Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a ‘good responder’ with improved naming and phrase length; P2 was a ‘poor responder’ without improved naming.Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2–43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5–6 words post-TMS.Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1–2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS.Lesion site may play a role in each patient’s fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke’s area, in parts of BA 21 and 37, whereas P1 did not.The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.     

Pat Duffy Hutcheon,Building Character and Culture

Studies in Philosophy and Education -     

Medical Psychology in Australia

Medical psychology in Australia is heavily influenced by British and American thought. The dominant model for clinical training and practice is the scientist–practitioner model, yet a gulf exists between academic and practice settings. Membership of the professional society requires 6 years of university study in psychology. However, registration requires only 4 years training in psychology. Medical psychologists provide a broad range of services in hospital and community settings, often within multidisciplinary teams. Challenges for the future include bridging the divide between university and health settings, increasing qualifications required for registration, making psychology culturally relevant, and demonstrating to funding managers that psychological interventions are both clinically effective and cost effective.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

Uncovering the links between brand choice and personal values among young British and Spanish girls

This paper presents empirical research which demonstrates how snacks brands can satisfy certain personal values for female 11–12 year‐old British and Spanish consumers. The qualitative research design uses a means‐end approach, based on a laddering technique, to uncover the links between brand choice and personal values. After reviewing the means‐end model and other relevant theory, the research methodology and design are presented in detail. The findings reveal significant scope for positioning snacks brands using the values of well being and fun and enjoyment (UK and Spain), while the value of friendship and belonging emerges as an extra dimension for the British respondents. Copyright © 2001 Henry Stewart Publications.