The assessment of hemineglect syndrome with cancellation tasks. A comparison between the bells test and the Apples test

Unilateral spatial neglect (USN) is a frequent consequence of acquired brain injury, especially following right hemisphere damage. Traditionally, unilateral spatial neglect is assessed with cancellation tests such as the Bells test. Recently, a new cancellation test, the Apples test, has been proposed. The present study aims at comparing the accuracy of these two tests in detecting hemispatial neglect, on a sample of 56 right hemisphere stroke patients with a diagnosis of USN. In order to evaluate the agreement between the Apples and Bells tests, Cohen's kappa and McNemar's test were used to assess differences between the two methods of evaluation. Poor agreement and statistically significant differences emerged between the Apples and Bells tests. Overall, the Apples test was significantly more sensitive than the Bells test in detecting USN. Based on these results, the use of the Apples test for peripersonal neglect assessment is therefore highly recommende

Groups with volunteers cardiac surgery patients: experience in a cardiovascular rehabilitation department

Objectives: This article aimed to describe a new experience activated inside of a more general psychological approach for patients who underwent cardiac surgery intervention. Material and Methods: The first 100 patients taking part to the groups were subjected to a questionnaire in order to evaluate the satisfaction degree of the meeting. Results: The questionnaire results, showed on the whole a good rating of the meeting. In addition to quantitative results, we express and discuss in this paper some considerations concerning the obtained results. Conclusions: Preliminary data analysis show that volunteers previously submitted to cardiac surgery seem to offer an important contribution to the psychological support of patients recently undergone cardiac surgery

'Less is more': validation with Rasch analysis of five short-forms for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs).

Background: Previous analyses demonstrated a lack of unidimensionality, item redundancy, and substantial administrative burden for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs). Objective: To use Rasch Analysis to calibrate five short-forms of the BIRT-PQs, satisfying the Rasch model requirements. Methods: BIRT-PQs data from 154 patients with severe Acquired Brain Injury (s-ABI) and their caregivers (total sample = 308) underwent Rasch analysis to examine their internal construct validity and reliability according to the Rasch model. Results: The base Rasch analyses did not show sufficient internal construct validity according to the Rasch model for all five BIRT-PQs. After rescoring 18 items, and deleting 75 of 150 items, adequate internal construct validity was achieved for all five BIRT-PQs short forms (model chi-square p-values ranging from 0.0053 to 0.6675), with reliability values compatible with individual measurements. Conclusions: After extensive modifications, including a 48% reduction of the item load, we obtained five short forms of the BIRT-PQs satisfying the strict measurement requirements of the Rasch model. The ordinal-to-interval measurement conversion tables allow measuring on the same metric the perception of the neurobehavioral disability for both patients with s-ABI and their caregivers

Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion

Background: The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient’s performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. Methods: The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman’s partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests’ corrected scores. Results: Of the 37 patients enrolled in this study, 29.7% made 3–11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = −0.408, p = 0.013; r = −0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = −0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = −0.468, p = 0.007; r = −0.499, p = 0.003). The orientation also correlated with the TT part III (r = −0.504, p = 0.002). Conclusion: Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory–verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests

Impaired reading not due to visual field loss in a patient with a right-hemipsheric lesion

We describe a right-handed patient (M.B.), who developed left hemianopsia and a severe reading impairment after right occipital-parietal hemorrhage. The pattern of his reading deficit was very similar to that of pure alexia (alexia-without-agraphia): extremely slow reading times with frequent grapheme substitutions and omissions. A test of letter reading while controlling for saccadic eye movements and hemifield of presentation ruled out hemianoptic alexia. Although there have already been reports of reading impairments in right handers following right- hemispheric lesions, ours is, to the best of our knowledge, the first where visual field loss can be definitely excluded as the main cause. Based on a standard neuropsychological assessment and on additional behavioral tests, we argue that M.B.'s difficulties are unlikely to be due to right-hemisphere dominance for language. After considering several candidate explanations, we suggest that M.B.'s symptoms may be related to an impairment in attentional processes related to reading. © 2013 © 2013 Taylor & Francis

Progressive Unspecified Motor Speech Disorder: A Longitudinal Single Case Study of an Older Subject

Introduction: In a few cases, neurodegenerative diseases debut with a speech disorder whose differential diagnosis can be difficult. Case Report: We describe the case of a right-handed woman with a progressive speech impairment, which debuted when she was 80 years old. We report the results of neurological, neuropsychological, and imaging assessments with positron emission tomography (PET) over a period of nine years. Metabolic PET with 18F-FDG was performed at the age of 81 and repeated two years later due to the worsening of symptoms; amyloid PET with 18F-flutemetamol was performed at the age of 86. All PET results were quantitatively analyzed. A speech impairment remained the isolated neurological symptom for a long time, together with a mood disorder. Early FDG-PET showed hypometabolism in the left superior and inferior frontal areas, in the left superior temporal area, and in the right superior frontal area. Two years later, the hypometabolic area was more extensive. Amyloid PET was qualitatively and quantitatively normal. Nine years after the first symptoms, the speech production progressively worsened until complete anarthria, in association with writing impairment onset and signs of behavioral impairments. No signs of motor involvement were found. Conclusions: A progressive articulatory disorder without an evolution of motor disorders may be a distinct neurological degenerative entity, mainly affecting speech production for very a long time and with a specific early metabolic pattern in brain FDG-PET in the language production area. Monitoring patients with FDG-PET could predict the disease evolution years before a clinical deterioration

Does word frequency affect lexical selection in speech production?

We evaluated whether lexical selection in speech production is affected by word frequency by means of two experiments. In Experiment 1 participants named pictures using utterances with the structure \u201cpronoun \ufe verb \ufe adjective\u201d. In Experiment 2 participants had to perform a gender decision task on the same pictures. Access to the noun\u2019s grammatical gender is needed in both tasks, and therefore lexical selection (lemma retrieval) is required. However, retrieval of the phonological properties (lexeme retrieval) of the referent noun is not needed to perform the tasks. In both experiments we observed faster latencies for high-frequency pictures than for low-frequency pictures. This frequency effect was stable over four repetitions of the stimuli. Our results suggest that lexical selection (lemma retrieval) is sensitive to word frequency. This interpretation runs against the hypothesis that a word\u2019s frequency exerts its effects only at the level at which the phonological properties of words are retrieved

Terapia dei disturbi della comunicazione nel cerebroleso adulto

Questo capitolo affronta le tematiche delle competenze comunicative verbali e non verbali nel paziente afasico, e come queste possano essere oggetto di intervento riabilitativo. Si occupa inoltre dei pazienti non afasici con disturbi della pragmatica comunicativa, e più in generale dei disturbi della comunicazione sociale, quadro di frequente riscontro nella fenomenologia del trauma cranio-encefalico. Infine, si occupa delle situazioni in cui le capacità cognitive e di linguaggio interno sono parzialmente o del tutto conservate, e sussiste un deficit nelle modalità espressive. In questi casi l'intervento riabilitativo è mirato alla ricerca e all'addestramento all'utilizzo di canali alternativi alla comunicazione, talvolta anche grazie all'uso di ausili esterni

Riabilitazione dei disturbi del comportamento conseguenti a lesioni cerebrali

Un evento cerebrolesivo pu\uf2 determinare alterazioni del comportamento relazionale, della personalit\ue0 e, pi\uf9 in generale, della condotta sociale. Variabili quali la sede e la vastit\ue0 delle lesioni cerebrali, la personalit\ue0 premorbosa, la presenza in anamnesi di eventuali disturbi psichiatrici, i disordini cognitivi associati e fattori ambientali possono contribuire allo sviluppo dei disordini comportamentali ed emozionali. L\u2019insieme di questi fattori contribuisce alla grande variabilit\ue0 delle alterazioni comportamentali e psicologiche in questa popolazione di pazienti, che spesso subiscono importanti limitazioni dell\u2019attivit\ue0 e della partecipazione sociale. Le modificazioni del comportamento, infatti, rappresentano un ostacolo sia alla partecipazione ai programmi riabilitativi sia a un adeguato e soddisfacente reinserimento familiare, sociale, scolastico e lavorativo, essendo inficiata da questi disturbi soprattutto la qualit\ue0 dei rapporti interpersonali. Negli ultimi decenni la pratica neuroriabilitativa ha focalizzato sempre di pi\uf9 l\u2019attenzione sull\u2019importanza di applicare programmi specifici e individualizzati per i disordini comportamentali conseguenti a una cerebrolesione. Oggi \ue8 possibile usufruire di diversi approcci che prevedono un armonico intersecarsi di interventi farmacologici e comportamentali, cognitivi e psicoterapeutici che accompagnano il paziente e la sua famiglia per tutto l\u2019arco della presa in carico riabilitativa e nel follow-up. Nel presente capitolo, dopo una descrizione delle diverse possibili manifestazioni cliniche dei disordini comportamentali e dei loro correlati anatomo-funzionali, saranno descritti gli strumenti di valutazione, di inquadramento e di approfondimento, atti a individuare i fattori che contribuiscono al loro manifestarsi e al loro mantenersi nel tempo. Seguir\ue0 una descrizione delle principali metodiche per la riabilitazione dei disordini del comportamento e della evidenza della loro efficacia. L\u2019ultimo paragrafo sar\ue0 infine dedicato al trattamento farmacologico dei disturbi comportamentali

Long-term cognitive sequelae in a case of Wernicke’s encephalopathy after allogeneic stem cell transplantation

We describe the case of a non-alcoholic patient with chronic myeloid leukemia who developed iatrogenic Wernicke’s encephalopathy (WE) following stem cell transplantation. Four years after the WE acute event, the patient’s cognitive profile was mainly characterized by moderate memory impairment, and functional and daily-living difficulties. Our report sustains the hypothesis that a iatrogenic form of WE may produce long-term cognitive sequelae even when thiamine therapy is administered in the acute phase until the resolution of the neurological signs