Motor skills assessments: support for a general motor factor for the Movement Assessment Battery for Children-2 and the Bruininks-Oseretsky Test of Motor Proficiency-2.

OBJECTIVE: To evaluate the construct validity and model-based reliability of general and specific contributions of the subscales of the Movement Assessment Battery for Children-2 (MABC-2) and Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) when evaluating motor skills across a range of psychiatric disorders. METHODS: Confirmatory factor analysis (CFA) and bifactor analysis were conducted on BOT-2 data from 187 elementary school students (grades 1 to 6) (mean age: 113 ± 20 months; boys: n = 117, 62.56%) and on MABC-2 data from 127 elementary school students (grade 1) (mean age: 76 ± 2 months; boys: n = 58, 45.67%). RESULTS: The results of the CFA fit the data for multidimensionality for the BOT-2 and presented poor fit indices for the MABC-2. For both tests, the bifactor model showed that the reliability of the subscales was poor. CONCLUSIONS: The BOT-2 exhibited factorial validity with a multidimensional structure among the current samples, but the MABC-2 showed poor fit indices, insufficient to confirm its multidimensional structure. For both tests, most of the reliable variance came from a general motor factor (M-factor), therefore the scoring and reporting of subscale scores were not justified for both tests.

Motor skills assessments: support for a general motor factor for the Movement Assessment Battery for Children-2 and the Bruininks-Oseretsky Test of Motor Proficiency-2 / Avaliação de habilidades motoras: suporte a um fator motor geral para o Movement Assessment Battery for Children-2 e o Bruininks-Oseretsky Test of Motor Proficiency-2

Abstract Objective To evaluate the construct validity and model-based reliability of general and specific contributions of the subscales of the Movement Assessment Battery for Children-2 (MABC-2) and Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) when evaluating motor skills across a range of psychiatric disorders. Methods Confirmatory factor analysis (CFA) and bifactor analysis were conducted on BOT-2 data from 187 elementary school students (grades 1 to 6) (mean age: 113 ± 20 months; boys: n = 117, 62.56%) and on MABC-2 data from 127 elementary school students (grade 1) (mean age: 76 ± 2 months; boys: n = 58, 45.67%). Results The results of the CFA fit the data for multidimensionality for the BOT-2 and presented poor fit indices for the MABC-2. For both tests, the bifactor model showed that the reliability of the subscales was poor. Conclusions The BOT-2 exhibited factorial validity with a multidimensional structure among the current samples, but the MABC-2 showed poor fit indices, insufficient to confirm its multidimensional structure. For both tests, most of the reliable variance came from a general motor factor (M-factor), therefore the scoring and reporting of subscale scores were not justified for both tests.

Resumo Objetivo Avaliar a validade de construto e a confiabilidade das subescalas do Movement Assessment Battery for Children-2 (MABC-2) e do Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) com base em modelos das contribuições gerais e específicas ao avaliar habilidades motoras em transtornos psiquiátricos. Métodos Foram realizadas análise fatorial confirmatória (AFC) e análise bifatorial em dados de 187 escolares do primeiro ao sexto ano do ensino fundamental (idade média: 113 ± 20 meses; meninos: n = 117, 62,56%) que foram avaliados com o BOT-2, e em dados de 127 escolares do primeiro ano do ensino fundamental (idade média: 76 ± 2 meses; meninos: n = 58, 45,67%) avaliados com o MABC-2. Resultados Os resultados da AFC apresentaram índices de ajuste satisfatórios de multidimensionalidade para o BOT-2 e apresentaram índices de ajuste insatisfatórios para o MABC-2. Para ambos os testes, o modelo bifatorial mostrou que a confiabilidade das subescalas era ruim. Conclusão O BOT-2 apresentou validade fatorial com uma estrutura multidimensional entre as amostras utilizadas, mas o MABC-2 apresentou índices de ajuste insatisfatórios, insuficientes para confirmar sua estrutura multidimensional. Para ambos os testes, a maior parte da variância confiável veio de um fator motor geral (fator-M), portanto, a pontuação e o relato dos escores das subescalas não se justificaram para ambos os testes.

Development of the clinical assessment scale in autoimmune encephalitis.

OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). INTERPRETATION: CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.

Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment.

BACKGROUND: Cognitive sequelae frequently follow subarachnoid hemorrhage (SAH) and include deficits across multiple domains of executive function. This factor affects overall functional outcomes negatively, especially in younger patients. Several clinical correlates predict development and severity of cognitive dysfunction after SAH. Hypothetical mechanisms of cognitive dysfunction in the absence of radiographic lesion include cerebral hypoperfusion and blood breakdown products, resulting in perturbed interneuronal communication and network synchrony, excitotoxicity, and altered microRNA expression. METHODS: The PubMed database was searched for articles discussing cognitive outcomes in patients with unruptured and ruptured intracranial aneurysmal disease, sequelae of treatment, and modalities for neuropsychologic testing. RESULTS: Treatment of unruptured intracranial aneurysms, although capable of preventing SAH, comes with its own set of complications and may also affect cognitive function. Neuropsychological tests such as the Montreal Cognitive Assessment, Mini-Mental Status Examination, and others have proved useful in evaluating cognitive decline. Studies using functional neurologic imaging modalities have identified regions with altered activation patterns during various cognitive tasks. The sum of research efforts in this field has provided useful insights and an initial understanding of cognitive dysfunction after aneurysm treatment and SAH that should prove useful in guiding and rendering future investigations more fruitful. CONCLUSIONS: Development of finer and more sensitive neuropsychological tests in evaluating the different domains of cognitive function after aneurysm treatment and SAH in general will be useful in accurately determining outcomes after ictus and comparing efficacy of different therapeutic strategies.

Brain activation in teenagers with isolated spelling disorder during tasks involving spelling assessment and comparison of pseudowords. fMRI study.

METHODS: The present study aimed at defining the specific traits of brain activation in teenagers with isolated spelling disorder in comparison with good spellers. fMRI examination was performed where the subject's task involved taking a decision 1/whether the visually presented words were spelled correctly or not (the orthographic decision task), and 2/whether the two presented letters strings (pseudowords) were identical or not (the visual decision task). Half of the displays showing meaningful words with an orthographic difficulty contained pairs with both words spelled correctly, and half of them contained one misspelled word. Half of the pseudowords were identical, half of them were not. The participants of the study included 15 individuals with isolated spelling disorder and 14 good spellers, aged 13-15. RESULTS: The results demonstrated that the essential differences in brain activation between teenagers with isolated spelling disorder and good spellers were found in the left inferior frontal gyrus, left medial frontal gyrus and right cerebellum posterior lobe, i.e. structures important for language processes, working memory and automaticity of behaviour. CONCLUSION: Spelling disorder is not only an effect of language dysfunction, it could be a symptom of difficulties in learning and automaticity of motor and visual shapes of written words, rapid information processing as well as automating use of orthographic lexicon.

A motor speech assessment for children with severe speech disorders: reliability and validity evidence.

PURPOSE: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). METHOD: Participants were 81 children between 36 and 79 months of age who were referred to the Mayo Clinic for diagnosis of speech sound disorders. Children were given the DEMSS and a standard speech and language test battery as part of routine evaluations. Subsequently, intrajudge, interjudge, and test-retest reliability were evaluated for a subset of participants. Construct validity was explored for all 81 participants through the use of agglomerative cluster analysis, sensitivity measures, and likelihood ratios. RESULTS: The mean percentage of agreement for 171 judgments was 89% for test-retest reliability, 89% for intrajudge reliability, and 91% for interjudge reliability. Agglomerative hierarchical cluster analysis showed that total DEMSS scores largely differentiated clusters of children with CAS vs. mild CAS vs. other speech disorders. Positive and negative likelihood ratios and measures of sensitivity and specificity suggested that the DEMSS does not overdiagnose CAS but sometimes fails to identify children with CAS. CONCLUSIONS: The value of the DEMSS in differential diagnosis of severe speech impairments was supported on the basis of evidence of reliability and validity.

Auditory pathways and processes: implications for neuropsychological assessment and diagnosis of children and adolescents.

Neuroscience research on auditory processing pathways and their behavioral and electrophysiological correlates has taken place largely outside the field of clinical neuropsychology. Deviations and disruptions in auditory pathways in children and adolescents result in a well-documented range of developmental and learning impairments frequently referred for neuropsychological evaluation. This review is an introduction to research from the last decade. It describes auditory cortical and subcortical pathways and processes and relates recent research to specific conditions and questions neuropsychologists commonly encounter. Auditory processing disorders' comorbidity with ADHD and language-based disorders and research addressing the challenges of assessment and differential diagnosis are discussed.

fMRI assessment of language lateralization: an objective approach.

Language lateralization based on functional magnetic resonance imaging (fMRI) is often used in clinical neurological settings. Currently, interpretation of the distribution, pattern and extent of language activation can be heavily dependent on the chosen statistical threshold. The aim of the present study was to 1) test the robustness of adaptive thresholding of fMRI data to yield a fixed number of active voxels, and to 2) develop a largely threshold-independent method of assessing when individual patients have statistically atypical language lateralization. Simulated data and real fMRI data in 34 healthy controls and 4 selected epilepsy patients performing a verbal fluency language fMRI task were used. Dependence of laterality on the thresholding method is demonstrated for simulated and real data. Simulated data were used to test the hypothesis that thresholding based upon a fixed number of active voxels would yield a laterality index that was more stable across a range of signal strengths (study power) compared to thresholding at a fixed p value. This stability allowed development of a method comparing an individual to a group of controls across a wide range of thresholds, providing a robust indication of atypical lateralization that is more objective than conventional methods. Thirty healthy controls were used as normative data for the threshold-independent method, and the remaining subjects were used as illustrative examples. The method could also be used more generally to assess relative regional distribution of activity in other neuroimaging paradigms (for example, one could apply it to the assessment of lateralization of activation in a memory task, or to the assessment of anterior-posterior distribution rather than laterality).

Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).

BACKGROUND AND AIMS: Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting. METHODS: Sixty severely demented patients (MMSE /=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected. RESULTS: Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients. CONCLUSIONS: The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.

[Event-related potentials - an objective tool for assessment of the speech understanding process. II. Syntactic potentials (ELAN, P600)].

Investigations into electrophysiological potentials reflecting the process of grammatical analysis of the speech structure revealed a positive wave with the latency of 600 ms and maximum amplitude within the parietal region (P 600 wave). Presumably, this wave can reflect some consciously controlled processes of re-analysis and correction of grammatical and syntactic inconsistencies. It can be used for the diagnosis of speech disorders.

[Event related potentials--an objective tool for the assessment of the speech understanding process. I. Semantic potential N400].

Auditory evoked potentials represent a specific "bioelectrical" reaction of the brain structures to a certain stimulus. N400 potential is recorded in response to the speech stimuli, its amplitude being inversely related to the correspondence of the word to the preceding text. The amplitude of the N400 wave is inversely related to a semantic similarity of a key word and a critical word. N400 potential is considered to reflect the process accompanying the decoding of a word, such as lexical analysis. It represents an objective tool providing the insight into the process accompanying speech understanding. It is of great clinical value as a diagnostic test for various language disorders [4].

Longitudinal assessment of language and memory impairments in pathologically confirmed cortico-basal ganglionic degeneration.

We report a longitudinal case study (patient EP) of histologically confirmed cortico-basal ganglionic degeneration (CBD) who presented with non-fluent progressive aphasia (NFPA). While NFPA has been documented in clinical descriptions of other reports of CBD, details are often limited and the majority of studies are cross-sectional in nature. The present study conducted detailed longitudinal assessment with EP over a period of two years that revealed substantial impairments of episodic memory, semantic memory, naming and particular aspects of reading and spelling. Our investigations identify key features of EP's pattern of impairment that warrant further examination with other cases of CBD. In particular, testing of EP's nonword reading and spelling found that both were impaired and declined over time. In addition, verbal recognition deteriorated faster than non-verbal recognition through the course of the disease. Our review of the literature suggests that poor nonword reading and spelling may be consistent features of CBD, but more studies are needed to confirm this suggestion, and to determine whether they warrant inclusion in profiling CBD.

Long-term cognitive functional limitations post stroke: objective assessment compared with self-evaluations and spouse reports.

This study was part of a Swedish interdisciplinary research project targeting accessibility problems in public transport for people with cognitive functional limitations (CFLs). The objective was to describe and compare different assessment perspectives of long-term CFLs among community citizens having had CFLs in the acute stroke phase but with moderate physical limitations. Eighty-four participants in ordinary housing 18-36 months post stroke, initially sampled from a national quality stroke register, received data collection home-visits. The Cognistat screening instrument was used for an objective assessment, and a study-specific questionnaire for self-evaluations of CFLs. A revised form of the latter questionnaire was used for reports from spouses of a subset of 30 participants. The agreement between self-evaluated CFLs and spouse reports was analysed by percentage agreement and Cohen's kappa, whereas differences in ratings were tested by McNemar's test, as were differences between objective and self-evaluated/spouse-reported occurrence of CFLs. Regardless of the different perspectives applied, CFLs were frequent. In absence of significant difference in ratings, the percentage agreement between self-evaluations and spouse reports was good or very good, whereas kappa values were less encouraging. Overall, participants and spouses expressed more CFLs, as compared with the screening. Most consistency was demonstrated for the area of calculation. When researchers and clinicians solely rely on cognitive screenings in their investigations, there is a considerable risk for underestimations of CFLs.

Cognitive and motor assessment in autopsy-proven corticobasal degeneration.

OBJECTIVE: To investigate the clinical features of autopsy-proven corticobasal degeneration (CBD). METHODS: We evaluated symptoms, signs, and neuropsychological deficits longitudinally in 15 patients with autopsy-proven CBD and related these observations directly to the neuroanatomic distribution of disease. RESULTS: At presentation, a specific pattern of cognitive impairment was evident, whereas an extrapyramidal motor abnormality was present in less than half of the patients. Follow-up examination revealed persistent impairment of apraxia and executive functioning, worsening language performance, and preserved memory. The motor disorder emerged and worsened as the condition progressed. Statistical analysis associated cognitive deficits with tau-immunoreactive pathology that is significantly more prominent in frontal and parietal cortices and the basal ganglia than temporal neocortex and the hippocampus. CONCLUSION: The clinical diagnosis of corticobasal degeneration should depend on a specific pattern of impaired cognition as well as an extrapyramidal motor disorder, reflecting the neuroanatomic distribution of disease in frontal and parietal cortices and the basal ganglia.

Use of a parent questionnaire in emergent and early literacy assessment of preschool children.

PURPOSE: The purpose of this project was to evaluate the use of a parent questionnaire in the assessment of emergent and early literacy skills of preschool children with language impairments (LI) and their typically developing (TD) peers to determine the relationship between parent report and more formal measures of early literacy, as well as to compare home literacy practices of these two groups of children. METHOD: Preschool children with LI (n = 17) were referred by area school district speech-language pathologists, and age-matched peers (n = 20) were recruited from local preschools. Examiner-administered measures of early literacy included assessment of rhyme, knowledge of environmental print, knowledge of print conventions, and letter-name and letter-sound knowledge, as well as analyses of narrative abilities. The parent questionnaire included 31 closed questions with responses chosen on a 5-point scale that addressed a number of domains of knowledge: phonological awareness, response to print in the environment, alphabet knowledge, interactions around books, writing, orientation to literacy, and parent practices, in addition to a number of open-ended questions. RESULTS: Results revealed a strong relationship between examiner-administered measures of early literacy and parent report for the children with LI only. Parents of children with LI rated their children more poorly across domains of literacy knowledge than did parents of the comparison group. Finally, a comparison of home literacy practices found differences between the groups in time spent watching television, age parents began reading to the child, and number of books owned by the child. CLINICAL IMPLICATIONS: Findings support the use of parent report as a tool in the assessment of emergent and early literacy knowledge and skills for children with LI.

Validation of a Developmental Neuropsychological Assessment (NEPSY) through comparison of neurological, scholastic concerns, and control groups.

Validity of the standard, 13 subtest A Developmental Neuropsychological Assessment (NEPSY) was investigated by comparing scores for 30 children with neurological conditions, 35 children with scholastic concerns, and 39 controls. Overall differences were found among the groups with and without controlling for IQ (Lambda = .60, Lambda = .001; Lambda = .70, P < .001). Four of five NEPSY domain scores differed among the three groups. Language and Sensorimotor domain score differences were found even when IQ was controlled, and group status accounted for substantial variance in these domain scores. Regarding specific tasks, Phonological Processing and Fingertip Tapping were among the subtests that varied the most between groups, especially when children with scholastic concerns were compared with controls. Findings offer preliminary support for the validity of several NEPSY indexes.

Towards assessment of prosodic abilities in Swedish children with language impairment.

Swedish children with language impairment (LI) have prosodic problems at word and phrase level, possibly also at discourse level. The aim of this study was to investigate the reliability and validity of a newly developed comprehensive procedure to capture prosody at word level (e.g., tonal word accent), phrase level (e.g., copula) and discourse level (e.g., conversation) in Swedish children with LI. Twenty-nine children with LI participated in the study. The reliability of the total score of the procedure was found to be sufficiently high, as was inter-examiner agreement. The total score significantly correlated with language comprehension and grammatical abilities. Prosodic problems were found by perceptual assessment in one third of the children. t test for equality of variances for presence versus absence of prosodic problems showed that these two groups significantly differed in total score of the procedure. This indicates that the procedure is a valid measure of prosodic problems.

Applying Luria's diagnostic principles in the neuropsychological assessment of children.

The first part of this article examines the theoretical justification for applying Luria's approach in the assessment of children. It is concluded that Luria's concepts of functional systems and the principle of specifying primary and secondary deficits may be applied to children. However, the selection of functional components to assess should be based on traditions of child neuropsychology rather than on Luria's assessment of adults. In addition, the tendency for comorbid disorders, mechanisms of neural adaptation to damage, and the prevalent types of brain abnormality in children render brain-behavior relationships more complex in children than in adults. The second part of the article describes how Luria's methods were adapted for use with children. An assessment, NEPSY, was developed by integrating Luria's views with contemporary child neuropsychological traditions. The NEPSY includes 27 homogeneous and psychometrically developed subtests, standardized in the United States and Finland for the age range of 3 to 12 years. The rationale of analyzing disorders of cognitive processes through a comprehensive and systematic assessment of their components, characteristic of Luria's approach, was preserved, but more specific principles of diagnosis were modified. Research findings obtained with a previously published, Finnish NEPSY version are presented.

ERP assessment of visual and auditory language processing in schizophrenia.

Language disturbance in schizophrenia has been recently attributed to disturbed priming mechanisms. In the present study, event-related potentials (ERPs), were recorded to final words in sentences presented to 13 chronic patients with schizophrenia and 12 normal controls. Half of the final words fit a sentence context and another half did not. The N400 (the ERP sensitive to language) latency was prolonged, and its amplitude was more negative to both correct and incorrect sentence endings in the group with schizophrenia relative to the group of normal controls. The early ERP components, N100 and P200, were similar in both groups. These results suggest that language abnormalities in schizophrenia are related to a dysfunction in the language system and not to a general cognitive dysfunction, and may be related to poor use of context in patients with schizophrenia.

A protocol for oral myofunctional assessment: for application with children.

The purpose of this research was to compare oral myofunctional disorder characteristics in subjects with tongue thrust and in subjects with no such disorder, and to suggest a protocol for oral myofunctional assessment, involving the most relevant characteristics for this diagnosis. The present study used 36 subjects with various disorders enrolled in the Speech-Language Pathology Department of Health Center "Escola Professor Samuel Barnsley Pessoa". Results showed that the main characteristics differentiating subjects with oral myofunctional disorders from those without it and, therefore important diagnostic considerations, are: hole in the feeding-bottle, nipple used in the feeding-bottle, breathing deviations, lips rest posture (information obtained from a person responsible for the subject), lips and tongue resting posture (information obtained from assessment), lip tonus, hard palate, swallow, breathing and occlusion.