On drawing inferences about the structure of normal cognitive systems from the analysis of patterns of impaired performance: the case for single-patient studies

An analysis of the logic of valid inferences about the structure of normal cognitive processes from the study of impaired cognitive performance in brain-damaged patients is presented. The logic of inferences from group studies and single-case studies is compared. It is shown that given certain assumptions, only the single-case method allows valid inferences about the structure of cognitive systems from the analysis of impaired performance. It is also argued that although the single-case approach is not entirely problem-free, the difficulties encountered are relatively minor.     

Computer use by the visually impaired

Several recent developments have made computers accessible to the blind and partially sighted: hard-copy (paper) and softcopy (raised-pin) braille output, magnified high-resolution characters, and synthetic speech. We report survey data on these users’ computer education, tasks, and goals; their hardware uses and preferences, particularly for special-purpose I/O devices; and seven classes of human-factors problems that affect the use of these I/O devices by the visually impaired.     

The use of restricted environmental stimulation therapy (REST) in the treatment of essential hypertension: Two case studies

The previous paper (Suedfeld et al., 1982, pp. 553–559) reported the use of Restricted Environmental Stimulation Therapy (REST) in treating hypertension. This paper reports the response of two patients to 24 hr of a similar treatment offered as an adjunct to a weight-control program. In both patients blood pressure dropped immediately following the REST session and remained lower for up to 9 months. The initial drop in blood pressure was independent of weight loss. These results are interpreted in terms of a psychobiological model of self-regulation.     

On the use of wireless response systems in experimental psychology: Implications for the behavioral researcher

A method of data collection is presented that unites the efficiency of mass testing with the ease of instant electronic data collection that is typical of computer-based experiments run on individual participants. A wireless response system (WRS), originally designed as a teaching tool, is used to replicate three classic and robust effects from the memory literature (effects of false memory, levels of processing, and word frequency). It is shown that for these types of experimental designs, data can be collected more efficiently (in both time and effort) with the WRS method than through traditional mass- and individual-testing methods alone. The advantages and limitations of WRSs for use in mass electronic data collection are discussed.     

The behavioral complications of pallidal stimulation: a case report

We report a case of recurrent manic episodes associated with chronic deep brain stimulation (DBS) targeting globus pallidus (GP) in the treatment of Parkinson's disease (PD). Cardinal PD symptoms and dyskinesia improved with DBS, and neuropsychological testing found improvements in visuospatial measures associated with left DBS and in verbal memory with right DBS when compared to the patient's preoperative baseline. Under conditions of right, left, and bilateral DBS, the patient experienced bouts of mania and hypomania lasting several days at a time. Positron emission tomography (PET) with (15)O-labeled water was performed after his first manic episode under four conditions: no stimulation, right DBS, left DBS, and bilateral DBS. Although no manic switch occurred during the course of the PET study, all three DBS conditions were associated with decreases in regional flow in the left parahippocampus and hippocampus and right mid-cingulate gyrus. Increases in flow in left inferior frontal area, bilateral insula, dorsolateral prefrontal cortex, and cuneus were common to all DBS conditions. GP stimulation in PD may be associated with behavioral and cognitive effects. Distributed blood flow changes observed with pallidal DBS support a role for the pallidum in cognition and affective regulation.     

CECoS: A case experience combination system for knowledge acquisition for expert systems

This paper presents a new knowledge-acquisition system—the Case Experience Combination System (CECoS). With CECoS, two information or knowledge sources are jointly analyzed. Previously recorded problem solutions (individual cases) are combined with an expert’s high-level understanding of the global structure of a task domain. By combining the detailed case information with an expert’s general insights, CECoS provides the domain knowledge with which skeletal plans can be automatically constructed.     

Permanently locked-in syndrome in the neurologically impaired neonate: report of a case of Werdnig-Hoffmann disease.

Echenberg, a physician and the chairman of a PEC (perinatal ethics committee) recounts a difficult case of an infant with congenital Werdnig-Hoffman disease, which is characterized by a severe, early-onset form of spinal muscular atrophy, secondary to progressive neurologic degeneration. The two-and-one-half-month-old girl was paralyzed and respirator dependent, but apparently mentally intact and aware. Her parents and other family members tried to avoid serious involvement in the case. The physicians caring for her were resigned to the futility of further treatment, but uncertain how to proceed. The infant's nurses, many of whom had bonded with the child, were strongly divided as to what course of action would be in her best interests, and who should make decisions about continuation or termination of life support. Echenberg summarizes the PEC meeting which was convened about this case, and reviews the issues involved.     

Repetitive transcranial magnetic stimulation improves depersonalization: a case report

Depersonalization disorder is a poorly understood and treatment-resistant condition. This report describes a patient with depersonalization disorder who underwent six sessions of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex. Repetitive transcranial magnetic stimulation produced a 28% reduction on depersonalization scores.     

Older adults' use of metacognitive knowledge in source monitoring: spared monitoring but impaired control

While episodic memory declines with age, metacognitive monitoring is spared. The current study explored whether older adults can use their preserved metacognitive knowledge to make source guesses in the absence of source memory. Through repetition, words from two sources (italic vs. bold text type) differed in memorability. There were no age differences in monitoring this difference despite an age difference in memory. Older adults used their metacognitive knowledge to make source guesses but showed a deficit in varying their source guessing based on word recognition. Therefore, older adults may not fully benefit from metacognitive knowledge about sources in source monitoring.     

The use of imagery in cognitive therapy for psychosis: a case example

There has been a long tradition of studying imagery in relation to psychotic symptoms. Recent studies have suggested that imagery may be involved in the development and maintenance of psychotic symptoms (hallucinations and delusions in particular). Following a review of this literature, including work conducted by the author and colleagues, a case study is used to illustrate the clinical applications of this work. Working with images that were associated with persecutory delusions appeared to contribute to a reduction in distress, preoccupation, and conviction in relation to these beliefs, which were assessed using a standardised measure (PSYRATS). The implications for theory, practice, and future research are considered.     

The use of imagery in cognitive therapy for psychosis: A case example

There has been a long tradition of studying imagery in relation to psychotic symptoms. Recent studies have suggested that imagery may be involved in the development and maintenance of psychotic symptoms (hallucinations and delusions in particular). Following a review of this literature, including work conducted by the author and colleagues, a case study is used to illustrate the clinical applications of this work. Working with images that were associated with persecutory delusions appeared to contribute to a reduction in distress, preoccupation, and conviction in relation to these beliefs, which were assessed using a standardised measure (PSYRATS). The implications for theory, practice, and future research are considered.     

Implicit word cues facilitate impaired naming performance: evidence from a case of anomia.

Word-finding difficulties observed in some patients with anomia have been attributed to an insufficient activation of phonology by semantics. There are, however, few direct tests of this hypothesis. This paper reports the case of FR, who presented with anomic aphasia following temporal lobe epilepsy and a cavernoma in the left superior temporal lobe. His anomic deficit was characterized by: (1) no apparent associated semantic impairment; (2) item consistency for accuracy and errors across different administrations; (3) accuracy strongly correlated with word frequency; and (4) a partial, albeit weak, knowledge of the gender of unnamed items. We conducted a naming experiment in which target pictures were implicitly primed by briefly presented masked words. Results showed that the prior presentation of the written target name improved accuracy. When compared with unprimed trials, the presence of the primes also increased phonological errors and decreased semantic errors. We argue that automatic phonological activation derived directly from the implicit written primes interacted with the remaining phonological input from the picture's semantic representation leading to increased accuracy and a change in the balance of error types.     

moral panics and disproportionality: the case of LSD use in the sixties

Critics of the moral panic dismiss this extremely useful, often-cited, and durable concept on the basis of inapplicable criteria. Drawing on the example of LSD use in the sixties, these critics mistakenly assume that the disaster analogy is apt, insisting that the threat to society, and society's responses, be very much like victims trapped in a burning building. In addition to the fact that the introduction of a new and potentially harmful drug into a society does not entail an on-the-spot threat or reaction, the natural disaster does not typically involve a folk devil or deviant. But the supposed threat of LSD use did entail sensitization, stereotyping, exaggeration, the rush to judgment, sensational anecdotes, and bogus claims. The moral panic notion continues to illuminate social processes and deserves to remain in the sociologist's conceptual tool-box.     

Observational assessment systems use for basic and applied research

Three observational assessment systems, the Time-Sample Behavioral Checklist, the Staff-Resident Interaction Chronograph, and the Clinical Frequencies Recording System, are shown to have remarkable utility for a wide range of basic and applied research questions. The assessment systems have already been employed to measure independent and dependent variables in a number of treatment outcome and staff training studies and as measures in more basic studies of environmental history effects for chronic mental patients. Current and planned investigations employing the observational measures are outlined. These include psychometric studies of the instruments themselves, investigations of various parameters of ongoing treatment programs, and empirical validations of proposed nosological diagnostic schemas. Finally, several metamethodological issues germaine to observational assessment, in general, are noted, including the observation vs. interpretation debate and the role of precise observational measurement in applied research contexts.The research reported in this article was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation, Illinois Department of Mental Health and Developmental Disabilities, and the Purdue Research Foundation.Based on a paper presented at the 87th Annual Meeting of the American Psychological Association, New York City, September 1979, as part of a symposium New Assessment systems for residential treatment, management, research, and evaluation.     

Dissociation between linguistic and nonlinguistic gestural systems: a case for compositionality.

This paper addresses the issue of the separability of disorders of sign language from disorders of gesture and pantomime. The study of a left-lesioned deaf signer presents one of the most striking examples to date of the cleavage between linguistic signs and manual pantomime. The left-hemisphere lesion produced a marked sign language aphasia disrupting both the production and the comprehension of sign language. However, in sharp contrast to the breakdown of sign language, the ability to communicate in nonlinguistic gesture was remarkably spared. This case has important implications for our understanding of the neural mediation of language and gesture. We argue that the differences observed in the fractionation of linguistic versus nonlinguistic gesture reflect differing degrees of compositionality of systems underlying language and gesture. The compositionality hypothesis receives support for the existence of phonemic paraphasias in sign language production, illustrating structural dissolution which is absent in the production of pantomimic gesture. Understanding the neural encoding of compositional motoric systems may lead to a principled anatomical account of the neural separability of language and gesture. This case provides a powerful indication of the left hemisphere's specialization for language-specific functions.     

Attributional differences for driving while impaired: a comparison of alcoholics, inmates, and impaired drivers

This study examines the differences among attributions for reasons for arrest and attributions for blame among groups of Canadian alcoholics, correctional facility inmates, and impaired drivers. Multiple-recidivist impaired driving offenders were more likely to attribute blame for impaired driving behavior to the mental-element factor alcoholism, even though they possessed lower General Alcoholism Scale (Wanberg, Horn, & Foster, 1977) scores than alcoholic subjects. They did not differ in their attributions to luck versus motivation or to general driving ability in their assessment of the reasons for arrest but did view the task of driving well while drunk as being less difficult than other groups. Inconsistencies in responses regarding responsibility for behavior are related to attribution theories which differentiate between perceptions of controllability and intentionality.