Virtual navigation for memory rehabilitation in a traumatic brain injured patient.

The use of 3D video games in memory rehabilitation has been explored very little. A virtual navigation task allows participants to encode the spatial layout of the virtual environment and activate areas involved in memory processing. We describe the rehabilitation of a 24-year-old man with traumatic brain injury presenting memory deficits, and evaluate the efficacy of a navigational training program measuring neuropsychological changes and fMRI modification cerebral activations. Memory improvement appears to be present both after navigational training and in follow-up testing. Furthermore, fMRI data suggest that this training may increase activation of the hippocampal and parahippocampal brain regions. The results suggest that intensive training in virtual navigational tasks may result in an enhancement of memory function in brain-damaged adults.

Do executive function and theory of mind predict pragmatic abilities following traumatic brain injury? An analysis of sincere, deceitful and ironic communicative acts.

Quality of life and social integration are strongly influenced by the ability to communicate and previous research has shown that pragmatic ability can be specifically impaired in individuals with traumatic brain injury (TBI). In addition, TBI usually results in damage to the frontotemporal lobes with a consequent impairment of cognitive functions, i.e., attention, memory, executive function (EF) and theory of mind (ToM). The role of the underlying cognitive deficits in determining the communicative-pragmatic difficulties of an individual with TBI is not yet completely clear. This study examined the relationship between the ability to understand and produce various kinds of communicative acts, (i.e., sincere, deceitful and ironic) and the above-mentioned cognitive and ToM abilities following TBI. Thirty-five individuals with TBI and thirty-five healthy controls were given tasks assessing their ability to comprehend and produce sincere, deceitful and ironic communicative acts belonging to the linguistic and extralinguistic scales of the Assessment Battery for Communication (ABaCo), together with a series of EF and ToM tasks. The results showed that, when compared to healthy individuals, participants with TBI performed poorly overall in the comprehension and production of all the pragmatic phenomena investigated, (i.e., sincere, deceitful and ironic communicative acts), and they also exhibited impaired performance at the level of all the cognitive functions examined. Individuals with TBI also showed a decreasing trend in performance in dealing with sincere, deceitful and ironic communicative acts, on both the comprehension and production subscales of the linguistic and extralinguistic scales. Furthermore, a hierarchical regression analysis revealed that - in patients with TBI but not in the controls - EF had a significant effect on the comprehension of linguistic and extralinguistic irony only, while the percentage of explained variance increased with the inclusion of theory of mind. Indeed, ToM had a significant role in determining patients' performance in the extralinguistic production of sincere and deceitful communicative acts, linguistic and extralinguistic comprehension of deceit and the linguistic production of irony. However, with regard to the performance of patients with TBI in the various pragmatic tasks investigated, (i.e., sincere, deceitful and ironic communicative acts), EF was able to explain the pattern of patients' scores in the linguistic and extralinguistic comprehension but not in production ability. Furthermore, ToM seemed not to be able to explain the decreasing trend in the performance of patients in managing the various kinds of communicative acts investigated.

Improvement of Communication Skills after Traumatic Brain Injury: The Efficacy of the Cognitive Pragmatic Treatment Program using the Communicative Activities of Daily Living.

OBJECTIVE: The pragmatic impairment often characterizing individuals after a traumatic brain injury (TBI) significantly limits their independence, preventing social participation. Rehabilitation programs aim to improve the impaired capacities to help participants communicate effectively, increasing their self-perceived life quality. The aim of this study was to verify the effectiveness of the Cognitive Pragmatic Treatment (CPT) in improving communication abilities after TBI, thus enabling better management of communication activities in daily living. METHOD: Nineteen individuals with TBI in a post-acute phase completed the CPT, a group-based training program designed to improve pragmatic abilities. Pre- and post-training, participants were administered the Communication Activities of Daily Living (CADL-2), and the equivalent forms of the Assessment Battery for Communication (ABaCo). RESULTS: Comparison of pre- and post-training performance showed an overall improvement in pragmatic abilities. Post-training, participants scored higher in communication skills on both the CADL-2 and ABaCo, with such scores remaining constant at a 3-month follow-up assessment. CONCLUSIONS: This study showed that the CPT was effective in improving the participants' communicative abilities. The possibility that the benefits of the CPT may generalize to everyday communicative interactions is discussed.

Subtle cerebral damage after shunting vs non shunting during carotid endarterectomy.

OBJECTIVE: To compare the extent of subtle cerebral damage (SCD) in patients undergoing carotid endarterectomy with or without shunt placement. DESIGN: Prospective, randomised study. PATIENTS AND METHODS: We assessed a consecutive series of 96 patients undergoing endarterectomy for severe unilateral left carotid stenosis who had been randomly assigned to receive a shunt (48) or not (48). Eligibility criteria included age up to 80 years and Mini-Mental State Examination score >24 points. Patients underwent neuropsychological testing before surgery. Serum concentrations of S100 protein, neuron-specific enolase (NSE) and interleukin-6 (IL-6) were measured intraoperatively before and after carotid clamping. Finally, each patient underwent neuropsychological testing 3 weeks after surgery. RESULTS: Patients with and without shunt had similar serum concentrations of S100 protein, NSE and IL-6 as well as similar neuropsychological test scores, all p>0.05. CONCLUSIONS: There was no difference in subtle cerebral damage between patients randomized to receive a shunt or not.

Neuropragmatics: neuropsychological constraints on formal theories of dialogue.

We are interested in the validation of a cognitive theory of human communication, grounded in a speech acts perspective. The theory we refer to is outlined, and a number of predictions are drawn from it. We report a series of protocols administered to 13 brain-injured subjects and to a comparable control group. The tasks included direct and indirect speech acts, irony, deceits, failures of communication, and theory of mind inferences. All the predicted trends of difficulty are consistently verified; in particular, difficulty increases form direct/indirect speech acts to irony, from irony to deceits, and from deceits to failure recovery. This trend symmetrically shows both in the successful situation and in the failure situation. Further, failure situations prove more difficult to handle than the relevant successful situation. In sharp contrast with previous literature, there is no difference between the subjects' comprehension of direct and indirect speech acts. The results are discussed in the light of our theoretical approach.

Communicative impairment in traumatic brain injury: a complete pragmatic assessment.

The aim of the present study was to examine the communicative abilities of traumatic brain injury patients (TBI). We wish to provide a complete assessment of their communicative ability/disability using a new experimental protocol, the Assessment Battery of Communication, (ABaCo) comprising five scales--linguistic, extralinguistic, paralinguistic, context and conversational--which investigate all the main pragmatic elements involved in a communicative exchange. The ABaCo was administered to 21 TBI subjects and to a control group. The results showed that performance by TBI patients was worse than that of controls on all scales; moreover they showed a trend of increasing difficulty in understanding and producing different pragmatic phenomena, i.e., standard communication acts, deceits and ironies, whether such phenomena are expressed through the linguistic or extralinguistic modality.

Evidence from aphasia for the role of proper names as pure referring expressions.

Here we describe a patient who, as a result of brain damage, had a dramatic inability to retrieve proper names, and who thus offered the opportunity of observing the distinction made in the brain between proper and common names. Although category specific aphasic disturbances are relatively common, this patient's anomia for proper names is very rare: only two other cases have been described so far. The opposite phenomenon, a selective sparing of proper names, has also been recently observed. It is widely assumed that double dissociations such as this reflect the premorbid organization of the cognitive system: the categories of proper and common nouns, therefore, would be separately represented or, at least, separately accessed in the intact brain. The only other such deficits, including the inability to learn arbitrary links between words and to guess the titles of pieces of music, are believed to be indicative of a problem in dealing with purely referential relations. This, in turn, would indirectly confirm the role of proper names as pure referring expressions.

Right hemisphere patients' judgements on emotions.

A triadic comparison technique was used to assess brain-damaged patients' ability to judge the relatedness of a number of emotions, using either a pictorial or verbal material. Emotionally neutral material served as a control. Right hemisphere patients also differed from normals in processing emotions when presented with verbal material. It is suggested that central rather than only peripheral aspects in recognition of emotions are disturbed after injury to the right hemisphere.

Discrimination and identification of emotions in human voice by brain-damaged subjects.

Discrimination and identification of emotions in human voice was studied in normal controls and in 4 groups of brain-damaged subjects, subdivided along the right/left and anterior/posterior dimensions. Results showed a failure of right-brain-damaged patients, the right posterior group being significantly worse than all the other groups. Qualitative differences emerged as well: both a conceptual and an acoustic deficit seem to contribute to right posterior patient performance.