Anterior operculum syndrome.

The anterior operculum syndrome (AOS) is a well-defined clinical entity that has received little attention in the English literature. We report the clinical and CT findings in 3 cases of AOS; 2 were caused by bilateral cerebral infarctions secondary to bilateral internal carotid occlusion and 1 by the residual effects of viral encephalitis. Although there was variability in the range of deficits found in our cases, each of these patients presented with characteristic facio-pharyngo-glosso-masticatory diplegia with a dramatic automatic-voluntary movement dissociation. This syndrome deserves attention for its characteristic anatomic and prognostic implications.

A longitudinal study of the psychosocial impact of stroke on primary support persons.

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.

Aphasic adults and their decisions on driving: an evaluation.

This study evaluated the propriety of decisions by aphasic adults to avoid or to return to driving following a cerebrovascular accident. A comparison was made of a rehabilitation team's assessments of driving skills with a group of 10 aphasic adults who had chosen to return to driving without professional consultation and 10 aphasic adults who had not returned to driving. The Fisher Exact Probability Test found that the team-assigned driver and nondriver groupings agreed with the patients' own groupings with the relationship significant at p less than 0.005. This suggested patients had appropriately judged their own compentency to drive. Discriminant analysis of variables tested by the team suggested language performance alone was not the most cogent indicator for driving candidacy.

Focal cranial dystonia.

In the neurologic literature there has been a growing recognition of a syndrome of focal cranial dystonias referred to variously as blepharospasm-oromandibular dystonia, Brueghel's syndrome, or Meige's syndrome. Typically, this syndrome presents as an isolated and idiopathic dystonia of facial or oromandibular muscles occasionally prompting a referral to a speech pathologist. Our findings in a group of 10 patients with this diagnosis are presented, and the negligible effect of an intensive program of speech management for one subject is described.

Comparing treatment intensities of tactile-thermal application.

The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.