Neuropsychological assessment with the Visual Gestalt Test: psychometric properties and differential diagnostic probabilities

The Visual Gestalt Test is a neuropsychological instrument developed for evaluation of learning and memory of visuo-spatial material. A revised strategy of scoring has motivated the present study, where data from 153 normal persons, 99 epilepsy patients, and 24 depressed patients are presented and compared. The Visual Gestalt Test is observed to discriminate between normal and diagnosed groups in several ways. Additionally it is found to discriminate between depressed and brain damage subgroups of patients. Data are presented in order to supplement previously published ways of scoring and norms. Practical guidelines for the clinical applications of the test are suggested as perspectives.     

The relationship between prosody and breathing in spontaneous discourse

This article is concerned with the role of prosody in discourse. Three experiments explored the relationship between inspiration, declination, and syntactic boundaries in normal and RHD participants. Fundamental frequency and intensity were measured at the beginning and end of breath units excised from conversational samples. The results revealed evidence of declination of intensity in all samples measured. However, resetting of fundamental frequency was observed only in the samples of normal participants and then only when a breath coincided with the beginning of a sentence. The results suggest that resetting and declination play separate roles in discourse parsing.     

Temporal parameters as cues to phrasal boundaries: a comparison of processing by left- and right-hemisphere brain-damaged individuals

Two experiments were conducted to examine the ability of left- (LHD) and right-hemisphere-damaged (RHD) patients and normal controls to use temporal cues in rendering phrase grouping decisions. The phrase "pink and black and green" was manipulated to signal a boundary after "pink" or after "black" by altering pre-boundary word durations and pause durations at the boundary in a stepwise fashion. Stimuli were presented to listeners auditorily along with a card with three alternative groupings of colored squares from which to select the presented alternative. Results revealed that normal controls were able to use both temporal cues to identify the intended grouping. In contrast, LHD patients required longer than normal pause durations to consistently identify the intended grouping, suggesting a higher than normal threshold for perception of temporal prosodic cues. Surprisingly, the RHD patients exhibited great difficulty with the task, perhaps due to the limited acoustic cues available in the stimuli.     

Effects of Right- and Left-Hemisphere Damage on Understanding Conversational Implicatures

Processing of implicatures was examined in 27 right-brain-damaged (RBD) and 31 left-brain-damaged (LBD) stroke patients with focal lesions using a new implicatures battery (IB) as part of an exploration of the neural basis and modularity of natural language pragmatics. Following Grice, we sampled implicatures of Quantity, Quality, Relation, and Manner. Verbal implicatures consisted of two-sentence conversational vignettes which are literally problematic. Nonverbal implicatures consisted mostly of famous paintings that are literally problematic (e.g., Magritte's "Le Domain d'Arnheim"). The patient has to identify and solve the problem. To compare with performance on the IB, patients also received a Hebrew adaptation of Gardner and Brownell's Right Hemisphere Communication Battery, a new test of basic speech acts (verbal and nonverbal assertions, questions, requests, and commands), a Hebrew version of the Western Aphasia Battery, and standardized neuropsychological tests. Both LBD and RBD patients were significantly impaired in implicature processing relative to age-matched normal controls. In general, both patient groups showed weak correlations of implicatures with extents of lesions in left perisylvian language area or its right-hemisphere (RH) homolog. However, performance of LBD and RBD patients on the IB revealed different patterns of correlations with other pragmatic, language, and nonlanguage tests. In LBD patients, there was a greater association between performance on verbal and nonverbal implicatures and between performance on implicatures and basic speech acts than in RBD patients. Given the different modes in which right-and left-hemisphere (LH) damage affect the processing of conversational implicatures, it remains to be discovered how the two hemispheres interact to process natural language pragmatics in the normal brain in real time.     

Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Publication trends in 25 years of the Journal of Applied Behavior Analysis

All articles published in the first 25 years of JABA (1968 to 1992) were reviewed to classify the percentage of articles published in the following categories: (a) type of article, (b) subjects, (c) setting, (d) behavior-change agent, (e) target behavior, (f) use of basic principles, and (g) miscellaneous procedures. Overall percentages and trends are reported in each category. Results indicate an increase in the percentage of articles with participants and target behaviors in developmental disabilities and a decrease in the percentage of studies targeting academic behavior, verbal behavior, and other child behavioral excesses. The most frequent setting continues to be a school; however, there is a clear trend towards community and other naturalistic settings. Results also highlight the increasing complexity and multicomponent nature of JABA interventions. Potential implications for future applications are discussed.     

Anencephalic infants and special relationships

This paper investigates the scope and limits of parents' and physicians' obligations to anencephalic newborns. Special attention is paid to the permissibility of harvesting anencephalic organs for transplant. My starting point is to identify the general justification for treating patients in order to benefit third parties. This analysis reveals that the presence of a close relationship between patients and beneficiaries is often crucial to justifying treating in these cases. In particular, the proper interpretation of the Kantian injunction against treating persons as means only takes on a different light in the context of special relationships. The implications of this analysis for our responsibilities to anencephalic infants is clarified.     

Orthogonal rotations to maximal agreement for two or more matrices of different column orders

Methods for orthogonal Procrustes rotation and orthogonal rotation to a maximal sum of inner products are examined for the case when the matrices involved have different numbers of columns. An inner product solution offered by Cliff is generalized to the case of more than two matrices. A nonrandom start for a Procrustes solution suggested by Green and Gower is shown to give better results than a random start. The Green-Gower Procrustes solution (with nonrandom start) is generalized to the case of more than two matrices. Simulation studies indicate that both the generalized inner product solution and the generalized Procrustes solution tend to attain their global optima within acceptable computation times. A simple procedure is offered for approximating simple structure for the rotated matrices without affecting either the Procrustes or the inner product criterion.The authors are obliged to Charles Lewis for helpful comments on a previous draft of this paper and to Frank Brokken for preparing a computer program that was used in this study.     

Psychological adjustment of pediatric lung transplantation candidates and their parents

Investigated psychological functioning of 45 children and adolescents (ages 5 to 17 years) and their parents presenting at a major medical center for evaluation for lung transplantation. Patients completed self-reports, and parents completed measures on their children's behavior problems and emotional distress as well as on their own symptoms of distress. In general, children and their parents reported normal functioning on standard psychological measures. Few children fell in the clinically significant range, whereas 21% of mothers and 14% of fathers reported clinically significant levels of distress. Older children reported lower levels of depressive symptoms than younger children, and patients with cystic fibrosis manifested lower levels of internalizing symptoms than those with other pulmonary diseases. Findings demonstrate the resiliency of children and their parents facing a stressful point in the child's medical status and document the usefulness of psychological screening of patients and parents to identify those in need of clinical intervention.     

Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation,stride characteristics,and ratings of perceived exertion during acute stroke rehabilitation

BackgroundIntensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1 month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase.ObjectiveTo examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure.DesignA prospective, repeated measures design was used.MethodsTen inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0 mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial.ResultsStride length, cadence, and paretic single limb support increased with faster walking speeds (p ⩽ 0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p ⩽ 0.001). RPE also was greatest at the fastest compared to two slowest speeds (p < 0.05).ConclusionsDuring the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0 mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.