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Espenes J, Lorentzen IM, Eliassen IV, Hessen E, Waterloo K, Timón-Reina S, Fladby T, Walhovd KB, Fjell AM, Kirsebom BE. Regression-based normative data for the D-KEFS Color-Word Interference Test in Norwegian adults ages 20-85. Clin Neuropsychol 2023:1-27. [PMID: 37974044 DOI: 10.1080/13854046.2023.2276967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
Objective: The Delis-Kaplan Executive Function System (D-KEFS) Color-Word-Interference Test (CWIT; AKA Stroop test) is a widely used measure of processing speed and executive function. While test materials and instructions have been translated to Norwegian, only American age-adjusted norms from D-KEFS are available in Norway. We here develop norms in a sample of 1011 Norwegians between 20 and 85 years. We provide indexes for stability over time and assess demographic adjustments applying the D-KEFS norms. Method: Participants were healthy Norwegian adults from Center for Lifespan Changes in Brain and Cognition (LCBC) (n = 899), the Dementia Disease Initiation (n = 77), and Oslo MCI (n = 35). Using regression-based norming, we estimated linear and non-linear effects of age, education, and sex on the CWIT 1-4 subtests. Stability over time was assessed with intraclass correlation coefficients (ICC). The normative adjustment of the D-KEFS norms was assessed with linear regression models. Results: Increasing age was associated with slower completion on all CWIT subtests in a non-linear fashion (accelerated lowering of performance with older age). Women performed better on CWIT-1&3. Higher education predicted faster completion time on CWIT-3&4. The original age-adjusted norms from D-KEFS did not adjust for sex or education. Furthermore, we observed significant, albeit small effects of age on all CWIT subtests. ICC analyses indicated moderate to good stability over time. Conclusion: We present demographically adjusted regression-based norms and stability indexes for the D-KEFS CWIT subtests. US D-KEFS norms may be inaccurate for Norwegians with high or low educational attainment, especially women.
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Affiliation(s)
- Jacob Espenes
- Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Ingrid Myrvoll Lorentzen
- Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Ingvild Vøllo Eliassen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Hessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Knut Waterloo
- Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Santiago Timón-Reina
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Departamento de Inteligencia Artificial, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Kristine B Walhovd
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Norway
- Computational Radiology and Artificial Intelligence, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Norway
- Computational Radiology and Artificial Intelligence, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Bjørn-Eivind Kirsebom
- Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
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Torregrossa W, Torrisi M, De Luca R, Casella C, Rifici C, Bonanno M, Calabrò RS. Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations. Biomedicines 2023; 11:1991. [PMID: 37509630 PMCID: PMC10376996 DOI: 10.3390/biomedicines11071991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Traumatic brain injury is damage to the brain occurring after birth, often resulting in the deterioration of cognitive, behavioural, and emotional functions. Neuropsychological evaluation can assist clinicians to better assess the patient's clinical condition, reach differential diagnoses, and develop interventional strategies. However, considering the multiple rating scales available, it is not easy to establish which tool is most suitable for the different brain injury conditions. The aim of this review is to investigate and describe the most used neurocognitive assessment tools in patients with traumatic brain injury to provide clinicians with clear indications on their use in clinical practice. Indeed, during the acute phase, after the head trauma, alertness and wakefulness of the patients affected by a disorder of consciousness can be assessed using different scales, such as the Coma Recovery Scale-Revised. In both postacute and chronic phases after traumatic brain injury, general cognitive assessment tools (such as the Mini Mental State Examination) or more specific cognitive tests (e.g., Wisconsin Card Sorting Test and Trail Making Test) could be administered according to the patient's functional status. In this way, clinicians may be aware of the patient's neuropsychological and cognitive level, so they can guarantee a personalized and tailored rehabilitation approach in this frail patient population.
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Affiliation(s)
- William Torregrossa
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Michele Torrisi
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine "AOU Policlinico G. Martino", University Hospital "G. Martino", 98124 Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
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3
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Parr T, Holmes E, Friston KJ, Pezzulo G. Cognitive effort and active inference. Neuropsychologia 2023; 184:108562. [PMID: 37080424 PMCID: PMC10636588 DOI: 10.1016/j.neuropsychologia.2023.108562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
This paper aims to integrate some key constructs in the cognitive neuroscience of cognitive control and executive function by formalising the notion of cognitive (or mental) effort in terms of active inference. To do so, we call upon a task used in neuropsychology to assess impulse inhibition-a Stroop task. In this task, participants must suppress the impulse to read a colour word and instead report the colour of the text of the word. The Stroop task is characteristically effortful, and we unpack a theory of mental effort in which, to perform this task accurately, participants must overcome prior beliefs about how they would normally act. However, our interest here is not in overt action, but in covert (mental) action. Mental actions change our beliefs but have no (direct) effect on the outside world-much like deploying covert attention. This account of effort as mental action lets us generate multimodal (choice, reaction time, and electrophysiological) data of the sort we might expect from a human participant engaging in this task. We analyse how parameters determining cognitive effort influence simulated responses and demonstrate that-when provided only with performance data-these parameters can be recovered, provided they are within a certain range.
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Affiliation(s)
- Thomas Parr
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, UK.
| | - Emma Holmes
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, UK
| | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
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4
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Kutash LA, Moschonas EH, O'Neil DA, Craine TJ, Iouchmanov AL, Sunleaf CR, Nicholas MA, Grobengieser KO, Patel AK, Toader M, Ranellone TS, Rennerfeldt PL, Cheng JP, Race NS, Kline AE, Bondi CO. Sustained attention performance deficits in the three-choice serial reaction time task in male and female rats after experimental brain trauma. Brain Res 2023; 1808:148336. [PMID: 36948353 PMCID: PMC11037439 DOI: 10.1016/j.brainres.2023.148336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
Impaired attention is central to the cognitive deficits associated with long-term sequelae for many traumatic brain injury (TBI) survivors. Assessing complex sustained attention post-TBI is clinically-relevant and may provide reliable avenues towards developing therapeutic and rehabilitation targets in both males and females. We hypothesized that rats subjected to a moderate TBI will exhibit attentional deficits seen as reduced accuracy and increased distractibility in an operant 3-choice serial reaction time task (3-CSRT), designed as an analogue of the clinical continuous performance test. Upon reaching baseline of 70% accuracy at the 300 ms cue, adult male and female Sprague-Dawley rats were subjected to a controlled cortical impact (2.8 mm deformation at 4 m/s) or sham injury over the right parietal cortex. After two weeks of recovery, they were retested on the 3-CSRT for ten days. Dependent measures include percent accuracy (overall and for each of the three cue ports), percent omissions, as well as latency to instrumental poke and retrieve reward. Results demonstrate that both males and females displayed reduced percent accuracy and increased omissions when re-tested post-TBI on 3-CSRT compared to Sham rats and to their own pre-insult baseline (p's < 0.05). Performance accuracy was impaired consistently throughout the ten days of post-surgery re-testing, suggesting pronounced and long-lasting dysfunction in sustained attention processes. Deficits were specifically more pronounced when the cue was pseudorandomly presented in the left-side cue port (p < 0.05), mirroring clinical hemispatial neglect. These data demonstrate significant and persistent complex attention impairments in both sexes after TBI, rendering identifying efficient therapies for cognitive recovery as pivotal.
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Affiliation(s)
- Lindsay A Kutash
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eleni H Moschonas
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darik A O'Neil
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy J Craine
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Anna L Iouchmanov
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlson R Sunleaf
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa A Nicholas
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katherine O Grobengieser
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aarti K Patel
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mihaela Toader
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tyler S Ranellone
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Piper L Rennerfeldt
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey P Cheng
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas S Race
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Association of Academic Physiatrists Rehabilitation Medicine Scientist Training Program, Owings Mills, MD, USA
| | - Anthony E Kline
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Corina O Bondi
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA; Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA.
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5
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Martinikova M, Ruzinak R, Hnilicova P, Bittsansky M, Grendar M, Babalova L, Skacik P, Kantorova E, Nosal V, Turcanova Koprusakova M, Sivak J, Sivakova J, Biringerova Z, Kolarovszki B, Zelenak K, Kurca E, Sivak S. Safety and efficacy of simple training protocol in patients after mild traumatic brain injury. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37157859 DOI: 10.5507/bp.2023.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
AIMS Mild Traumatic Brain Injury (mTBI) is the most common type of craniocerebral injury. Proper management appears to be a key factor in preventing post-concussion syndrome. The aim of this prospective study was to evaluate the effect and safety of selected training protocol in patients after mTBI. METHODS This was a prospective study that included 25 patients with mTBI and 25 matched healthy controls. Assessments were performed in two sessions and included a post-concussion symptoms questionnaire, battery of neurocognitive tests, and magnetic resonance with tractography. Participants were divided into two groups: a passive subgroup with no specific recommendations and an active subgroup with simple physical and cognitive training. RESULTS The training program with slightly higher initial physical and cognitive loads was well tolerated and was harmless according to the noninferiority test. The tractography showed overall temporal posttraumatic changes in the brain. The predictive model was able to distinguish between patients and controls in the first (AUC=0.807) and second (AUC=0.652) sessions. In general, tractography had an overall predictive dominance of measures. CONCLUSION The results from our study objectively point to the safety of our chosen training protocol, simultaneously with the signs of slight benefits in specific cognitive domains. The study also showed the capability of machine learning and predictive models in mTBI patient recognition.
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Affiliation(s)
- Martina Martinikova
- Second Department of Neurology, F. D. Roosevelt Faculty Hospital, Slovak Medical University, Banska Bystrica, Slovak Republic
| | - Robert Ruzinak
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Petra Hnilicova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Michal Bittsansky
- Department of Medical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marian Grendar
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Lucia Babalova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Pavol Skacik
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ema Kantorova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Vladimir Nosal
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Monika Turcanova Koprusakova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jozef Sivak
- Department of Radiology, The Central Slovak Institute for Cardiovascular Diseases in Banska Bystrica, Banska Bystrica, Slovak Republic
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jana Sivakova
- Clinic of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Zuzana Biringerova
- Medical Education Support Center, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Branislav Kolarovszki
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Kamil Zelenak
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Egon Kurca
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Stefan Sivak
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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6
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Jeong E, Ireland SJ. Criterion-Related Validation of a Music-Based Attention Assessment for Individuals with Traumatic Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16285. [PMID: 36498353 PMCID: PMC9738551 DOI: 10.3390/ijerph192316285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The music-based attention assessment (MAA) is a melody contour identification task that evaluates different types of attention. Previous studies have examined the psychometric and physiological validity of the MAA across various age groups in clinical and typical populations. The purpose of this study was to confirm the MAA's criterion validity in individuals with traumatic brain injury (TBI) and to correlate this with standardized neuropsychological measurements. The MAA and various neurocognitive tests (i.e., the Wechsler adult intelligence scale DST, Delis-Kaplan executive functioning scale color-word interference test, and Conner's continuous performance test) were administered to 38 patients within two weeks prior to or post to the MAA administration. Significant correlations between MAA and neurocognitive batteries were found, indicating the potential of MAA as a valid measure of different types of attention deficits. An additional multiple regression analysis revealed that MAA was a significant factor in predicting attention ability.
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Affiliation(s)
- Eunju Jeong
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul 03760, Republic of Korea
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7
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Alnawmasi MM, Khuu SK. Deficits in multiple object-tracking and visual attention following mild traumatic brain injury. Sci Rep 2022; 12:13727. [PMID: 35962018 PMCID: PMC9374772 DOI: 10.1038/s41598-022-18163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Difficulty in the ability to allocate and maintain visual attention is frequently reported by patients with traumatic brain injury (TBI). In the present study, we used a multiple object tracking (MOT) task to investigate the degree to which TBI affects the allocation and maintenance of visual attention to multiple moving targets. Fifteen adults with mild TBI and 20 control participants took part in this study. All participants were matched for age, gender, and IQ. The sensitivity and time taken to perform the MOT task were measured for different conditions in which the duration of the tracking, number of target, and distractor dots were systematically varied. When the number of target dots required to be tracked increased, sensitivity in correctly detecting them decreased for both groups but was significantly greater for patients with mild TBI. Similarly, increasing the number of distractor dots had a greater effect on reducing task sensitivity for patients with mild TBI than control participants. Finally, across all conditions, poorer detection performance was observed for patients with mild TBI when the tracking duration was longer compared to control participants. The present study showed that patients with mild TBI have greater deficits (compared to control participants) in their ability to maintain visual attention on tracking multiple moving objects, which was particularly hindered by increased tracking load and distraction.
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Affiliation(s)
- Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia. .,College of Applied Medical Science, Department of Optometry, Qassim University, Buraydah, Saudi Arabia.
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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8
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García-Rudolph A, García-Molina A, Opisso E, Tormos JM, Madai VI, Frey D, Bernabeu M. Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation. Front Neurol 2021; 12:701946. [PMID: 34434163 PMCID: PMC8380987 DOI: 10.3389/fneur.2021.701946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001).
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Affiliation(s)
- Alejandro García-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Alberto García-Molina
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Eloy Opisso
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Josep María Tormos
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Vince I. Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Faculty of Computing, Engineering and the Built Environment, School of Computing and Digital Technology, Birmingham City University, Birmingham, United Kingdom
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Montserrat Bernabeu
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
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9
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Fuller GW, Gardner A, Tucker R, Douglas M, Readhead C, McDonald W, Murphy I, Saco M, Raftery M, Falvey E. Expansion of cognitive testing for off-field concussion screening in elite rugby players: A cohort study. J Sci Med Sport 2021; 24:1204-1210. [PMID: 34247976 DOI: 10.1016/j.jsams.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/30/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Current off-field concussion screening instruments have sub-optimal accuracy and additional testing domains may be necessary to detect the full spectrum of concussion presentations. This study aimed to determine if additional cognitive tests add utility to off-field screening for sport-related concussion. DESIGN Reproducibility and diagnostic accuracy cohort studies were performed in the 2017 and 2018 seasons of the Super Rugby competition, conducted in Argentina, Australia, Japan, New Zealand, and South Africa. METHODS Abridged versions of Stroop (score, time), Spatial Memory (score, failed trials), and Trail Making Trial-B (time, errors) cognitive tests, modified for off-field use, were examined. Players performed baseline testing prior to each season. Cases undergoing off-field screening as part of the World Rugby Head Injury Assessment Process underwent evaluation with the same cognitive tests during competition matches. Agreement between repeated pre-season baseline measurements, and the diagnostic accuracy of off-field testing against a clinical reference standard of concussion, was evaluated. RESULTS Data were available for repeated preseason baseline testing in 644 players, and 100 cases undergoing off-field concussion screening. There was little individual agreement across pre-season baseline assessments for all tests (Lin's correlation and Gwets AC1 coefficients ranging between 0.2 and 0.3). There was significantly worse performance for the time taken to complete the modified Stroop Test in concussed players undergoing off-field screening, compared to non-concussed players (median time 21.1 v 18.4 s, p < 0.01; area under the receiver operating characteristic curve 0.7 (95% CI 0.5-0.8)). Other cognitive measures did not discriminate between injured and un-injured players, with no-statistically significant differences in distribution medians (p = 0.6-0.9) and AUROC values close to 0.5. CONCLUSIONS The time taken to perform a modified Stroop Test may provide additional diagnostic accuracy if added to current off-field concussion screening tools. Abridged Spatial Memory and Trail Making Trial-B tests did not discriminate between concussed and non-concussed players.
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Affiliation(s)
- Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, UK.
| | - Andrew Gardner
- Hunter New England Local Health District Sports Concussion Program, Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Australia.
| | - Ross Tucker
- University of Cape Town School of Management Studies, South Africa.
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10
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Faroqi-Shah Y, Gehman M. The Role of Processing Speed and Cognitive Control on Word Retrieval in Aging and Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:949-964. [PMID: 33621116 DOI: 10.1044/2020_jslhr-20-00326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose When speakers retrieve words, they do so extremely quickly and accurately-both speed and accuracy of word retrieval are compromised in persons with aphasia (PWA). This study examined the contribution of two domain-general mechanisms: processing speed and cognitive control on word retrieval in PWA. Method Three groups of participants, neurologically healthy young and older adults and PWA (n = 15 in each group), performed processing speed, cognitive control, lexical decision, and word retrieval tasks on a computer. The relationship between word retrieval speed and other tasks was examined for each group. Results Both aging and aphasia resulted in slower processing speed but did not affect cognitive control. Word retrieval response time delays in PWA were eliminated when processing speed was accounted for. Word retrieval speed was predicted by individual differences in cognitive control in young and older adults and additionally by processing speed in older adults. In PWA, word retrieval speed was predicted by severity of language deficit and cognitive control. Conclusions This study shows that processing speed is compromised in aphasia and could account for their slowed response times. Individual differences in cognitive control predicted word retrieval speed in healthy adults and PWA. These findings highlight the need to include nonlinguistic cognitive mechanisms in future models of word retrieval in healthy adults and word retrieval deficits in aphasia.
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Affiliation(s)
- Yasmeen Faroqi-Shah
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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11
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Rivera D, Mascialino G, Brooks BL, Olabarrieta-Landa L, Longoni M, Galarza-Del-Angel J, Arango-Lasprilla JC. Multivariate Base Rates of Low Scores on Tests of Executive Functions in a Multi-Country Latin American Sample. Dev Neuropsychol 2020; 46:1-15. [PMID: 33356560 DOI: 10.1080/87565641.2020.1863407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of the study was to determine the prevalence of low scores in a diverse Latin American population for two neuropsychological commonly used tests to evaluate executive functions and to compare the number of low scores obtained using normative data from a Spanish-speaking population from Latin America versus an English-speaking population from U.S.A. Healthy adults (N = 5402) were administered the Modified Wisconsin Card Sorting Test and Stroop Color-Word. Low scores on measures of executive functioning are common. Clinicians working with Spanish-speaking adults should take into account the higher probability of low scores on these measures to reduce false-positive diagnoses of cognitive deficits in an individual.
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Affiliation(s)
- Diego Rivera
- Departamento De Ciencias De La Salud, Universidad Pública De Navarra , Pamplona, Spain
| | - Guido Mascialino
- Escuela De Psicología, Universidad De Las Américas , Quito, Ecuador
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada
| | | | - Melina Longoni
- Dirección de Discapacidad de Ituzaingo , Buenos Aires, Argentina
| | | | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute. Cruces University Hospital . Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science ., Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU) , Bizkaia, Spain
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12
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de Guise E, Degré C, Beaujean O, Julien J, Lague-Beauvais M, Dagher J, Marcoux J. Comparison of executive functions and functional outcome between older patients with traumatic brain injury and normal older controls. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1174-1187. [DOI: 10.1080/23279095.2020.1862118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Elaine de Guise
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Centre de Recherche Interdisciplinaire en Readaptation du Montreal Metropolitain, Montreal, Quebec, Canada
| | - Catherine Degré
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Océane Beaujean
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jessica Julien
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Maude Lague-Beauvais
- Traumatic Brain Injury Program-McGill University Health Center, Montreal, Canada
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Slavoaca D, Birle C, Stan A, Tatomir A, Popa O, Rosu P, Vulcan AM, Chira D, Livint Popa L, Dina C, Vacaras V, Strilciuc S, Vos P. Prediction of Neurocognitive Outcome after Moderate-Severe Traumatic Brain Injury Using Serum Neuron-Specific Enolase and S100 biomarkers. J Med Life 2020; 13:306-313. [PMID: 33072201 PMCID: PMC7550145 DOI: 10.25122/jml-2020-0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Seric biomarkers have been tested in a large number of studies on traumatic brain injuries (TBI) patients in order to predict severity, especially related to the short-term outcome. However, TBI patients have a high risk of developing long-term complications such as physical disability, cognitive impairment, psychiatric pathology, epilepsy, and others. The aim of this study was to assess the correlation between protein biomarkers S100 and neuron-specific enolase (NSE) and neurocognitive status at 10- and 90-days post-injury. Both biomarkers were tested in the first 4h and after 72h post-injury in 62 patients with moderate-severe TBI. The patients were evaluated by a series of neurocognitive tests: Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale-Extended (GOSE), The Mini-Mental State Examination (MMSE), Processing Speed Index (PSI), and Stroop Test, at 10 and 90 days post-injury and supplementary by the Hospital Anxiety and Depression Scale at 90 days. For evaluating the whole neurocognitive status instead of every scale separately, we used Structural Equation Modeling (SEM), while for anxiety and depressive symptoms, we used multiple regression analyses. SEM showed that NSE values at 4 hours were significant predictors of the cognitive status at 10 (p=0.034) and 90 days (p= 0.023). Also, there were found significant correlations between NSE at 4h and the anxiety level. This study demonstrated a significant correlation between NSE at 4h and short and medium-term neuropsychological outcomes, which recommends using this biomarker for selecting patients with a higher risk of cognitive dysfunction.
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Affiliation(s)
- Dana Slavoaca
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Codruta Birle
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Alexandru Tatomir
- Department of Neurology, University of Maryland, School of Medicine, Baltimore, United States of America
| | - Oana Popa
- Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Paula Rosu
- Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Ana-Maria Vulcan
- Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Diana Chira
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Livia Livint Popa
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Constantin Dina
- Department of Radiology, "Ovidius" University, Faculty of Medicine, Constanta, Romania
| | - Vitalie Vacaras
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania.,Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Pieter Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
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14
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Calvillo M, Irimia A. Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury. Front Psychol 2020; 11:1423. [PMID: 32733322 PMCID: PMC7358255 DOI: 10.3389/fpsyg.2020.01423] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.
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Affiliation(s)
- Maria Calvillo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States.,Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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15
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Ferreira-Correia A, Anderson DG, Cockcroft K, Krause A. The neuropsychological deficits and dissociations in Huntington Disease-Like 2: A series of case-control studies. Neuropsychologia 2020; 136:107238. [DOI: 10.1016/j.neuropsychologia.2019.107238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/23/2019] [Accepted: 10/25/2019] [Indexed: 01/01/2023]
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16
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Leshem R, Icht M, Bentzur R, Ben-David BM. Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels. Front Psychiatry 2020; 11:601763. [PMID: 33281649 PMCID: PMC7691229 DOI: 10.3389/fpsyt.2020.601763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.
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Affiliation(s)
- Rotem Leshem
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Roni Bentzur
- Psychiatric Division, Sheba Medical Center, Tel Hashomer, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada
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17
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Norman RS, Shah MN, Turkstra LS. Language Comprehension After Mild Traumatic Brain Injury: The Role of Speed. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1479-1490. [PMID: 31454258 PMCID: PMC7251601 DOI: 10.1044/2019_ajslp-18-0203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Purpose The aim of this study was to characterize language comprehension in mild traumatic brain injury (mTBI) by testing a speed-based hypothesis. We hypothesized that adults with mTBI would perform worse than a group of adults with orthopedic injuries (OIs) on an experimental language comprehension task. Method The study employed a prospective experimental design. Participants were 19 adults with mTBI and 19 adults with OI ages 18-55 years. Participants completed the Whatdunit task, a sentence agent selection task in speeded and unspeeded conditions. Results In the unspeeded condition, the mTBI group performed with a marginally significant higher accuracy than the OI group. In the speeded condition, the mTBI group performed with lower accuracy than the OI group; however, this difference did not reach statistical significance. There was a marginally significant interaction of Sentence Type × Group for reaction time in the speeded condition. Conclusions While our task might have been sensitive to cognitive processing abilities in both groups (as evidenced by the main effects of condition and sentence type), the task was not specific enough to capture mTBI-related deficits. The similarities in performance between both groups have clinical implications for the treatment of not just brain-related trauma but also trauma in general.
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Affiliation(s)
- Rocío S. Norman
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | - Manish N. Shah
- Berbee Walsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Lyn S. Turkstra
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Neuroscience Training Program and Department of Surgery, University of Wisconsin–Madison
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18
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Contributions to Executive Dysfunction in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:E41-E52. [PMID: 28520663 DOI: 10.1097/htr.0000000000000313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD), history of mild traumatic brain injury (mTBI), and executive function (EF) difficulties are prevalent in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. We evaluated the contributions of injury variables, lower-order cognitive component processes (processing speed/attention), and psychological symptoms to EF. PARTICIPANTS OEF/OIF Veterans (N = 65) with PTSD and history of mTBI were administered neuropsychological tests of EF and self-report assessments of PTSD and depression. RESULTS Those impaired on one or more EF measures had higher PTSD and depression symptoms and lower processing speed/attention performance than those with intact performance on all EF measures. Across participants, poorer attention/processing speed performance and higher psychological symptoms were associated with worse performance on specific aspects of EF (eg, inhibition and switching) even after accounting for injury variables. Although direct relationships between EF and injury variables were equivocal, there was an interaction between measures of injury burden and processing speed/attention such that those with greater injury burden exhibited significant and positive relationships between processing speed/attention and inhibition/switching, whereas those with lower injury burden did not. CONCLUSION Psychological symptoms as well as lower-order component processes of EF (attention and processing speed) contribute significantly to executive dysfunction in OEF/OIF Veterans with PTSD and history of mTBI. However, there may be equivocal relationships between injury variables and EF that warrant further study. Results provide groundwork for more fully understanding cognitive symptoms in OEF/OIF Veterans with PTSD and history of mTBI that can inform psychological and cognitive interventions in this population.
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Norman RS, Shah MN, Turkstra LS. Reaction time and cognitive-linguistic performance in adults with mild traumatic brain injury. Brain Inj 2019; 33:1173-1183. [PMID: 31291747 DOI: 10.1080/02699052.2019.1632487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study was to characterize cognitive-linguistic performance in adults with mild traumatic brain injury (mTBI) to advance assessment and treatment practices. We hypothesized that individuals with mTBI would demonstrate longer reaction times (RTs) and greater error rates when compared to an orthopedic injury (OI) group on a category-naming task. Method: Participants were age and education-matched adults with mTBI (n = 20; 12 females) and adults with OI (n = 21; 5 females) who were discharged to home after an Emergency Department visit. Our primary task was a category-naming task shown to be sensitive to language deficits after mTBI. The task was adapted and administered under speeded and unspeeded conditions. Results: There was a significant main effect of condition on RT (speeded faster than unspeeded) and accuracy (more errors in the speeded condition). There was a marginally significant effect of group on errors, with more errors in the mTBI group than the OI group. Naming RT and accuracy in both conditions were moderately correlated with injury variables and symptom burden. Conclusions: Our data showed a marginal effect of group on accuracy of performance. Correlations found between naming and neurobehavioural symptoms, including sleep quality, suggest that the latter should be considered in future research.
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Affiliation(s)
- Rocío S Norman
- a Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison , WI , USA
| | - Manish N Shah
- b BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, School of Medicine and Public Health , Madison , WI , USA
| | - Lyn S Turkstra
- a Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison , WI , USA.,c Neuroscience Training Program and Department of Surgery, University of Wisconsin-Madison , Madison , WI , USA
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Turkstra LS, Duff MC, Politis AM, Mutlu B. Detection of text-based social cues in adults with traumatic brain injury. Neuropsychol Rehabil 2019; 29:789-803. [PMID: 28594270 PMCID: PMC6170715 DOI: 10.1080/09602011.2017.1333012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Written text contains verbal immediacy cues-word form or grammatical cues that indicate positive attitude or liking towards an object, action, or person. We asked if adults with moderate-severe traumatic brain injury (TBI) would respond to these cues, given evidence of TBI-related social communication impairments. METHODS Sixty-nine adults with TBI and 74 healthy comparison (HC) peers read pairs of sentences containing different types of immediacy cues (e.g., speaker A said "these Canadians" vs. B said "those Canadians.") and identified which speaker (A or B) had a more positive attitude towards the underlined entity (Task 1); and pairs of sentences comprised of a context sentence (e.g., Fred is asked, "Did you visit Joan and Sue?") and a statement sentence (Fred says, "I visited Sue and Joan.") and were asked to indicate how much Fred liked or disliked the underlined words (Task 2). RESULTS HC group scores were significantly higher on Task 1, indicating more sensitivity to cues. On Task 2, TBI and HC group ratings differed across cue types and immediacy types, and the TBI group appeared to have less sensitivity to these cues. CONCLUSIONS Findings suggest that TBI-related impairments may reduce sensitivity to subtle social cues in text.
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Affiliation(s)
- Lyn Siobhan Turkstra
- a Department of Communication Sciences and Disorders , University of Wisconsin-Madison , Madison , USA
- b Neuroscience Training Program and Department of Surgery , University of Wisconsin-Madison , Madison , USA
| | - Melissa Collins Duff
- c Department of Hearing and Speech Sciences , Vanderbilt University , Nashville , USA
| | - Adam Michael Politis
- a Department of Communication Sciences and Disorders , University of Wisconsin-Madison , Madison , USA
- d Rehabilitation Medicine Department , National Institutes of Health , Bethesda , USA
| | - Bilge Mutlu
- e Department of Computer Sciences , University of Wisconsin-Madison , Madison , USA
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Disturbed neurovascular coupling in type 2 diabetes mellitus patients: Evidence from a comprehensive fMRI analysis. NEUROIMAGE-CLINICAL 2019; 22:101802. [PMID: 30991623 PMCID: PMC6447740 DOI: 10.1016/j.nicl.2019.101802] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 02/08/2023]
Abstract
Background Previous studies presumed that the disturbed neurovascular coupling to be a critical risk factor of cognitive impairments in type 2 diabetes mellitus (T2DM), but distinct clinical manifestations were lacked. Consequently, we decided to investigate the neurovascular coupling in T2DM patients by exploring the MRI relationship between neuronal activity and the corresponding cerebral blood perfusion. Methods Degree centrality (DC) map and amplitude of low-frequency fluctuation (ALFF) map were used to represent neuronal activity. Cerebral blood flow (CBF) map was used to represent cerebral blood perfusion. Correlation coefficients were calculated to reflect the relationship between neuronal activity and cerebral blood perfusion. Results At the whole gray matter level, the manifestation of neurovascular coupling was investigated by using 4 neurovascular biomarkers. We compared these biomarkers and found no significant changes. However, at the brain region level, neurovascular biomarkers in T2DM patients were significantly decreased in 10 brain regions. ALFF-CBF in left hippocampus and fractional ALFF-CBF in left amygdala were positively associated with the executive function, while ALFF-CBF in right fusiform gyrus was negatively related to the executive function. The disease severity was negatively related to the memory and executive function. The longer duration of T2DM was related to the milder depression, which suggests T2DM-related depression may not be a physiological condition but be a psychological condition. Conclusion Correlations between neuronal activity and cerebral perfusion maps may be a method for detecting neurovascular coupling abnormalities, which could be used for diagnosis in the future. Trial registry number: This study has been registered in ClinicalTrials.gov (NCT02420470) on April 2, 2015 and published on July 29, 2015. Multi-modal MRI is a method to reflect neurovascular coupling condition. Neurovascular coupling dysfunction was found in diabetics. The memory, executive function and emotion were disrupted in diabetics. The limbic system, basal ganglia, and prefrontal lobe was damaged in diabetics.
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Jeong E, Ryu H, Shin JH, Kwon GH, Jo G, Lee JY. High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis. Sci Rep 2018; 8:16737. [PMID: 30425287 PMCID: PMC6233191 DOI: 10.1038/s41598-018-35172-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Attention deficits due to auditory distractibility are pervasive among patients with acquired brain injury (ABI). It remains unclear, however, whether attention deficits following ABI specific to auditory modality are associated with altered haemodynamic responses. Here, we examined cerebral haemodynamic changes using functional near-infrared spectroscopy combined with a topological vector-based analysis method. A total of thirty-seven participants (22 healthy adults, 15 patients with ABI) performed a melodic contour identification task (CIT) that simulates auditory distractibility. Findings demonstrated that the melodic CIT was able to detect auditory distractibility in patients with ABI. The rate-corrected score showed that the ABI group performed significantly worse than the non-ABI group in both CIT1 (target contour identification against environmental sounds) and CIT2 (target contour identification against target-like distraction). Phase-associated response intensity during the CITs was greater in the ABI group than in the non-ABI group. Moreover, there existed a significant interaction effect in the left dorsolateral prefrontal cortex (DLPFC) during CIT1 and CIT2. These findings indicated that stronger hemodynamic responses involving oxygen exchange in the left DLPFC can serve as a biomarker for evaluating and monitoring auditory distractibility, which could potentially lead to the discovery of the underlying mechanism that causes auditory attention deficits in patients with ABI.
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Affiliation(s)
- Eunju Jeong
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea.
- Division of Industrial Information Studies, Hanyang University, Seoul, 04763, Republic of Korea.
| | - Hokyoung Ryu
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
| | - Gyu Hyun Kwon
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Geonsang Jo
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
| | - Ji-Yeong Lee
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
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Ben-David BM, van Lieshout PHHM, Shakuf V. Sensory source for stroop effects in persons after TBI: support from fNIRS-based investigation. Brain Imaging Behav 2018; 10:1135-1136. [PMID: 26572142 DOI: 10.1007/s11682-015-9477-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Boaz M Ben-David
- Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel. .,Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada. .,Toronto Rehabilitation Institute, Toronto, ON, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Pascal H H M van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada.,Department of Spanish & Portuguese, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Vered Shakuf
- Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
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Ben-David BM, Icht M. The Effect of Practice and Visual Feedback on Oral-Diadochokinetic Rates for Younger and Older Adults. LANGUAGE AND SPEECH 2018; 61:113-134. [PMID: 28610466 DOI: 10.1177/0023830917708808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessments of oral-diadochokinetic rates are commonly performed to evaluate oral-motor skills. However, the appropriate administration protocol is not defined, and varies across therapists, clinics and laboratories. In three experiments and an auxiliary one, this study analyzes the effects of brief (motor) practice and visual feedback on the performance of 98 younger (20-40 years old) and 78 older adults (over 65) with the sequential motion rate (SMR) version. Overall rates were significantly faster for younger over older adults. Irrespective of age-group, averaged performance was significantly better on the second round, but the third round was found to be superfluous, across experiments and age-groups. Visual feedback (using a mirror) was found to be detrimental for younger adults, eliminating the advantage reaped from a practice round. For older adults, visual feedback did not alter the effect of a practice round. Sensory (visual) degradation is presented as a possible source for this age-related difference. We discuss these findings and suggest an administration protocol for younger and older adults with the SMR version, including a total of two rounds and no visual feedback.
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Ben-David BM, Malkin G, Erel H. Ageism and Neuropsychological Tests. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Thiessen A, Brown J, Beukelman D, Hux K. The effect of human engagement depicted in contextual photographs on the visual attention patterns of adults with traumatic brain injury. JOURNAL OF COMMUNICATION DISORDERS 2017; 69:58-71. [PMID: 28783543 DOI: 10.1016/j.jcomdis.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Photographs are a frequently employed tool for the rehabilitation of adults with traumatic brain injury (TBI). Speech-language pathologists (SLPs) working with these individuals must select photos that are easily identifiable and meaningful to their clients. In this investigation, we examined the visual attention response to camera- (i.e., depicted human figure looking toward camera) and task-engaged (i.e., depicted human figure looking at and touching an object) contextual photographs for a group of adults with TBI and a group of adults without neurological conditions. Eye-tracking technology served to accurately and objectively measure visual fixations. Although differences were hypothesized given the cognitive deficits associated with TBI, study results revealed little difference in the visual fixation patterns of adults with and without TBI. Specifically, both groups of participants tended to fixate rapidly on the depicted human figure and fixate more on objects in which a human figure was task-engaged than when a human figure was camera-engaged. These results indicate that strategic placement of human figures in a contextual photograph may modify the way in which individuals with TBI visually attend to and interpret photographs. In addition, task-engagement appears to have a guiding effect on visual attention that may be of benefit to SLPs hoping to select more effective contextual photographs for their clients with TBI. Finally, the limited differences in visual attention patterns between individuals with TBI and their age and gender matched peers without neurological impairments indicates that these two groups find similar photograph regions to be worthy of visual fixation. LEARNING OUTCOMES Readers will gain knowledge regarding the photograph selection process for individuals with TBI. In addition, readers will be able to identify camera- and task-engaged photographs and to explain why task-engagement may be a beneficial component of contextual photographs.
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Affiliation(s)
- Amber Thiessen
- Department of Communication Sciences and Disorders, University of Houston, 114 Clinical Research Services, Houston, TX 77004, United States.
| | - Jessica Brown
- Department of Speech-Language-Hearing Sciences at the University of Minnesota, 164 Pillsbury Dr. SE, 115 Shevlin Hall, Minneapolis, MN 55455, United States
| | - David Beukelman
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 301 Barkley Memorial Center, Lincoln, NE 68583, United States
| | - Karen Hux
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 301 Barkley Memorial Center, Lincoln, NE 68583, United States
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Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: An expert overview. Rev Neurol (Paris) 2017; 173:461-472. [PMID: 28847474 DOI: 10.1016/j.neurol.2017.07.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/13/2017] [Indexed: 01/12/2023]
Abstract
Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors.
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Affiliation(s)
- P Azouvi
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France.
| | - A Arnould
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - E Dromer
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - C Vallat-Azouvi
- HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France; Laboratoire de psychopathologie et neuropsychologie, EA 2027, université Paris-8-Saint-Denis, 2, rue de la Liberté, 93526 Saint-Denis, France; Antenne UEROS- UGECAMIDF, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Abstract
OBJECTIVES The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning. METHODS Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected. RESULTS The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education. CONCLUSIONS The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017, 23, 400-411).
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Anderson LB, Jaroh R, Smith H, Strong CAH, Donders J. Criterion validity of the D-KEFS color-word and verbal fluency switching paradigms following traumatic brain injury. J Clin Exp Neuropsychol 2017; 39:890-899. [PMID: 28095735 DOI: 10.1080/13803395.2016.1277513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study was composed of two parts examining the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency and Color-Word subtests in traumatic brain injury (TBI). In the first part, the performance of 128 outpatients with mild to severe TBI on the Verbal Fluency and Color-Word subtests was examined in relation to two primary indicators of TBI severity: length of coma and the presence of intracranial lesions on neuroimaging through regression analysis. After controlling for education, ethnicity, and complicating premorbid and comorbid factors, length of coma predicted performance on the Color-Word Inhibition/Switching subtest, whereas the presence of diffuse lesions was related to Verbal Fluency Category Switching performance. In the second part of this study, performance on the Category Switching and Inhibition/Switching subtests was compared between a group of 28 participants with moderate-to-severe TBI and demographically matched groups with mild-uncomplicated TBI (n = 28) and neurologically healthy control participants (n = 56). The moderate-to-severe TBI group performed significantly worse on both subtests than the mild-uncomplicated TBI and control groups, and the latter groups did not differ from each other on these subtests. Logistic regression analysis showed that the combined group classification accuracy of these subtests was 66.07%, with an area under the curve (AUC) of .70 and a likelihood ratio of 1.93. The findings provide modest support for the clinical utility of the Color-Word Inhibition/Switching subtest in the cognitive assessment of TBI, while also replicating prior research suggesting clinical utility of the Category Switching subtest in this population.
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Affiliation(s)
- Luke B Anderson
- a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA
| | - Rebekah Jaroh
- b Department of Psychology , Calvin College , Grand Rapids , MI , USA
| | - Hillary Smith
- c Department of Psychology , Hope College , Holland , MI , USA
| | - Carrie-Ann H Strong
- a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA
| | - Jacobus Donders
- a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA
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Womack KB, Paliotta C, Strain JF, Ho JS, Skolnick Y, Lytton WW, Turtzo LC, McColl R, Diaz-Arrastia R, Bergold PJ. Measurement of Peripheral Vision Reaction Time Identifies White Matter Disruption in Patients with Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:1539-1545. [PMID: 27927083 DOI: 10.1089/neu.2016.4670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study examined whether peripheral vision reaction time (PVRT) in patients with mild traumatic brain injury (mTBI) correlated with white matter abnormalities in centroaxial structures and impairments in neuropsychological testing. Within 24 h after mTBI, crossed reaction times (CRT), uncrossed reaction times (URT), and crossed-uncrossed difference (CUD) were measured in 23 patients using a laptop computer that displayed visual stimuli predominantly to either the left or the right visual field of the retina. The CUD is a surrogate marker of the interhemispheric transfer time (ITT). Within 7 days after the injury, patients received a diffusion tensor-MRI (DTI) scan and a battery of neuropsychological tests. Nine uninjured control subjects received similar testing. Patients 18-50 years of age were included if they had a post-resuscitation Glasgow Coma Scale >13 and an injury mechanism compatible with mTBI. Healthy controls were either age- and gender-matched family members of the TBI patients or healthy volunteers. CUD deficits >2 standard deviations (SD) were seen in 40.9% of patients. The CUD of injured patients correlated with mean diffusivity (MD) (p < 0.001, ρ = -0.811) in the posterior corpus callosum. Patients could be stratified on the basis of CUD on the Stroop 1, Controlled Oral Word Association Test (COWAT), and the obsessive-compulsive component of the Basic Symptom Inventory tests. These studies suggest that the PVRT indirectly measures white matter integrity in the posterior corpus callosum, a brain region frequently damaged by mTBI.
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Affiliation(s)
- Kyle B Womack
- 1 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center , Dallas, Texas.,2 Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas.,3 Berman Laboratory for Learning and Memory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas , Dallas, Texas
| | - Christopher Paliotta
- 1 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jeremy F Strain
- 3 Berman Laboratory for Learning and Memory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas , Dallas, Texas.,4 Department of Neurology, Washington University , St. Louis, Missouri
| | - Johnson S Ho
- 5 Department of Physiology and Pharmacology, State University of New York-Downstate Medical Center , Brooklyn, New York
| | - Yosef Skolnick
- 5 Department of Physiology and Pharmacology, State University of New York-Downstate Medical Center , Brooklyn, New York
| | - William W Lytton
- 5 Department of Physiology and Pharmacology, State University of New York-Downstate Medical Center , Brooklyn, New York
| | - L Christine Turtzo
- 6 National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland
| | - Roderick McColl
- 7 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Ramon Diaz-Arrastia
- 6 National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland.,8 Center for Neuroscience and Regenerative Medicine, Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Peter J Bergold
- 5 Department of Physiology and Pharmacology, State University of New York-Downstate Medical Center , Brooklyn, New York
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Batty R, Francis A, Thomas N, Hopwood M, Ponsford J, Johnston L, Rossell S. Executive dysfunction in psychosis following traumatic brain injury (PFTBI). J Clin Exp Neuropsychol 2016; 37:917-30. [PMID: 26332172 DOI: 10.1080/13803395.2015.1068279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. METHOD Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. RESULTS Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. CONCLUSIONS These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.
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Affiliation(s)
- Rachel Batty
- a Brain and Psychological Sciences Research Centre (BPsyC) , Swinburne University of Technology , Melbourne , VIC , Australia
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Ben-David BM, Icht M. Voice Changes in Real Speaking Situations During a Day, With and Without Vocal Loading: Assessing Call Center Operators. J Voice 2016; 30:247.e1-11. [DOI: 10.1016/j.jvoice.2015.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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Ben-David BM, Multani N, Shakuf V, Rudzicz F, van Lieshout PHHM. Prosody and Semantics Are Separate but Not Separable Channels in the Perception of Emotional Speech: Test for Rating of Emotions in Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:72-89. [PMID: 26903033 DOI: 10.1044/2015_jslhr-h-14-0323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Our aim is to explore the complex interplay of prosody (tone of speech) and semantics (verbal content) in the perception of discrete emotions in speech. METHOD We implement a novel tool, the Test for Rating of Emotions in Speech. Eighty native English speakers were presented with spoken sentences made of different combinations of 5 discrete emotions (anger, fear, happiness, sadness, and neutral) presented in prosody and semantics. Listeners were asked to rate the sentence as a whole, integrating both speech channels, or to focus on one channel only (prosody or semantics). RESULTS We observed supremacy of congruency, failure of selective attention, and prosodic dominance. Supremacy of congruency means that a sentence that presents the same emotion in both speech channels was rated highest; failure of selective attention means that listeners were unable to selectively attend to one channel when instructed; and prosodic dominance means that prosodic information plays a larger role than semantics in processing emotional speech. CONCLUSIONS Emotional prosody and semantics are separate but not separable channels, and it is difficult to perceive one without the influence of the other. Our findings indicate that the Test for Rating of Emotions in Speech can reveal specific aspects in the processing of emotional speech and may in the future prove useful for understanding emotion-processing deficits in individuals with pathologies.
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Plenger P, Krishnan K, Cloud M, Bosworth C, Qualls D, Marquez de la Plata C. fNIRS-based investigation of the Stroop task after TBI. Brain Imaging Behav 2015; 10:357-66. [DOI: 10.1007/s11682-015-9401-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Icht M, Ben-David BM. Oral-diadochokinetic rates for Hebrew-speaking school-age children: real words vs. non-words repetition. CLINICAL LINGUISTICS & PHONETICS 2015; 29:102-114. [PMID: 25259403 DOI: 10.3109/02699206.2014.961650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Oral-diadochokinesis (DDK) tasks are a common tool for evaluating speech disorders. Usually, these tasks involve repetitions of non-words. It has been suggested that repeating real words can be more suitable for preschool children. But, the impact of using real words with elementary school children has not been studied yet. This study evaluated oral-DDK rates for Hebrew-speaking elementary school children using non-words and real words. The participants were 60 children, 9-11 years old, with normal speech and language development, who were asked to repeat "pataka" (non-word) and "bodeket" (Hebrew real word). Data replicate the advantage generally found for real word repetition with preschoolers. Children produced real words faster than non-words for all age groups, and repetition rates were higher for the older children. The findings suggest that adding real words to the standard oral-DDK task with elementary school children may provide a more comprehensive picture of oro-motor function.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University , Ariel , Israel
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Ozen LJ, Fernandes MA, Clark AJ, Roy EA. Evidence of cognitive decline in older adults after remote traumatic brain injury: an exploratory study. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:517-33. [PMID: 25532692 DOI: 10.1080/13825585.2014.993584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Separate bodies of literature indicate that a history of a traumatic brain injury (TBI) and natural aging may result in overlapping cognitive profiles, yet little is known about their combined effect. We predicted that a remote TBI would compound normal age-related cognitive decline, particularly affecting executive function. Neuropsychological task performance was compared between a group of older adults who sustained a TBI in their distant past (N = 9) and a group of older adults with no history of head injury (N = 15). While all participants scored in the normal range on the Mini-Mental State Examination, the TBI group scored lower than the non-TBI group. Also, in line with predictions, the TBI group made more errors on measures of executive functioning compared to the non-TBI group (the Trail Making B test and the incongruent condition of the Stroop Test), but performed similarly on all tasks with little executive requirements. Findings from this exploratory study indicate that a past TBI may put older adults at a higher risk for exacerbated age-related cognitive decline compared to older adults with no history of TBI.
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Affiliation(s)
- Lana J Ozen
- a Department of Psychology , University of Waterloo , Waterloo , Ontario , Canada
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Ben-David BM, Eidels A, Donkin C. Effects of aging and distractors on detection of redundant visual targets and capacity: do older adults integrate visual targets differently than younger adults? PLoS One 2014; 9:e113551. [PMID: 25501850 PMCID: PMC4264737 DOI: 10.1371/journal.pone.0113551] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022] Open
Abstract
In the redundant target effect, participants respond faster with two (redundant) targets. We compared the magnitude of this effect in younger and older adults, with and without distractors, in a simple visual-detection task. We employed additional measures that allow non-parametric assessment of performance (Townsend's capacity coefficient) and parametric estimates (Linear Ballistic Accumulator model). Older participants' latencies were slower, especially in the presence of distractors, and their calculated capacity indicators increased with distractors. Parametric estimates indicated that these increases were generated by the older adults' increased difficulty in inhibiting the distractors, and not the results of either improved detection of redundant-targets, or of a generalized slowing of processing.
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Affiliation(s)
- Boaz M. Ben-David
- School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Research, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Ami Eidels
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Chris Donkin
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Klenberg L, Närhi V, Korkman M, Hokkanen L. Examining methodological variation in response inhibition: The effects of outcome measures and task characteristics on age-related differences. Child Neuropsychol 2014; 21:586-602. [PMID: 25175830 DOI: 10.1080/09297049.2014.950215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study addressed methodological issues common to developmental studies on response inhibition. Age-related differences were investigated using two Stroop-like tasks with different levels of complexity and comparing different outcome measures in a sample of 340 children and adolescents aged 7-15 years. First, speed and accuracy of task performance were examined; the results showing that improvement in speed continued until age 13 in both the basic naming task and the two inhibition tasks. Improvement in accuracy was less consistent and continued until age 9 or 13 years. Second, two different algorithms were employed to control for the effects of basic processes in inhibition tasks. The difference algorithm indicated age-related differences similar to those for speed. The ratio algorithm, however, suggested earlier deceleration of development of response inhibition at 9 or 11 years of age. Factors related to the cognitive requirements and presented stimuli also had an effect on the results. The present findings shed light on the inconsistencies in the developmental studies of response inhibition and demonstrated that the selection of outcome measures and task characteristics are critical because they affect the way development is depicted.
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Affiliation(s)
- Liisa Klenberg
- a Institute of Behavioural Sciences , University of Helsinki , Helsinki , Finland
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McLay R, Ram V, Murphy J, Spira J, Wood DP, Wiederhold MD, Wiederhold BK, Johnston S, Reeves D. Effect of Virtual Reality PTSD Treatment on Mood and Neurocognitive Outcomes. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 17:439-46. [DOI: 10.1089/cyber.2013.0383] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Robert McLay
- Directorate for Mental Health, Naval Medical Center San Diego, San Diego, California
| | - Vasudha Ram
- Naval Center for Combat & Operational Stress Control, San Diego, California
| | - Jennifer Murphy
- Naval Center for Combat & Operational Stress Control, San Diego, California
| | | | | | | | | | - Scott Johnston
- Naval Center for Combat & Operational Stress Control, San Diego, California
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Lieshout PV, Ben-David B, Lipski M, Namasivayam A. The impact of threat and cognitive stress on speech motor control in people who stutter. JOURNAL OF FLUENCY DISORDERS 2014; 40:93-109. [PMID: 24929470 DOI: 10.1016/j.jfludis.2014.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 02/14/2014] [Accepted: 02/15/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE In the present study, an Emotional Stroop and Classical Stroop task were used to separate the effect of threat content and cognitive stress from the phonetic features of words on motor preparation and execution processes. METHOD A group of 10 people who stutter (PWS) and 10 matched people who do not stutter (PNS) repeated colour names for threat content words and neutral words, as well as for traditional Stroop stimuli. Data collection included speech acoustics and movement data from upper lip and lower lip using 3D EMA. RESULTS PWS in both tasks were slower to respond and showed smaller upper lip movement ranges than PNS. For the Emotional Stroop task only, PWS were found to show larger inter-lip phase differences compared to PNS. General threat words were executed with faster lower lip movements (larger range and shorter duration) in both groups, but only PWS showed a change in upper lip movements. For stutter specific threat words, both groups showed a more variable lip coordination pattern, but only PWS showed a delay in reaction time compared to neutral words. Individual stuttered words showed no effects. Both groups showed a classical Stroop interference effect in reaction time but no changes in motor variables. CONCLUSION This study shows differential motor responses in PWS compared to controls for specific threat words. Cognitive stress was not found to affect stuttering individuals differently than controls or that its impact spreads to motor execution processes. EDUCATIONAL OBJECTIVES After reading this article, the reader will be able to: (1) discuss the importance of understanding how threat content influences speech motor control in people who stutter and non-stuttering speakers; (2) discuss the need to use tasks like the Emotional Stroop and Regular Stroop to separate phonetic (word-bound) based impact on fluency from other factors in people who stutter; and (3) describe the role of anxiety and cognitive stress on speech motor processes.
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Affiliation(s)
- Pascal van Lieshout
- University of Toronto, Speech-Language Pathology, Oral Dynamics Lab (ODL), Canada; Department of Psychology, Canada; Institute of Biomaterials and Biomedical Engineering, Canada; Graduate Department of Rehabilitation Science, Canada; Toronto Rehabilitation Institute, Canada.
| | - Boaz Ben-David
- University of Toronto, Speech-Language Pathology, Oral Dynamics Lab (ODL), Canada; Department of Psychology, Canada; Toronto Rehabilitation Institute, Canada; Interdisciplinary Center (IDC) Herzliya, School of Psychology, Communication, Aging and Neuropsychology Lab (CANlab), Israel
| | - Melinda Lipski
- University of Toronto, Speech-Language Pathology, Oral Dynamics Lab (ODL), Canada
| | - Aravind Namasivayam
- University of Toronto, Speech-Language Pathology, Oral Dynamics Lab (ODL), Canada
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Icht M, Ben-David BM. Oral-diadochokinesis rates across languages: English and Hebrew norms. JOURNAL OF COMMUNICATION DISORDERS 2014; 48:27-37. [PMID: 24630145 DOI: 10.1016/j.jcomdis.2014.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 01/29/2014] [Accepted: 02/15/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Oro-facial and speech motor control disorders represent a variety of speech and language pathologies. Early identification of such problems is important and carries clinical implications. A common and simple tool for gauging the presence and severity of speech motor control impairments is oral-diadochokinesis (oral-DDK). Surprisingly, norms for adult performance are missing from the literature. The goals of this study were: (1) to establish a norm for oral-DDK rate for (young to middle-age) adult English speakers, by collecting data from the literature (five studies, N=141); (2) to investigate the possible effect of language (and culture) on oral-DDK performance, by analyzing studies conducted in other languages (five studies, N=140), alongside the English norm; and (3) to find a new norm for adult Hebrew speakers, by testing 115 speakers. We first offer an English norm with a mean of 6.2syllables/s (SD=.8), and a lower boundary of 5.4syllables/s that can be used to indicate possible abnormality. Next, we found significant differences between four tested languages (English, Portuguese, Farsi and Greek) in oral-DDK rates. Results suggest the need to set language and culture sensitive norms for the application of the oral-DDK task world-wide. Finally, we found the oral-DDK performance for adult Hebrew speakers to be 6.4syllables/s (SD=.8), not significantly different than the English norms. This implies possible phonological similarities between English and Hebrew. We further note that no gender effects were found in our study. We recommend using oral-DDK as an important tool in the speech language pathologist's arsenal. Yet, application of this task should be done carefully, comparing individual performance to a set norm within the specific language. LEARNING OUTCOMES Readers will be able to: (1) identify the Speech-Language Pathologist assessment process using the oral-DDK task, by comparing an individual performance to the present English norm, (2) describe the impact of language on oral-DDK performance, and (3) accurately detect Hebrew speakers' patients using this tool.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University, Israel
| | - Boaz M Ben-David
- Communication Aging and Neuropsychology Lab (CANlab), School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel; Department of Speech-Language Pathology and Graduate Department of Rehabilitation Sciences, University of Toronto, Canada; Toronto Rehabilitation Institute, Canada.
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Abstract
PURPOSE This study assessed the prevalence of convergence insufficiency (CI) with and without simultaneous vision dysfunctions within the traumatic brain injury (TBI) sample population because although CI is commonly reported with TBI, the prevalence of concurrent visual dysfunctions with CI in TBI is unknown. METHODS A retrospective analysis of 557 medical records from TBI civilian patients was conducted. Patients were all evaluated by a single optometrist. Visual acuity, oculomotor function, binocular vision function, accommodation, visual fields, ocular health, and vestibular function were assessed. Statistical comparisons between the CI and non-CI, as well as inpatient and outpatient subgroups, were conducted using χ and Z tests. RESULTS Approximately 9% of the TBI sample had CI without the following simultaneous diagnoses: saccade or pursuit dysfunction; third, fourth, or sixth cranial nerve palsy; visual field deficit; visual spatial inattention/neglect; vestibular dysfunction; or nystagmus. Photophobia with CI was observed in 16.3% (21 of 130), and vestibular dysfunction with CI was observed in 18.5% (24 of 130) of the CI subgroup. Convergence insufficiency and cranial nerve palsies were common and yielded prevalence rates of 23.3% (130 of 557) and 26.9% (150 of 557), respectively, within the TBI sample. Accommodative dysfunction was common within the nonpresbyopic TBI sample, with a prevalence of 24.4% (76 of 314). Visual field deficits or unilateral visual spatial inattention/neglect was observed within 29.6% (80 of 270) of the TBI inpatient subgroup and was significantly more prevalent compared with that of the outpatient subgroup (p < 0.001). Most TBI patients had visual acuities of 20/60 or better in the TBI sample (85%; 473 of 557). CONCLUSIONS Convergence insufficiency without simultaneous visual or vestibular dysfunctions was observed in about 9% of the visually symptomatic TBI civilian population studied. A thorough visual and vestibular examination is recommended for all TBI patients.
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Ben-David BM, Chajut E, Algom D. The Pale Shades of Emotion: A Signal Detection Theory Analysis of the Emotional Stroop Task. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/psych.2012.37079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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