Sensorized assessment of bilateral hand movements in patients with stroke driven by rhythmic auditory or visual-auditory stimulation.

There is a growing body of literature about the efficacy in neurorehabilitation of the devices providing rhythmic auditory stimulations or visual-auditory stimulations, such as videogames, for guiding the patients' movements. Despite being presented as tools able to motivate patients, their efficacy was not been proven yet, probably due to the limited knowledge about the factors influencing the capability of patients to move the upper limbs following an external stimulus. In this study, we used a marker less system based on two infrared sensors to assess the kinematics of up and down in-phase and anti-phase bilateral hand oscillations synchronized or not with an external stimulus. A group of stroke survivors, one of age-matched healthy subjects and one of young healthy subjects were tested in three conditions: no stimulus, auditory stimulus, and video-auditory stimulus. Our results showed significant negative effects of visual-auditory stimulus in the frequency of movements (p = 0.001), and of auditory stimulus in their fluidity (p = 0.013). These results are conceivably related to the attentional overload required during the execution of bilateral movements driven by an external stimulus. However, a positive effect of external stimulus was found in increasing the range of movements of the less functional hand in all subjects (p = 0.023). These findings highlight as the type of stimulus may play a crucial role in the patient's performance with respect to movements that are not-externally driven.

Reading skills in children with mild to borderline intellectual disability: a cross-sectional study on second to eighth graders.

BACKGROUND: Students with intellectual disabilities (IDs) have various learning difficulties and are at risk for school failure. Large inter-individual differences are described for reading, but it is unclear how these vary as a function of grade. The aim of this study was to examine various reading fluency, accuracy and comprehension parameters in second-to-eighth-grade Italian children with either borderline intellectual functioning (BIF) or mild ID (MID). METHODS: We examined 106 children with BIF (67 M and 39 F) and 168 children with MID (107 M and 61 F). The children were in the second to eighth grade and were comparable for chronological age (7 to 14 years). They were administered a battery of tests that assessed fluency and accuracy of word, pseudo-word and text reading, as well as text comprehension. Standardised scores allowed us to compare the performance of the two groups with normative values. RESULTS: Children with ID obtained generally low scores compared with normative values. Those with MID had greater difficulty than those with BIF. Furthermore, difficulty was greater for speed than for accuracy measures and for words than for pseudo-words. Difficulty (particularly in the case of reading speed) tended to be pronounced at later grades. Marked individual differences were present independently of MID-BIF subgrouping, as well as stimulus category and reading parameter. CONCLUSIONS: As a group, children with ID showed difficulty in reading acquisition; the effect was greater for children with more severe ID, but large individual differences were observed in children with both BIF and MID. Relatively spared pseudo-word reading skills indicate efficient use of the grapheme-to-phoneme conversion routine. This processing mode may prove more ineffective at higher levels of schooling when even in regular orthographies such as Italian typically developing children rely on lexical activation.

Italian normative data for a stroke specific cognitive screening tool: the Oxford Cognitive Screen (OCS).

Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.

Italian standardization of the Apples Cancellation Test.

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect).

Abnormal motor preparation in severe traumatic brain injury with good recovery.

Movement-related cortical potentials (MRCPs) were examined in seven patients with severe traumatic brain injury (TBI) and 12 matched control subjects. All patients had clinically established good recovery by the time of testing. Flexion movements of the index finger of the left or right hand were recorded in two (alternating and repetitive) self-paced conditions and in one externally triggered condition. In control subjects, the bereitschaftspotential (BP) component of MRCP was detected approximately 2000 msec prior to movement onset in the self-paced conditions and was larger and earlier in the alternating compared to the repetitive condition. The BP component was absent in the externally triggered condition. In TBI patients, the BP was greatly reduced and no difference between the alternating-repetitive conditions was detected; in contrast, only small differences were present in the controls for the negative slope (NS) and MP components and no difference for the reafferent positivity (RAP) component. A dipole analysis indicated the supplementary motor area and the premotor area as the likely generators of BP and NS' components, respectively. Gradientrecalled echo magnetic resonance imaging allowed the detection of a number of small hypointense lesions primarily located in the frontal lobes, as in diffuse axonal injury. This pattern of results indicates a selective deficit in motor preparation and a relatively spared pattern of activation during and following movement in these patients. Imaging data appear generally consistent with the pattern of MRCPs observed in the patient group. Implications of these results for the problem of slowness in TBI patients are discussed.

Perception of moving and stationary gratings in brain damaged patients with unilateral spatial neglect.

Contrast sensitivity for stationary and drifting sinusoidal gratings of different spatial frequencies was measured in 17 brain damaged patients (five left-brain damaged and 12 right-brain damaged patients, six of whom showed symptoms of spatial hemi-neglect). Twenty-nine combinations of spatio-temporal stimuli were considered in the drifting condition. No specific deficit for the group of patients with neglect symptom in the perception of moving and stationary gratings was observed. Also, no systematic deficit for perceiving the direction of motion--toward the neglect hemispace or away from it--was apparent. A small, selective impairment in the detection of stationary or very slow drifting gratings of low spatial frequency was observed in the presence of unilateral cortical damage, independently from its side (left or right) and from the presence of neglect. Some difficulty to detect the direction of motion was observed in a few individual patients.

Contrast sensitivity and low spatial frequency discrimination in hemi-neglect patients.

Contrast sensitivity for sinusoidal gratings of different spatial frequencies and low spatial frequency discrimination of high contrast squarewave gratings were measured in 26 right brain damaged patients, 15 of whom showed symptoms of spatial hemi-neglect. No difference was present between neglect and non-neglect patients in either task. A difference in contrast sensitivity restricted to low spatial frequencies was present between controls and patients, independent of neglect. Overall, results indicated that spatial vision at threshold and suprathreshold levels is not selectively impaired in patients with hemi-neglect, a finding consistent with theories which postulate a post-perceptual locus of impairment in this syndrome.

The Wundt-Jastrow illusion in the study of spatial hemi-inattention.

A new test to detect unilateral neglect was devised using a modified version of the Wundt-Jastrow area illusion. The test was given to three groups of subjects: left brain damaged (LBD), right brain damaged (RBD) patients and controls. Of RBD patients, 40.4% but no LBD patient or control, showed responses inconsistent with the visual illusion when the determinant features of the illusion pointed to the left visual field. These unexpected responses were highly related to a clinical evaluation of the severity of the hemi-inattention disorder. The sensitivity of this test and of other standard measures of hemi-neglect were compared. The possibility of identifying qualitatively different forms of hemi-neglect was also discussed.

Eye movement patterns in linguistic and non-linguistic tasks in developmental surface dyslexia.

Ten subjects who could be reliably assessed as surface dyslexics were selected on the basis of a large test battery. Eye movements in non-linguistic and linguistic tasks were studied in these subjects. Stability of fixation on a stationary stimulus was examined. Performance of dyslexics was no different from that of an age-matched control group. Similarly, no difference was observed between the two groups when they were requested to saccade to a rightward or leftward target. On the other hand, while reading short passages, dyslexics showed an altered pattern of eye movements with more frequent and smaller rightward saccades as well as longer fixation times. The reading pattern was analysed by eye tracking. Numerous fixations were used to read a single word in a fragmented way. Longer words showed a higher number of fixations. Overall, it was concluded that surface dyslexia is not associated with oculo-motor dysfunction and the study of eye movements in reading reveals the processing through orthography-to-phonology conversion characteristic of surface dyslexia. The importance is stressed of examining selected groups of subjects in the psychophysiological study of dyslexia.

Developmental surface dyslexia is not associated with deficits in the transient visual system.

Deficits of the transient visual system have been reported in unselected groups of dyslexics. The aim of this study was to examine whether this finding holds when subjects with a specific type of developmental reading disorder (surface dyslexia) are considered. Ten Italian children were examined. They all presented the characteristic markers of surface dyslexia: slow and laborious reading with errors in tasks which cannot be solved with a grapheme-phoneme conversion (i.e., homophones). Contrast sensitivity thresholds to phase-reversal gratings were within normal limits for most subjects both for stimuli presented centrally and in the right parafovea. This indicates that developmental surface dyslexia is not associated with a deficit in the transient system. In contrast, sensitivity to high spatial frequency stationary stimuli was reduced.

Patterns of lateralization and performance levels for verbal and spatial tasks in congenital androgen deficiency.

The effects of congenital deficiency of gonadal hormones on verbal and spatial performance and on the establishment of hemispheric asymmetries were investigated in a group of patients with idiopathic hypogonadotropic hypogonadism. The patients showed a left hemispheric advantage for verbal material and were mildly impaired, mainly on tasks involving a short-term memory load, in comparison with a matched control group. These results do not indicate a specific role of gonadal hormones on the establishment of hemispheric asymmetries. Lack of exposure during brain development results in a decrease in memory functions which is not specific for verbal or spatial material.

Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross-over study.

A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

Sex and cognitive influence on visual hemifield superiority for face and letter recognition.

Two groups of field independent individuals (one M and one F) and two groups of field dependent individuals (one M and one F) were selected as subjects in the experiment. The classification of field dependence-independence was based on predetermined RFT and EFT standards. The subjects, all right-handed, were given a face and a letter recognition task in a tachistoscopic visual hemifield paradigm; reaction time with either hand was the dependent measure. field independent subjects of both sexes showed a clear right-field superiority for letter and a left-field superiority in both letter and face recognition, although of a smaller magnitude than the previous group. The results of the experiment do not support previous findings of no field superiority in females for face recognition; on the contrary, they provide additional evidence that measures of cognitive style significantly predict hemispheric specialization.

Field dependence and lateralization of verbal and configurational processing.

With tachistoscopic presentation, relatively field-dependent 18- to 30-year-old males were found to show a significant right-visual-field advantage in reaction-time in a letter discrimination task, while relatively field-dependent subjects did not show a significant hemifield difference. In a second study, relatively field-independent 18- to 30-year-old males again showed a significant right-visual-field superiority in reaction time to letter discrimination, and in addition showed a significant left-visual-field superiority in tachistoscopic face discrimination, while relatively field-dependent subjects showed no significant hemifield difference on either task. The results are interpreted as indicating a link between Witkin's concept of psychological differentiation and differentiation at the neural level, as manifested by specialization of function of the cerebral hemispheres.

Vertical neglect: behavioral and electrophysiological data.

Both behavioral and electrophysiological methods were used to assess altitudinal neglect. In the first experiment, 100 patients with neglect completed Albert's Barrage test. Most omissions were present in the lower left quadrant. In 16 patients, visual evoked potentials to stimuli in the four quadrants were separately recorded (Exp. 2). Latencies in the lower left quadrant were longer than those in the other quadrants. A third experiment provided electrophysiological normative data from 13 young normal subjects. Overall, the results showed that both the horizontal and vertical dimensions of space are affected in neglect patients.

Eye movement patterns in reading as a function of visual field defects and contrast sensitivity loss.

Saccadic eye movements during reading were examined as a function of the side of visual field cut and the impairment of visual contrast sensitivity Five patients with various visual field defects were compared to five age-matched controls. Patients with right visual field defect showed an increase in the number of rightward saccades and a decrease in their amplitude, and patients with left visual field defects showed a pattern more similar to that of the control subjects. Two patients showed a selective deficit in the range of medium-high spatial frequency; they were the only patients to show a lengthening of mean fixation time during reading. These results indicate selective effects on reading depending on primary sensory defects. The clinical relevance of these findings is briefly discussed.

Spontaneous facial expression of emotions in brain-damaged patients.

Spontaneous facial expression of emotion was studied in two groups of right (N = 23) and left (N = 39) brain-damaged patients and in a control group of normal subjects (N = 28). To elicit emotions four short movies, constructed to produce positive, negative or neutral emotional responses, were used. The method used to assess the facial expression of emotions was the Facial Action Coding System. Brain-damaged patients showed less facial responses to emotional stimuli than normal controls, but no difference was observed between subjects with right and left-sided lesions either with global or disaggregated data analyses, inconsistent with the hypothesis of a specialization of the right hemisphere for facial emotional expressions. An unexpected difference was observed in response to the unpleasant movie. Both normal controls and left brain-damaged patients often averted their gaze from the screen when unpleasant material was displayed, whereas right brain-damaged patients rarely showed gaze aversion. This finding suggests that the degree of emotional involvement or manner of coping with stressful input may be reduced as a result of right brain damage.

Posed emotional expression in unilateral brain damaged patients.

The facial expressions of six basic emotions were posed by two groups of right (N = 23) and left (N = 34) brain damaged patients and by a control group of normal subjects (N = 28). The posed expressions were examined by means of the Facial Action Coding System (FACS) which provides analytical and objective scoring, as by a subjective scale of appropriateness of expression. Results indicated no difference between controls and patients with a lesion in the right or left hemisphere. These findings are inconsistent with the hypothesis that the right hemisphere plays a specific role in the control of posed facial expression. No relationship was observed between posed emotional expressions and facial paralysis or the presence of oral apraxia.

Visual neglect for far and near extra-personal space in humans.

The possible dissociation of unilateral neglect in far and near extra-personal space was systematically investigated using a modified version of the Wundt-Jastrow area illusion test. This task, which requires no motor response, has been shown to be sensitive to unilateral neglect. Stimuli were presented at two different distances (near and far) to a group of 70 patients with right hemispheric lesion (18 in acute and 52 in chronic stage). Twenty-eight patients evidenced unilateral neglect; that is, they displayed unexpected (i.e., contrary to the known illusory effect) responses when the stimuli were perceived as oriented toward the left side. However, performances in the two conditions were highly correlated and there were no individual instances of dissociation. These results suggest that the presence of a motor response may be necessary to show behavioral dissociations between different parts of extra-personal space.