Movement parameters that distinguish between voluntary movements and levodopa-induced dyskinesia in Parkinson's disease

It is well known that long-term use of levodopa by patients with Parkinson's disease causes dyskinesia. Several methods have been proposed for the automatic, unsupervised detection and classification of levodopa induced dyskinesia. Recently, we have demonstrated that neural networks are highly successful to detect dyskinesia and to distinguish dyskinesia from voluntary movements. The aim of this study was to use the trained neural networks to extract parameters, which are important to distinguish between dyskinesia and voluntary movements.Thirteen patients were continuously monitored in a home-like situation performing in about 35 daily life tasks for a period of approximately 2.5 h. Behavior of the patients was measured using triaxial accelerometers, which were placed at six different positions of the body. A neural network was trained to assess the severity of dyskinesia. The neural network was able to assess the severity of dyskinesia and could distinguish dyskinesia from voluntary movements in daily life. For the trunk and the leg, the important parameters appeared to be the percentage of time that the trunk or leg was moving and the standard deviation of the segment velocity of the less dyskinetic leg. For the arm, the combination of the percentage of time, that the wrist was moving, and the percentage of time, that a patient was sitting, explained the largest part of the variance of the output. Dyskinesia differs from voluntary movements in the fact that dyskinetic movements tend to have lower frequencies than voluntary movements and in the fact that movements of different body segments are not well coordinated in dyskinesia.     

BEHAVIORAL RESEARCH IN PREVENTIVE DENTISTRY: EDUCATIONAL AND CONTINGENCY MANAGEMENT APPROACHES TO THE PROBLEM OF PATIENT COMPLIANCE

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3–5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.     

Recorded Readings: A Taped Parent-Tutoring Intervention

Parent tutoring has been successfully used to increase children’s oral reading fluency. However, commonly used procedures pose a challenge for parents who are not proficient in reading or who speak English as a second language. A taped reading program that included listening passage preview, repeated reading, and performance feedback was developed for parental implementation during home tutoring sessions. A multiple baseline design across participants was used to evaluate the effects of parent tutoring on the oral reading fluency of two elementary-aged English language learners. Data were collected on oral reading fluency using high- and low-word overlap passages. Results revealed an immediate increase in generalized oral reading fluency for one child upon intervention implementation and continued growth for both children 2 months following termination. Findings suggest recorded readings was an effective and acceptable parent tutoring intervention for increasing reading performance for language minority families.     

Mood, memory, and motor performance and the severity of tardive dyskinesia

This study tested the hypothesis that the features of tardive dyskinesia were associated with motor slowing, memory impairment, and depressive apathy all of which are considered to characterize the so-called subcortical dementias. In a sample of 48 psychiatric patients all fulfilling research criteria for tardive dyskinesia and without other signs of organic illness age-independent correlations were observed between severity of orofacial dyskinesia and measures of memory, motor performance and mood providing some empirical support for the hypothesis.     

Comparison between Oral and Written Spelling in Alzheimer's Disease

Written and oral spelling were compared in 33 patients with Alzheimer's disease (AD) and 25 control subjects. AD patients had poorer spelling results which were influenced by orthographic difficulty and word frequency, but not by grammatical word class. Lexical spelling was also more deteriorated than phonological spelling. Moreover, oral spelling was more impaired than written spelling in AD patients, whereas no difference was present between oral and written spelling of controls. Analysis of spelling errors showed that, for controls, errors were predominantly phonologically accurate in both spelling tasks. Significantly, AD patients produced more phonologically accurate than inaccurate errors in written spelling, whereas these errors did not differ in oral spelling. In contrast to controls who produced more constant than variable responses in oral and written spelling, AD patients made more variable responses (words correctly spelled in one task but incorrectly in the other) and they showed many instances of variable errors (different misspellings from one spelling task to the other). Two stepwise regression procedures showed that written misspellings were specifically correlated with language impairment, whereas oral spelling errors were correlated with attentional and language disorders. These results suggest that AD increases the attentional demands of oral spelling process as compared to written spelling. This dissociation argues, either for a unique Graphemic Buffer in which oral spelling requires more attentional resources than written spelling or for the hypothesis of separate buffers for oral and written spelling.     

Tardive dyskinesia and perceptual dysfunction

There is equivocal evidence for a relationship between neuroleptic-induced tardive dyskinesia and central nervous system (CNS) dysfunction. Using the Bender-Gestalt test as the dependent measure, we hypothesized that a group of chronic schizophrenic patients with tardive dyskinesia would show more perceptual dysfunction than those without. Our results supported this hypothesis. CNS dysfunction is discussed in terms of a possible predisposition to tardive dyskinesia.     

Oral overcorrection: side effects and extended applications.

Experiment 1: In a specialized daycare program the use of oral overcorrection (contingent toothbrushing with an oral antiseptic) to suppress one child's thumbsucking at Language Time was found to suppress the behavior of another child who was not treated but who witnessed the target child's treatment. Experiment 2: The main effects of oral overcorrection were replicated. Contingent overcorrection threats (warnings), used independently, were then shown to suppress thumbsucking behavior that had returned to its baseline level. These effects were maintained one month after the threats were discontinued, but they did not generalize to other activity periods, particularly Nap Time. Experiment 3: Contingent threats were found to suppress the persistent nap-time thumbsucking of the child from Expt 2. Increments in certain other (nonoral) inappropriate behaviors were correlated with the suppression of thumbsucking. Threats to use oral overcorrection contingent upon nonoral misbehaviors at Nap Time were not effective. However, the actual use of oral overcorrection for these categories of nonoral misbehavior served to suppress these behaviors. Experimental controls combined treatment reversal and multiple baseline single-subject designs.     

Functional analysis of tardive dyskinesia: implications for assessment and treatment

We conducted an analogue functional analysis contrasting motor tasks with varying types of social consequences for movements associated with tardive dyskinesia (TD) in 2 men who had been diagnosed with developmental disabilities and TD. Our findings suggest that TD-related movements were not a function of social reinforcement contingencies. However, motor-activation tasks decreased TD-related movements, suggesting a possible novel intervention.     

Handwriting movement analyses for monitoring drug-induced motor side effects in schizophrenia patients treated with risperidone

Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 47 healthy comparison participants were enrolled. Participants performed a 20-min handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r = .91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients.     

Olfactory test performance and its relationship with the perceived location of odors

Odors are generally perceived as arising via the nose when sniffed and as part of an orally located flavor during ingestion. The perceived location of an odor may in part be an attentional phenomenon, with concurrent oral stimulation occurring at the expense of access to the olfactory channel. Two predictions were derived from this account: (a) tasks dependent on a capacity to attend to the olfactory channel--odor discrimination and naming--should be adversely affected by oral localization; and (b) tasks not dependent upon a capacity to attend--incidental learning/recognition memory--should not. Using a procedure to generate oral localization, in which odors were presented via the nose with concurrent oral stimulation (sucrose, a viscous fluid or water), greater reported oral localization was associated with poorer odor discrimination and naming, but not with recognition memory performance. These results support the notion that attentional processes contribute to oral localization of odors by reducing the capacity to attend to the olfactory channel.     

Tardive dyskinesia and malpractice

Tardive dyskinesia is a potentially irreversible disorder of involuntary movement which may result from the prolonged use of neuroleptic medication in some patients. Its increase in prevalence in recent years has been accompanied by increased apprehension in the medical community regarding malpractice litigation. Following an update of current knowledge about tardive dyskinesia, several legal aspects of tardive dyskinesia are reviewed, including negligence, breach of contract, fraud, strict liability and informed consent. Despite considerable criticism of the doctrine of informed consent, it is suggested that it constitutes an inherent and indispensable component of long-term psychiatric treatment, where tardive dyskinesia is at issue.     

Inpatient tube weaning in children with long‐term feeding tube dependency: A retrospective analysis

This study investigates the outcome of an intervention program to establish oral feeding after prolonged tube feeding in children. The intervention is based on supervised reduction of enteral formula within a few days supported by a 3‐week program of speech therapy, occupational therapy, psychoanalytically based eating therapy, physical therapy, psychodynamic coaching, and nutritional counseling of the infant and his or her parents. Two hundred twenty‐one cases were included in this study. All patients had been severely ill or were handicapped and had been exclusively fed by tube for most of their lives. The major outcome variable was complete discontinuation of tube feeding with sufficient oral feeding after treatment, defined as the child's ability to sustain stable body weight by self‐motivated oral feeding. Two hundred three patients (92%) were completely fed orally after treatment. Tube feeding was discontinued completely within 8 days in mean, and mean in‐patient treatment time was 21.6 days. The current method can be used by a trained and experienced team to wean tube‐dependent children from prolonged tube feeding. Tube weaning should be addressed from the beginning of tube feeding in all children who are expected to restore oral feeding after the phase of nutritional stabilization. Since successful programs are rare, we were motivated to present our results of this elaborate program in this article.     

Does sexist language reflect personal characteristics?

We investigated whether or not sexist language in written form can be linked to traditional views of sex roles, assertiveness, psychological androgyny, Christian beliefs, or sexist language in oral form. In Experiment 1, undergraduates were given an essay designed to test written sexist language and several pencil-and-paper personality inventories. No relationship between sexist language and interpersonal assertiveness or psychological androgyny was found. However, those who avoided sexist language were less traditional in their sex role perceptions scored lower on a scale of Christian beliefs. In Experient 2, the method of measuring sexist language was expanded by using three essay responses and a brief oral interview. Those who used sexist language in written form were more likely than others to use sexist language in oral form on some responses. Interpretations and implications of the findings are discussed.     

Outcome comparison of patients receiving oral or depot neuroleptic medication.

Three outcome measures of psychiatric treatment were retrospectively compared between two groups of acutely hospitalized psychotic patients who had been prescribed either oral haloperidol (n = 58) or depot haloperidol (n = 95) as the only medication at the time of discharge. There were no significant differences between the groups on demographic variables, including sex, age, and ethnicity. There were no significant differences between the groups on keeping the initial outpatient appointment, in readmission history over a 4-yr. follow-up, or in length of time to subsequent readmission, if any. It appears that there is no benefit in choosing one form of medication over the other from a clinical perspective, as neither appears more clinically efficacious when examined on these outcome variables. However, there is a significant difference in cost of the two forms of the medication in favor of the oral form, making the oral form more favorable if cost is to be minimized.     

Pregenital fixation and perceptual distortions to conflict-laden material.

Three standard questionnaire measures of oral and anal fixation were administered to 142 students. On the basis of their scores 26 students were selected and shown tachistoscopic exposures of pictures designed to activate oral or anal conflicts. Five subjects in each group had extremely high scores on the corresponding measure of fixation, five had extremely low scores, and 16 had intermediate scores. It was hypothesised that individuals who were fixated at one or other of the psychosexual stages would show stereotyped perceptual distortions to repeated dim exposures of the corresponding picture. Highly fixated subjects showed significantly more deviant responses than did subjects who showed low levels of fixation at the same stage. A form of Q-factor analysis indicated that subjects who were fixated at the oral sadistic or anal stages showed different patterns of perceptual distortions to the anal picture than those who were not fixated. These results were interpreted as supporting the link between defenses against anal eroticism and the anal character.     

Effects of intralaminar thalamic stimulation on language functions

Fifteen neurosurgical subjects, who were undergoing thalamic chronic electrode implants as a treatment for dyskinesia and chronic pain, were evaluated on a series of neurolinguistic functions to determine if the stimulation of the centromedianum nucleus of the thalamus affected language and cognitive processing. Analysis of the data revealed that the stimulation of the left centromedianum nucleus had resulted in a notable facilitatory influence on the processing of language functions; this facilitatory effect was measured in terms of the number of errors produced and the patients' response latency time. The facilitatory effect was also noted to have extended to other language functions. The nature of the facilitation from the stimulation of the left centromedianum nucleus, an extension of the brainstem reticular formation, on language functions is discussed.     

Use of the personal orientation inventory with disabled athletes

Athletes who are blind or have impairments in hand-eye coordination that prevent writing are unable to complete psychological inventories in the standardized manner, i.e., read silently and answered independently and anonymously. Two studies were conducted on the oral administration of the Personal Orientation Inventory as a measure of self-actualization of disabled athletes. Reliabilities were examined across modalities (oral vs written) by administering the inventory both ways to 25 high school and college athletes, M age = 21.6 yr. Test-retest reliability for oral administration was affirmed in a study of 15 blind elite male athletes and 15 cerebral palsied elite male and female athletes. It was concluded that the inventory, administered orally, may be appropriately used with disabled athletes.     

Family Dynamics and Drug Overdoses*

ABSTRACT: In a study of 40 patients who had taken an overdose, and with the relatives of 18 of these subjects, a pattern of family factors that appeared relevant to the choice of drugs was found. These family factors included: (a) a specific expectation that the person would use drugs; (b) an identification with another suicidal family member; (c) a high level of oral preoccupation and oral fixation; (d) trauma in the life history associated with food or orality; and (e) a direct participation of other family members in the suicidal act. The direct study of family interactions in evaluating suicidal potential is recommended for its unique diagnostic and therapeutic implications.     

THE EFFECT OF INFORMATIONAL FEEDBACK ON FOOD INTAKE OF ADULT BURN PATIENTS

The effect of informational feedback on the protein and caloric consumption of burn patients was investigated using a multiple-baseline across subjects. The patients were four severely burned adult males who failed to consume sufficient foods to achieve prescribed levels of protein or kilocalories via standard burn unit procedures during recovery. Feedback consisted of informing patients of (a) their prescribed levels of protein and kilocalories, (b) the protein and kilocalorie content of hospital foods and beverages, and (c) their actual intake of protein and kilocalories. Following the provision of feedback, there was an increase in protein and kilocalorie intakes and in the number of days during which prescribed levels for protein and kilocalories were achieved. These results suggest that the informational feedback was effective for improving the oral caloric intake of burn patients.