Stroke survivors over-estimate their medication self-administration (MSA) ability, predicting memory loss.

BACKGROUND AND OBJECTIVE: Medication self-administration (MSA) may be cognitively challenging after stroke, but guidelines are currently lacking for identifying high-functioning stroke survivors who may have difficulty with this task. Complicating this matter, stroke survivors may not be aware of their cognitive problems (cognitive anosognosia) and may over-estimate their MSA competence. The authors wished to evaluate medication self-administration and MSA self-awareness in 24 consecutive acute stroke survivors undergoing inpatient rehabilitation, to determine if they would over-estimate their medication self-administration and if this predicted memory disorder. METHODS: Stroke survivors were tested on the Hopkins Medication Schedule and also their memory, naming mood and dexterity were evaluated, comparing their performance to 17 matched controls. RESULTS: The anosognosia ratio indicated MSA over-estimation in stroke survivors compared with controls--no other over-estimation errors were noted relative to controls. A strong correlation was observed between over-estimation of MSA ability and verbal memory deficit, suggesting that formally assessing MSA and MSA self-awareness may help detect cognitive deficits. CONCLUSIONS: Assessing medication self-administration and MSA self-awareness may be useful in rehabilitation and successful community-return after stroke.

Psychometric evaluation of neglect assessment reveals motor-exploratory predictor of functional disability in acute-stage spatial neglect.

OBJECTIVE: To determine the psychometric properties of 2 neglect measures, the Behavioral Inattention Test (BIT)-conventional and the Catherine Bergego Scale (CBS), in acute spatial neglect. Spatial neglect is a failure or slowness to respond, orient, or initiate action toward contralesional stimuli, associated with functional disability that impedes stroke recovery. Early identification of specific neglect deficits may identify patients likely to experience chronic disability. However, psychometric evaluation of assessments has focused on subacute/chronic populations. DESIGN: Correlational/psychometric study. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Screening identified 51 consecutive patients with a right-hemisphere stroke with left neglect (BIT score <129 or CBS score >11) tested an average of 22.3 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We obtained BIT, CBS, and Barthel Index assessments for each participant and clinical and laboratory measures of perceptual-attentional and motor-intentional deficits. RESULTS: The BIT showed good reliability and loaded onto a single factor. Consistent with our theoretical prediction, principal components analysis of the CBS identified 2 underlying factors: Where perceptual-attentional items (CBS-PA) and embodied, motor-exploratory items (CBS-ME). The CBS-ME uniquely predicted deficits in activities of daily living (ADLs) assessed by using the Barthel Index, but did not predict clinical and laboratory assessments of motor-intentional bias. More severe neglect on the CBS-PA correlated with greater Where perceptual-attentional bias on clinical and laboratory tests, but did not uniquely predict deficits in ADLs. CONCLUSIONS: Our results indicate that assessments of spatial neglect may be used to detect specific motor-exploratory deficits in spatial neglect. Obtaining CBS-ME scores routinely might improve the detection of acute-stage patients with spatial action deficits requiring increased assistance that may persist to the chronic stage.

Social, thermal, and temporal influences on isolation-induced and maternally potentiated ultrasonic vocalizations of rat pups.

Sensory and temporal factors have been demonstrated to be involved in the regulation of isolation-induced ultrasonic vocalizations (USV) of young rats. Sensory cues include thermal, olfactory, and tactile modalities. Temporal factors include the time spent in isolation. The goal of the present research was to examine the interaction of these factors in both isolation-induced and maternally potentiated USV. Maternal potentiation of USV occurs when a brief interaction with the dam, even a passive (anesthetized) dam, elicits an augmented vocal response to a subsequent isolation, with rates of USV in rat pups well above those emitted in standard isolation tests. We found that passive maternal potentiation of USV did occur under all conditions tested. Neither a 30-min prior isolation nor high ambient temperature prevented an increase in USV rate over the rate of the original isolation. After 30-min isolation at warm temperatures when the rate of USV had fallen to zero, the pups increased vocalization in the presence of the dam as well as in the subsequent isolation. Temporal and thermal factors also interacted significantly in regulating the level of the USV emitted by the pups during the first isolation, in the presence of the anesthetized dam, and during the second isolation.