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PubMed1989

Effectiveness of a sensory integrative therapy program for children with perceptual-motor deficits.

This study was an evaluation of the sensory integrative therapy (SIT) program (Ayres, 1972a) for children at the Christchurch Hospital. Fifty-five children were randomly assigned to the SIT program, a parallel physical education program, or to a no-treatment condition. The children were assessed before and after treatment on measures of perceptual-motor development, language and reading development, self-concept, and handwriting skills. Covariance analysis, with age and pretest scores as covariates, found no significant differences between groups on any of the measures except reading progress among those children who could already read at the beginning of the program. Children who made the least progress during therapy were those who (a) had epilepsy, (b) were from a low-income, single-parent family, or (c) had behavioral problems.

Child↗
PubMed2003

Errors in performance testing: a comparison of ethanol and temazepam.

Both ethanol and benzodiazepines impair psychomotor function. Previous work has suggested that ethanol may have a greater effect on errors while benzodiazepines may cause greater slowing, but this has not been tested in a direct comparison. We assessed the effects of ethanol, at blood concentrations of approximately 80-100 mg/100 ml, compared to two doses of temazepam (20 mg and 30 mg) on psychomotor speed and accuracy and on long-term memory. Sixteen healthy volunteers (eight male, aged 20-25 years) took part in a four-period, placebo-controlled cross-over study. Performance was evaluated using analysis of covariance (critical significance level, p = 0.05) comparing the areas under the response-time curves. Performance on a psychomotor maze showed an almost complete dissociation, with ethanol leading to a substantial and significant increase in errors with little effect on speed, while temazepam slowed performance with no significant change in accuracy. Other tasks showed a similar pattern, but the dissociation was less complete. Handwriting size was substantially increased by ethanol, but not by temazepam. Information processing capacity and long-term memory formation were reduced by a similar amount both for ethanol and 30 mg temazepam. The faster, more error-prone, behaviour on ethanol than with a similarly impairing dose of temazepam has clear implications for the relative potential of the two drugs to contribute to accidents. The results are also important in understanding the differential effects of drugs with different mechanisms of action on human performance.

Adult↗
PubMed1996

Valproic acid treatment of learning disorder and severely epileptiform EEG without clinical seizures.

Using a single-patient (n = 1) clinical trial, we studied a 7-year-old boy who presented with unsatisfactory progress in school and whose electroencephalogram had very active independent frontal spike discharges. He had not had clinical seizures. The patient was randomized to receive valproic acid, 125 mg twice daily, (four periods) or matching placebo (four periods) over 8 weeks. Primary endpoints were the Wechsler Intelligence Scale for Children-Revised Coding sub-test and a handwriting sample. Behavior was monitored using teacher's and parent's Conners questionnaires. His score on the Wechsler Intelligence Scale for Children-Revised Coding subtest was significantly improved while he was taking valproic acid (P = .03). His electroencephalogram improved from a pretreatment recording of 28 spike discharges per minute to a normal recording while on valproic acid. We conclude that in this patient, valproic acid had a cognitive enhancing effect, probably by reducing epileptiform discharges.

Anticonvulsants↗
PubMed1992

A computerized intensive care unit order-writing protocol.

OBJECTIVE: To present a computerized intensive care unit order-writing protocol. DESIGN: Descriptive report. SETTING: Eight-bed surgical intensive care unit, Department of Surgery, Department of Veterans Affairs Medical Center, Bronx, NY. METHODS: IBM-based, computer network program that provides user-friendly, logical, and comprehensive organ-system order sequences for patient management. RESULTS: Since July 1988, an order program that stresses (1) improved and more efficient patient care, (2) the use of program-integrated automatic safety features, (3) the substitution of computer entry for handwriting, and (4) the assurance that physicians deliver obligatory care in a logical organ-system-based progression has been implemented. CONCLUSIONS: The order protocol system presented is simple to introduce and operate, has minimal training and technical requirements, and is demonstrably reliable.

Computer Security↗
PubMed2005

Self-reported parkinsonian symptoms in the EPIC-Norfolk cohort.

BACKGROUND: Parkinsonian symptoms have been associated with increased morbidity and mortality. Several studies have reported on the prevalence of signs and symptoms. Symptoms questionnaires can identify potential PD cases for further neurological examination to save resources. They can also provide information about how much of the population reports specific signs and symptoms. The objective of the study was to determine the self-reported prevalence of parkinsonian symptoms from a questionnaire, and to examine their association with age and self-reported Parkinson's disease in a large cohort. METHODS: A cross-sectional study was conducted within a sub-cohort of the EPIC-Norfolk (European Prospective Investigation of Cancer) cohort study. RESULTS: The prevalence of six self-reported parkinsonian symptoms are reported for 11,539 individuals who answered all symptoms questions (62% of sub-cohort): rest tremor (4%), difficulty starting to walk (4%), difficulty getting out of a chair (6%), slower walking (34%), smaller handwriting (micrographia- 9%), and less acute sense of smell (olfactory dysfunction- 9%). The presence of individual symptoms increased with age except for difficulty getting out of a chair. CONCLUSION: The results support previous findings that the presence of self-reported parkinsonian symptoms is strongly associated with age and self-reported PD diagnosis. The data also provide information regarding the prevalence of symptoms in a large, younger population of adults than previously reported in the literature.

Aged↗
PubMed2006

Contribution of lower order skills to the written composition of college students with and without dyslexia.

There has been a growth in students with dyslexia attending university. These students commonly rate writing as one of their greatest problem areas. Our research set out to describe the effects of dyslexia on the writing skills of students compared to age-matched peers and a spelling-skill-matched group. Generally, the texts of the students with dyslexia were poorer than age controls but not poorer than the spelling-skill controls. However, there were no major differences in "higher order" skills such as ideas and organization with the chronological age controls, only in "lower order" transcription skills such as spelling and handwriting fluency. The students with dyslexia made more spelling errors in their essays than one would predict given their dictated spelling skills.

Adolescent↗
PubMed1975

Essential tremor: treatment with propranolol.

A double-blind trial of propranolol, in a dosage of 120 mg a day, and placebo was conducted in 11 patients with essential tremor. An improvement in tremor was observed in all patients who received propranolol and was most pronounced in the upper extremities. The favorable clinical assessment was further confirmed by improvement in a grooved pegboard test and in the quality of handwriting as evaluated by two "blind" observers. No side effects were encountered. It is concluded that propranolol is at present the best available drug for the treatment of essential tremor.

Adult↗
PubMed1982

Right thalamic injury, impaired visuospatial perception, and alexia.

In pure alexia, acquired inability to read contrasts with normal speech and handwriting. Rare cases of right hemisphere lesions causing this syndrome are usually attributed to right hemisphere dominance for language. After infarction of the right occipital lobe and thalamus, a fully right-handed man became alexia, but language and spontaneous and dictated writing were intact. Left hemispatial neglect and constructional disturbances were marked, and we suggest that pure alexia was mimicked by the impairment in visuospatial perception. Injury of the nondominant hemisphere and thalamus together may have been important in causing these deficits.

Cerebral Infarction↗
PubMed1989

Psychogenic tremors.

We diagnosed 24 patients, 9 men and 15 women ranging in age from 15 to 78 years, with clinically established or documented psychogenic tremors. Clinical presentations were unique, with complex tremors (often resting, postural, and kinetic), unusual temporal profiles (abrupt onset with a variable course), absence of other neurologic signs, inconsistent and incongruous symptomatology, selective disability with ability to perform some functions despite severe tremors, distractibility that lessens or abolishes tremor, atypical tremorgraphic recordings with changing amplitude and frequency, unusual handwriting and drawing specimens, presence of multiple undiagnosed somatizations, unresponsiveness to all treatments, absence of documented disease by laboratory or radiographic tests, presence of psychiatric disease, spontaneous remissions, or recovery with psychotherapy. We present criteria for the diagnosis of psychogenic tremor.

Adolescent↗
PubMed1996

Deep brain stimulation for essential tremor.

We examined the effects and safety of deep brain stimulation (DBS) as a treatment for essential tremor (ET). Ten ET patients with disabling medication-refractory tremor underwent stereotactic implantation of a DBS lead in the left Vim thalamic nucleus and completed a 6-month follow-up. The Clinical Tremor Rating Scale and disability assessments were performed at baseline, 1-, 3-, and 6-month follow-up. There were significant improvements in dressing, drinking, eating, bathing, and handwriting as reported by the subjects. Tremor severity, writing, pouring, and spiral and line drawing were significantly improved as rated by the examiner. Improvements persisted through the 6-month follow-up period. Although global disability significantly lessened in the group as a whole, one subject with hand-finger tremor accentuated by writing had no change in disability status. In this 6-month open-label study, DBS was effective and safe in reducing tremor and functional disability in ET.

Aged↗
PubMed1997

Spatial dysgraphia and cerebellar lesion: a case report.

Spatial dysgraphia is a writing disorder that occurs in patients with right hemisphere lesion. We report a patient with cerebellar atrophy and spatial dysgraphia. To explain this finding, we hypothesize a discoordination between planning of the movement and performance due to a lack of the cerebellar modulation between supratentorial (premotor cortex) and peripheral (proprioceptive) afference during the ongoing handwriting movement.

Aged↗
PubMed2004

Open-label dose-escalation study of oral 1-octanol in patients with essential tremor.

Twenty-one single oral doses of 1-octanol were given to patients with essential tremor (ET) in an open-label dose-escalation study. The drug was well tolerated up to 64 mg/kg. The main side effect was an unusual taste. No overt intoxication was seen. There was evidence for efficacy, with a significant reduction in tremor amplitude as measured by accelerometry and handwriting that was maximal at 2 hours. Higher doses may produce more sustained benefit.

1-Octanol↗
PubMed1990

The Wood Library-Museum's 1858 edition of John Snow's On chloroform and other anaesthetics.

The original 1858 edition of John Snow's On Chloroform and Other Anaesthetics, from which came the Wood Library-Museum of Anesthesiology reprints in 1971 and 1989, was donated to the Wood Library-Museum by Ralph Waters of Madison, Wisconsin, in 1967. The book contains a message of appreciation to Waters, dated October 1937, with the signatures of J. Blomfield, Charles King, and R.R. Macintosh as representatives of anesthesiology in England. Correspondence exists in the archives of the University of Wisconsin-Madison between Macintosh, Professor of Anaesthetics in Oxford, and Waters, Associate Professor in Madison. This reveals that Waters, during his visit to England in 1936, inspired British anesthetists to discover more of Snow's early contributions to anesthesiology, even though Waters himself did not possess On Chloroform and Other Anaesthetics. King, a manufacturer of anesthetic equipment, found a copy in the hands of Blomfield, an anesthetist at St. George's Hospital, London, where John Snow had worked. It was this copy that they presented to Waters, and that was delivered to Waters by hand when Waters' resident, Ivan Taylor, returned from Oxford to Madison. Blomfield's ownership of the book, in addition to his position as president of the Association of Anaesthetists of Great Britain and Ireland, explains why the inscription is in his handwriting.

Anesthesiology↗
PubMed2005

Two-year follow-up of chronic stimulation of the posterior subthalamic white matter for tremor-dominant Parkinson's disease.

OBJECTIVE: To determine the efficacy and safety of unilateral deep brain stimulation on the posterior subthalamic white matter, including the zona incerta (ZI) and the prelemniscal radiation (PRL), for tremor-dominant parkinsonian patients and to determine the exact location of electrodes that were most effective. METHODS: Eight parkinsonian patients with severe resting tremor underwent unilateral stimulation of the ZI/PRL by use of stereotactic guidance. Electrophysiological targeting was obtained by macrostimulation and by somatosensory evoked potentials recorded directly through a quadripolar deep brain stimulation lead. Postoperative computed tomographic scans and magnetic resonance images were performed to confirm anatomic location of the electrode. Parkinsonian motor disabilities were evaluated by use of the Unified Parkinson's Disease Rating Scale in the medication-off state before surgery and every 6 months after electrode implantations. RESULTS: The mean location of the clinically effective contacts was in the posterior subthalamic white matter, including the ZI and the PRL (mean, 5.6 +/- 1.2 mm posterior to the midcommissural point, 3.2 +/- 1.1 mm inferior to the anterior commissure-posterior commissure line, and 10.5 +/- 1.2 mm lateral to the midline). At 24 months after operation, ZI/PRL stimulation resulted in significant improvement in mean Unified Parkinson's Disease Rating Scale motor score by 44.3%, contralateral tremor by 78.3%, contralateral rigidity by 92.7%, and contralateral akinesia by 65.7% above the "off-stimulation" scores. Handwriting, posture, and gait were also improved. There were no or only mild adverse events. CONCLUSION: Unilateral ZI/PRL stimulation is a reliable and long-term therapeutic modality and can be considered another surgical target for the treatment of tremor-dominant Parkinson's disease.

Aged↗
PubMed2003

[Electronic links between hospitals or clinics and pharmacies: structure and operation of WAKASHIO pharmacotherapeusis network].

We developed the WAKASHIO Pharmacotherapeusis Network system. This system electronically links physicians' offices with pharmacies to share clinical records and offers the means for real time bi-directional information input. The system is equipped with individual signature (handwriting) recognition protocols to ensure strict enforcement of security and privacy. The network enables front-line pharmacists to access to pertinent clinical records. We performed a series of tests (a "shakedown cruise") of the system and examined the role of the pharmacist as a counselor for patient compliance with prescribed therapeutic regimens. The results indicated the following: 1) This system provides an unequivocal means of communication between physicians and pharmacists. 2) This system is useful for judicious resolution of potential problems arising from separation of the domains of prescriber and dispenser. 3) A noteworthy finding was that community pharmacists devote substantial time/effort to counseling patients concerning their pharmacotherapeutic regimens. 4) Over 80% of patients responded with statements such as "Now I understand my medicines better," and "I am free of anxiety over my medication now." Thus the system provides a powerful tool to promote patient compliance based on pharmacological knowledge. Our future plans for the system include: 1) implementation of an inquiry/response protocol to enhance risk management; 2) online prescription issuance; and 3) expansion of the database used for patient counseling and improvement of the counseling method. Finally, physician-pharmacist collaboration through the system will contribute to a clear redefinition of their respective roles in community medical care services.

Computer Communication Networks↗
PubMed2004

Predictors of writing competence in 4- to 7-year-old children.

BACKGROUND: This longitudinal study sought to improve understanding of the factors at home and school that influence children's attainment and progress in writing between the ages of 4 and 7 years. AIMS: (i) To investigate the relationship between home variables and writing development in preschool children; (ii) to determine associations between child characteristics and writing development (iii) to conduct an analysis of the areas of continuity and discontinuity between variables at home and at school, and influences on subsequent writing development. SAMPLE: Sixty children attending four urban primary schools participated in this study. METHOD: Semi-structured interviews, questionnaires, observation schedules and standardized assessments were used. Writing samples were collected each term. Associations between measures and continuity over time were assessed using multiple regression analysis. RESULTS: Preschool variables that were found to be significantly associated with writing proficiency at school entry included mother's educational level, family size, parental assessment of writing and a measure of home writing. Child characteristics, skills and competencies were measured at school entry and those found to be significantly associated with writing at 7 years included season of birth, vocabulary score, pre-reading skills, handwriting and proficiency in writing name. The only preschool variable that maintained its significant relationship to writing at 7 years was home writing. Teacher assessments of pupil attitudes to writing were consistently found to be significantly associated with writing competence. CONCLUSIONS: This comprehensive study explored the complex interaction of cognitive, affective and contextual processes involved in learning to write, and identified specific features of successful writers. Results are discussed in relation to educational policy and practice issues.

Child↗
PubMed2006

Sydenham's chorea in western Pennsylvania.

OBJECTIVE: Chorea is characterized by involuntary, fleeting, irregular, nonrhythmic movements that flow from 1 body region to another. There are many causes of childhood chorea, including cerebrovascular accidents, collagen vascular diseases, drug intoxication, hyperthyroidism, Wilson's disease, Huntington's disease, and infectious agents. Although Sydenham's chorea (SC), a nonsuppurative sequela of group A streptococcal infection, is known to be a common cause of chorea, multiple laboratory and radiographic studies are often obtained to determine the cause of pediatric chorea. We conducted a retrospective chart review to determine the causes of childhood chorea seen in a large children's hospital in an area endemic for acute rheumatic fever (ARF). The utility of neuroimaging in establishing a final diagnosis of SC is discussed. METHODS: Patients who received a diagnosis of chorea between 1980 and 2004 at the Children's Hospital of Pittsburgh were identified from databases that are maintained by the divisions of Infectious Diseases and Cardiology and from the hospital's medical records department. Charts were abstracted retrospectively. All patients who had new-onset chorea and did not have any underlying neurologic disorders were included in this study. Patient demographic, clinical, laboratory, and imaging information was analyzed. Follow-up information was not found consistently and therefore was not included. Charts of patients with questionable diagnoses were reviewed with a neurologist. RESULTS: A total of 144 patients met the search criterion. Eleven patients had incomplete charts, and 6 charts could not be located. Thirty patients were excluded because they had preexisting neurologic diagnoses, eg, cerebral palsy. Fifteen patients were excluded because they were miscoded as having chorea. Eighty-two patients had new-onset chorea. The cause was SC (n = 79), postoperative cerebral ischemia (n = 1), and basal ganglion infarct (n = 2). Seventy-six (71%) children with SC were female. The mean age of presentation was 9.8 years (range: 5-14.5 years). Chorea was unilateral in 23 (30%) patients. Family history of ARF existed in 30% of patients. Neurologic symptoms of SC included behavior change (46%), dysarthria (67%), gait change (51%), deterioration of handwriting (29%), and headache (11%). Nonneurologic manifestations of ARF were carditis (44%), arthritis (11%), erythema marginatum (3%), and subcutaneous nodules (0%). Antecedent group A streptococcal infection was documented in 99% of patients who were tested by an elevated antistreptolysin O titer (n = 53), an elevated anti-deoxyribonuclease B titer (n = 7), a positive streptozyme (n = 53), or acute throat infection with Streptococcus pyogenes (n = 19). A total of 52 neuroimaging tests were obtained from 46 patients with SC. In patients with SC, brain MRI was abnormal in 8 of 32 patients, and brain computed tomography was abnormal in 1 of 20 patients. Abnormalities did not aid in diagnosis and included nonspecific increased signal (n = 2), nonspecific punctate lesions (n = 2), asymmetry of the hippocampal fissures, unrelated petrous bone anomaly, Arnold Chiari malformation, and medulloblastoma in a macrocephalic patient. Three patients with chorea that was not attributed to ARF had atypical presentations: 1 developed chorea after a perioperative hypoxic/ischemic central nervous system insult; 1 had an episode of disorientation, aphasia, and transient facial droop (angiography showed basal ganglia infarct); and 1 with hemichorea had basal ganglion infarct seen on MRI. CONCLUSIONS: Ninety-six percent of children who had acute chorea and presented to a large children's hospital in an area that is endemic for ARF had SC. These patients had characteristic demographic and clinical features of SC. The most common concurrent major Jones criterion was carditis. Arthritis, erythema marginatum, and subcutaneous nodules were uncommon in this population. Neuroimaging was obtained in 58% of patients with SC and did not aid in any of their diagnoses. The 3 patients with chorea that was not caused by SC had histories that were atypical for SC and warranted neuroimaging. SC can be readily diagnosed on the basis of history, physical examination, and laboratory evaluation; neuroimaging is not necessary and should be reserved for patients who have an atypical presentation, including hemichorea.

Acute Disease↗
PubMed2002

Assessment of chronic neuropsychological effects of mercury vapour poisoning in chloral-alkali plant workers.

A prospective case study was conducted in the Department of Occupational Medicine, Tuzla. The purpose of this study was to indicate negative effects from occupational exposure to mercury on behavioural and mental health, memory and psychomotor function that was tested in 46 chloral-alkali plant workers (mean age was 38. 8+/- 5. 7 years; mean age of occupational history 16. 5+/- 6. 0 years). Data on toxicological monitoring on atomic absorption spectrometer, and data on mental health were collected, psychiatric and other subjective symptoms, and behavioural, psychomotor and memory function tested. The data were compared to control group, 32 healthy non exposed workers. The study was designed to assess blood and urine mercury levels and length of occupational exposure and investigate its relationships to effects on the mental health. The mean air mercury levels were 0.23 mg/m3, the mean blood mercury concentrations was 3. 6 mg/ dl and the mean urine mercury concentrations were 151.7 +/- 180.4 mg/l. In 25 (53%) workers exposed to mercury vapour was identified Depression-Hypochondrias Syndrome (p trend < 0. 001) with higher scores for scales: Hysteria (p trend <0. 001), Schizoid and Psychoastenia (MMPI). All psychological parameters were in highly significantly correlations with mercury levels and length of occupational exposure. Pathological parameters were possible general identified if the concentration of blood mercury levels are >2. 9 mg/ dl, or urine mercury levels > 87 mg/l workers exposed to mercury vapour knew that toxic effects in body resulted in loosing some of intellectual abilities, and that people who handle chemicals had an increased health risk (ESW questionnaire). The occupational mercury exposed workers had introvert behaviour (EPQ). Aggressiveness was found in 71.7% workers. The cognitive disturbances: short-term memory loss, difficult to concentrate on tasks which require attention and thinking, were significantly differed compared to those of controls (p trend < 0. 001). In 24 (52%) exposed to mercury workers we have determined ego strength loss and regressive defensive mechanisms (LB). Handwriting disturbances-micrography we have identified in 27 (58.7%) workers.

Journal Article↗