heed of the major philosophical revolution which Kant initiated with the publication of the Critique of Pure Reason in 1781. Virtually all major philosophers since then have adhered to the view that the mind objectifies whatever energy fields/atoms, etc., are 'out there'. The thesis put forward in this lecture will be that schizophrenia is a condition in which this process proceeds too far. Evidence from the psychopathology of body, time and world is offered in support of such morbid objectivization.

Body Image↗
PubMed2005

Cognitive functioning in siblings discordant for schizophrenia.

OBJECTIVE: The objective of this study was to investigate neuropsychological impairment as a genetically mediated risk indicator for schizophrenia while accounting for prevalence of schizotypy signs/symptoms in siblings. METHOD: Cognitive functioning in 25 individuals with schizophrenia, 25 unaffected siblings and 25 unrelated healthy controls, was assessed using neuropsychological tests of sustained attention, memory and learning, executive function, visual-spatial ability and psychomotor performance. RESULTS: Unaffected siblings demonstrated better performance than patients on some measures of memory and learning and executive function. Patients and siblings demonstrated impaired Full Scale IQ and verbal fluency, otherwise siblings performed similarly to healthy controls. Controlling for differences in IQ, the shared deficit in verbal fluency disappeared. CONCLUSION: Patients with schizophrenia and unaffected siblings (without schizotypy personality disorder) shared a neuropsychological deficit in verbal fluency. This deficit appeared to be mediated by IQ. Deficits, which differentiated patients from controls, may not be inherited and perhaps are related to the manifestation or treatment of schizophrenia.

Adult↗
PubMed2004

Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients.

OBJECTIVES: The evolutionary pattern of spontaneous recovery from acute neglect was studied by assessing cognitive deficits and motor impairments. Detailed lesion reconstruction was also performed to correlate the presence of and recovery from neglect to neural substrates. METHODS: A consecutive series of right brain-damaged (RBD) patients with and without neglect underwent weekly tests in the acute phase of the illness. The battery assessed neglect deficits, neglect-related deficits, and motor impairment. Age-matched normal subjects were also investigated to ascertain the presence of non lateralised attentional deficits. Some neglect patients were also available for later investigation during the chronic phase of their illness. RESULTS: Partial recovery of neglect deficits was observed at the end of the acute period and during the chronic phase. Spatial attention was impaired in acute neglect patients, while non spatial attentional deficits were present in RBD patients with and without acute neglect. A strong association was found between acute neglect and fronto-parietal lesions. Similar lesions were associated with neglect persistence. In the chronic stage, neglect recovery was paralleled by improved motor control of the contralesional upper limb, thus emphasising that neglect is a negative prognostic factor in motor functional recovery. CONCLUSIONS: These findings show that spatial attention deficits partially improve during the acute phase of the disease in less than half the patients investigated. There was an improvement in left visuospatial neglect at a later, chronic stage of the disease, but this recovery was not complete.

Acute Disease↗