Spoken language correlates of reading impairments acquired in childhood

This study reports the reading difficulties of five children following unilateral left hemisphere stroke sustained either before or during the early stages of literacy acquisition. Although each of the children experienced a period of disturbed language processing in the initial stages postonset, at the time of testing none of the children were considered to be clinically aphasic. Yet, on a standardized test of oral reading each of the children achieved a reading age that lagged behind chronological age and marked reading impairments were disclosed in four of the five children. A set of standardized and nonstandardized tests, aimed at measuring aspects of cognitive and spoken language processing that are considered to be important for normal reading acquisition, was administered. Where nonstandardized tests were used, performance of each of the stroke children was compared to that of groups of normally developing control children, closely matched for chronological age. A range of residual deficits in cognitive and spoken language processing was disclosed among the five brain-damaged children that appeared to be associated with their reading impairments. Two children had expectedly poor reading due to a selective impairment in verbal IQ; a specific phonological reading disorder was revealed in two children, each of which had a residual impairment to phonological awareness; and delayed reading acquisition was observed in one child with a general language deficit. It is suggested that when a child suffers damage to the left hemisphere in the early stages of reading acquisition, difficulties with learning to read are likely to ensue and may arise as a consequence of an underlying cognitive or linguistic deficit.     

Late acquired words in childhood are lost earlier in primary progressive aphasia.

The psycholinguistic nature of the dissolution of the mental lexicon in a primary progressive aphasic patient was investigated in light of the general regression hypothesis that language dissolution is the inverse of language acquisition. Four years after onset of the symptoms, the patient scored 60% correct on a picture naming test, exhibiting some effects of lexical and sublexical age-of-acquisition, but 7 years after onset, he scored only 15% correct. While even a weak form of the regression hypothesis is not fully supported, age-of-acquisition effects seem to be preserved throughout the course of the lexical dissolution. Some implications are briefly discussed for future research.     

Dichotic listening in the recovery of aphasia after stroke

Three different dichotic listening tests were given to a group of aphasic patients at various stages of the recovery process. Results were different for each test and in the course of time fluent aphasics demonstrated a tendency to increase right ear preference while nonfluent aphasics showed an increase of left ear preference in the test of dichotic words. The importance of these findings to the understanding of recovery of function is discussed in terms of the role played by the right hemisphere.     

Social networks as assets and liabilities in recovery from stroke by geriatric patients

Interactions in the social networks of 48 elderly stroke patients were examined as factors influencing outcomes after hospital discharge. Structured interviews assessed the frequency of perceived positive and negative interactions, as well as patients' behavioral independence, time use, personal adjustment, and cognitive functioning. Negative interactions occurred less frequently than positive ones. After controlling for status at hospital discharge, negative and positive interactions differentially explained variance in morale, psychiatric symptoms, and cognitive functioning. Although negative interactions were associated with poorer morale and greater psychiatric symptoms, positive interactions were associated with less mental confusion. Patients' reporting and not reporting negative interactions did not differ significantly on a variety of social and demographic variables previously shown to predict social interactions and well-being. Findings indicate that social interactions may both impede and facilitate rehabilitation for older adults and have implications for both theories of social support and the design of therapeutic interventions.     

Cognitive functioning, behavior, and quality of life after stroke in childhood.

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion). Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN). Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10-21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79-129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p = .000; Digit Span p = .000, Arithmetic's p = .007, Divided Attention p = .028, Alertness p = .002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p = .000; impulsivity/hyperactivity p = .006; psychosomatics p = .006). Certain aspects of quality of life were reduced (autonomy p = .003; parents' relation p = .003; social acceptance p = .037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p = .000, hand alternation p = .001, foot tapping p = .043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5-10 years) led to better cognitive outcome than lesion in the very early (0-5 years) or late childhood (10-18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis. Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.     

A comparison of lexical-semantic impairments in left hemisphere stroke and Alzheimer's disease

Patients with aphasia due to left hemisphere stroke and patients with Alzheimer's disease, who were matched for severity of naming impairment, were compared on tests of lexical-semantic processing. The results suggest that the lexical-semantic impairments in both groups are due to a combination of impaired access to, and loss of, lexical-semantic information, but that impaired access is more prominent in stroke patients, whereas Alzheimer's disease patients suffer a greater loss of information. The results are discussed in terms of a brain model of the storage and processing of lexical-semantic information, and with respect to implications for treatment strategies.     

Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation

One of the most frequent symptoms of unilateral stroke is aphasia, the impairment or loss of language functions. Over the past few years, behavioral and neuroimaging studies have shown that rehabilitation interventions can promote neuroplastic changes in aphasic patients that may be associated with the improvement of language functions. Following left hemisphere strokes, the functional reorganization of language in aphasic patients has been proposed to involve both intrahemispheric interactions between damaged left hemisphere and perilesional sites and transcallosal interhemispheric interactions between the lesioned left hemisphere language areas and homotopic regions in the right hemisphere. A growing body of evidence for such reorganization comes from studies using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), two safe and noninvasive procedures that can be applied clinically to modulate cortical excitability during post-stroke language recovery. We discuss a hierarchical model for the plastic changes in language representation that occur in the setting of dominant hemisphere stroke and aphasia. We further argue that TMS and tDCS are potentially promising tools for enhancing functional recovery of language and for further elucidating mechanisms of plasticity in patients with aphasia.     

Traits and trade-offs are an important tier

Replies to comments by K. M. Sheldon et al on the author's original article on evolution and personality variation. Sheldon et al concurred with the thrust of that article that the way natural selection shapes or gives rise to interindividual variation is a worthy topic for evolutionary psychologists to consider, so at a broad level Sheldon et al and Nettle are in agreement. The contention concerns the utility of broad traits such as the Big Five personality factors in undertaking evolutionary personality psychology. Nettle does not concur that traits do not provide a good approach to understanding interindividual variation. They have proved their utility in humans and in other species. Nettle does agree that traits alone are not sufficient for understanding personality functioning, particularly in humans, and hopes that other psychologists, including perhaps Sheldon et al, will add an evolution-informed understanding of those higher tiers of personality to the framework Nettle has suggested for the base tier.     

Social brain development and the affective consequences of ostracism in adolescence

Recent structural and functional imaging studies have provided evidence for continued development of brain regions involved in social cognition during adolescence. In this paper, we review this rapidly expanding area of neuroscience and describe models of neurocognitive development that have emerged recently. One implication of these models is that neural development underlies commonly observed adolescent phenomena such as susceptibility to peer influence and sensitivity to peer rejection. Experimental behavioural evidence of rejection sensitivity in adolescence is currently sparse. Here, we describe a study that directly compared the affective consequences of an experimental ostracism manipulation (Cyberball) in female adolescents and adults. The ostracism condition led to significantly greater affective consequences in the adolescents compared with adults. This suggests that the ability to regulate distress resulting from ostracism continues to develop between adolescence and adulthood. The results are discussed in the context of models of neurocognitive development.     

Risk factors for arterial ischemic stroke in childhood

Stroke affects up to 13 of 100,000 children, is more common in boys and African Americans, and is associated with considerable cognitive and psychiatric morbidity, as well as motor disability. Around half are hemorrhagic and half are ischemic. Underlying conditions include sickle cell disease, cardiac abnormalities, chromosomal abnormalities (eg, Down syndrome), and neurocutaneous conditions (eg, neurofibromatosis), but up to half the patients with ischemic stroke have no previously diagnosed condition. Although there is almost certainly an important genetic component to stroke risk, head trauma, infections, drugs and radiation appear to play an etiological role in some patients. The majority of the patients with infarction in an arterial distribution have associated cerebrovascular disease. Vascular pathologies include carotid or vertebrobasilar dissection, intracranial vasculopathy affecting the middle and anterior cerebral arteries, which is often transient, and moyamoya. Intermediate risk factors may include hypertension, hypoxia, and poor nutrition leading, for example, to iron deficiency and hyperhomocysteinemia. Some chronic conditions may directly influence the child's behavior and stroke recurrence risk, although large cohorts and randomized controlled trials will be needed before strategies for modification can be evidence-based.     

Social support and recovery from surgery

This study examined the relationship of naturally occurring social support from the spouse with the preoperative anxiety and postoperative recovery of 56 male coronary-bypass patients. Patients were divided into groups based on whether the overall quality of their marital relationship was perceived to be relatively good or bad at the time of surgery and on whether they received relatively high or low spouse support in the hospital (defined in terms of frequency of visits). A fifth group (n = 16), consisting of unmarried patients, enabled additional comparisons. The results indicated that, although groups were essentially equivalent in preoperative physical status, married patients who received higher hospital support took less pain medication and recovered more quickly than their low-support counterparts. In contrast, perceived quality of the marital relationship was a relatively insignificant factor. Speed of recovery for unmarried patients was generally slower than for married, high-support patients and faster than for married, low-support patients.     

Functional and anatomical profile of visual motion impairments in stroke patients correlate with fMRI in normal subjects

We used six psychophysical tasks to measure sensitivity to different types of global motion in 45 healthy adults and in 57 stroke patients who had recovered from the initial results of the stroke, but a large subset of them had enduring deficits on selective visual motion perception tasks. The patients were divided into four groups on the basis of the location of their cortical lesion: occipito-temporal, occipito-parietal, rostro-dorsal parietal, or frontal-prefrontal. The six tasks were: direction discrimination, speed discrimination, motion coherence, motion discontinuity, two-dimensional form-from-motion, and motion coherence – radial. We found both qualitative and quantitative differences among the motion impairments in the four groups: patients with frontal lesions or occipito-temporal lesions were not impaired on any task. The other two groups had substantial impairments, most severe in the group with occipito-parietal damage. We also tested eight healthy control subjects on the same tasks while they were scanned by functional magnetic resonance imaging. The BOLD signal provoked by the different tasks correlated well with the locus of the lesions that led to impairments among the different tasks. The results highlight the advantage of using psychophysical techniques and a variety of visual tasks with neurological patients to tease apart the contribution of different cortical areas to motion processing.     

Social adjustment in the offspring of parents with bipolar affective disorder

The social adjustment of the adolescent offspring of parents with bipolar affective disorder (n=41) was compared to that of the offspring of parents with nonaffective psychiatric disorders (n=22) and the offspring of normal controls (n=26). In addition, the relationship between social adjustment and cyclothymia in offspring was determined. Social adjustment was assessed using the Life Activities Inventory, a new measure developed to assess social functioning in adolescents and young adults. Cyclothymia was assessed with the General Behavior Inventory. As a group, the offspring of bipolar parents did not differ significantly from either control group on social adjustment. However, the cyclothymic offspring of bipolar parents exhibited significantly poorer social adjustment than the noncyclothymic offspring of bipolars and the offspring of psychiatric and normal controls. These findings suggest that poor social functioning in the adolescent offspring of parents with bipolar illness may be associated with the early manifestations of affective disorder. In addition, these data indicate that despite its subsyndromal intensity, cyclothymia can result in significant social impairment.This study was supported in part by National Institute of Mental Health (NIMH) Research Grant MH-39782 to Daniel N. Klein and NIMH Grants MH-33083 and MH-37195 to Richard A. Depue.     

Depression and literacy are important factors for missed appointments

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.     

Social cure and social curse: Social identity resources and adjustment to acquired brain injury

There is increasing evidence that identification with social groups can protect and enhance health, establishing a kind of ‘social cure’. However, for those affected by chronic or disabling conditions such as acquired brain injury (ABI), their identity may also represent a burden, a form of ‘social curse’. The present study explored the identity benefits and burdens available to 15 participants living with ABI using semi-structured interviews. The qualitative data was then analysed systematically using thematic analysis. The findings highlight social identity changes as central to the experience of brain injury. Participants reported changes in their social networks and social group memberships after injury. Identity loss and reduced social support were described as disabling. Engagement in meaningful group activity with others affected by ABI and access to affected peers enabled new group-based resources such as social support. In this way, group activity can be seen as a form of identity enactment that can drive social cure effects. Similarly, adaptation to life after injury was demonstrably linked to social identity processes pointing to the importance of a social cure approach to rehabilitation.     

Neuroprotection and stroke rehabilitation: modulation and enhancement of recovery

Recent advances in research are modifying our view of recovery after nervous system damage. New findings are changing previously held concepts and providing promising avenues for treatment of patients after stroke. This review discusses mechanisms of neuronal injury after brain ischemia and the attempts to study neuroprotection options based on such mechanisms. It also considers measures available at present to improve outcome after stroke and presents new areas of research, particularly stimulation techniques, neurogenesis and trophic factors to enhance recovery. In order to improve outcomes, medications that may be detrimental to recovery should be avoided, while symptomatic therapy of problems such as depression, pain syndromes and spasticity may contribute to better results. Continued surveillance and early treatment of complications associated with acute stroke, along with supportive care remain the mainstay of treatment for stroke patients in the recovery phase. Present research on limiting brain damage and improving recovery and plasticity enhance the prospects for better clinical treatments to improve recovery after stroke.