Imitation assessment and its utility to the diagnosis of autism: evidence from consecutive clinical preschool referrals for suspected autism

The present study sought to examine imitation difficulties as a risk factor for autism. Imitation aptitude was examined in 86 preschoolers suspected of autism (1.9-4.5 years) using the Preschool Imitation and Praxis Scale (PIPS). Differences between imitation, language, motor age-equivalents and nonverbal mental age were used to predict the diagnosis of autism. Multidisciplinary team diagnoses and ADOS-G classifications were used to differentiate children with autism spectrum disorders and non-spectrum developmental disorders. Two factors were found to be significantly associated with autism using simple logistic regression analyses: procedural imitation delay and receptive language delay. In a multivariable setting, only procedural imitation delay remained a significant predictor of autism. Results are new to the literature and require replications

Preferences of urban Zimbabweans for health and life lived at different ages.

OBJECTIVE: To determine the age-weighting preferences of urban Zimbabweans in relation to health care priorities. METHOD: A total of 67 randomly selected residents of a high-density area of Harare participated in the study. Participants were asked "person trade-off" questions to determine their preferences in terms of the numbers of people of various ages who would be saved from death and from suffering a year of ill-health relative to the number of 30-year-olds who would be saved from these eventualities. FINDINGS: The responses indicate that the value of averting a year of ill-health was judged greatest for 15-year-olds and was equal for people aged 1, 30, and 45 years. The value of averting a death primarily reflected the expected years of life lost, but the influence of age-weighting was evident in that 15 years was the most highly valued age. CONCLUSION: Although the age-weighting curves did not correspond exactly with the Global Burden of Disease (GBD) age-weights, Zimbabweans showed a preference for saving the lives of young adults. The GBD age-weights should be used to determine the disability-adjusted life years lost in the Zimbabwean population

Validation of Driving Simulation to Assess On-Road Performance in Huntington Disease

Driving simulators are increasingly used to assess the driving capabilities of persons with neurodegenerative conditions. However, few driving simulator evaluations have been validated against standardized on-road tests. The aim of this study was to investigate the concurrent validity of a comprehensive driving simulator evaluation in 29 persons with Huntington disease (HD). The Test Ride for Investigating Practical fitness to drive (TRIP) checklist was administered after a 15 km simulator drive and 20 km on-road drive. The total driving simulator TRIP score and each of its item scores were compared with the on-road TRIP scores using Spearman rho correlation statistics. We found significant correlations for 9 of the 12 items. Correlations ranged between 0.12 for the item gap distance at speed below 50 km/h and 0.72 for the total TRIP score, indicating variable strength of the associations. Items assessing operational skills correlated better with on-road driving performance than tactical or higher-order visual items. The results indicate that a fixed-base, single screen driving simulator is a valid tool to assess on-road driving capabilities in persons with HD

Five-year mortality and related prognostic factors after inpatient stroke rehabilitation : A European multi-centre study

Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR = 1.06, 95% CI: 1.04-1.09), cognitive impairment (HR = 1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR = 1.68, 95% CI: 1.16- 2.41) and atrial fibrillation (HR = 1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR = 0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR = 0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80-0.89) for patients in BI6mthsclass: 95-100, 0.72 (95% CI: 0.63-0.79) in BI6mths-class: 65-90 and 0.50 (95% CI: 0.40-0.60) in BI6mths-class: 0-60 (p < 0.0001). Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival

Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed \u3e80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed >80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Determinants of Driving After Stroke

Objective: To identify from a predriving assessment the tests that best predict the driving ability of stroke patients. Design: Examination of records of 104 first ever stroke patients who visited the Belgian Institute for Road Safety in 1998 and 1999 and performed the medical, visual, perceptual and the ‘on the road’ assessments. Measures: Variables such as age, sex, side of lesion, driving experience, visual tests, neuropsychological assessments most of which are from the Test for Attentional Performance (TAP) battery and an ‘on the road’ test were considered. Based on performances of subjects on the tests, a suitable, not immediately suitable or not suitable to drive decision was jointly taken by the team of assessors. Results: Following a logistic regression analysis, a combination of side of lesion, kinetic vision, visual scanning and the ‘on the road’ tests led to the best model in predicting the final group decision (R2 =0.53). The ‘on the road’ test was the most important determinant (R2 =0.42). Conclusion: The predictive accuracy of the decision is moderate. Inclusion of assessments more closely related to real road situations should be considered