Word Memory Test Predicts Recovery in Claimants With Work-Related Head Injury.

OBJECTIVE: To investigate the predictive validity of the Word Memory Test (WMT), a verbal memory neuropsychological test developed as a performance validity measure to assess memory, effort, and performance consistency. DESIGN: Cohort study with 1-year follow-up. SETTING: Workers' compensation rehabilitation facility. PARTICIPANTS: Participants included workers' compensation claimants with work-related head injury (N=188; mean age, 44y; 161 men [85.6%]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures for determining predictive validity included days to suspension of wage replacement benefits during the 1-year follow-up and work status at discharge in claimants undergoing rehabilitation. Analysis included multivariable Cox and logistic regression. RESULTS: Better WMT performance was significantly but weakly correlated with younger age (r=-.30), documented brain abnormality (r=.28), and loss of consciousness at the time of injury (r=.25). Claimants with documented brain abnormalities on diagnostic imaging scans performed better (∼9%) on the WMT than those without brain abnormalities. The WMT predicted days receiving benefits (adjusted hazard ratio, 1.13; 95% confidence interval, 1.04-1.24) and work status outcome at program discharge (adjusted odds ratio, 1.62; 95% confidence interval, 1.13-2.34). CONCLUSIONS: Our results provide evidence for the predictive validity of the WMT in workers' compensation claimants. Younger claimants and those with more severe brain injuries performed better on the WMT. It may be that financial incentives or other factors related to the compensation claim affected the performance.

Implicit and explicit processing in deep dyslexia: Semantic blocking as a test for failure of inhibition in the phonological output lexicon.

The failure of inhibition hypothesis posits a theoretical distinction between implicit and explicit access in deep dyslexia. Specifically, the effects of failure of inhibition are assumed only in conditions that have an explicit selection requirement in the context of production (i.e., aloud reading). In contrast, the failure of inhibition hypothesis proposes that implicit processing and explicit access to semantic information without production demands are intact in deep dyslexia. Evidence for intact implicit and explicit access requires that performance in deep dyslexia parallels that observed in neurologically intact participants on tasks based on implicit and explicit processes. In other words, deep dyslexics should produce normal effects in conditions with implicit task demands (i.e., lexical decision) and on tasks based on explicit access without production (i.e., forced choice semantic decisions) because failure of inhibition does not impact the availability of lexical information, only explicit retrieval in the context of production. This research examined the distinction between implicit and explicit processes in deep dyslexia using semantic blocking in lexical decision and forced choice semantic decisions as a test for the failure of inhibition hypothesis. The results of the semantic blocking paradigm support the distinction between implicit and explicit processing and provide evidence for failure of inhibition as an explanation for semantic errors in deep dyslexia.

Semantic ambiguity and the failure of inhibition hypothesis as an explanation for reading errors in deep dyslexia.

We report evidence for dissociation between explicit and implicit access to word representations in a deep dyslexic patient (JO). JO read aloud a series of ambiguous (e.g., bank) and unambiguous (e.g., food) words and performed a lexical decision task using these same items. When required to explicitly access the items (i.e., naming), JO showed relative impairment for ambiguous compared with unambiguous words. In contrast, the same stimuli produced an advantage for ambiguous words in lexical decision. The results are discussed within a framework of deep dyslexia that considers errors in production to arise through a failure to inhibit spuriously activated candidate representations.

Speculation about behavior, brain damage, and self-organization: the other way to herd a cat.

This article contrasts aphasic patients' performance of word naming and lexical decision with that of intact college-aged readers. We discuss this contrast within a framework of self-organization; word recognition by aphasic patients is destabilized relative to intact performance. Less stable performance shows itself as an increase in the dispersion of patients' response times compared to college students'. Dispersion is also more pronounced for low-frequency words than for high frequency words. We speculate, that increased dispersion originates in a reduction of constraints that support naming and lexical decision performances. A sufficient reduction of constraints yields qualitative changes in performance such as the production of semantic errors in deep dyslexia. These hypotheses are offered as alternatives to postulating distinct modules.

A diffusion model account of normal and impaired readers.

Acquired aphasics and dyslexics with even very profound word reading impairments have been shown to perform relatively well on the lexical decision task, but direct contrasts with unimpaired participant's data is often complicated by extremely long reaction times for patient data. The dissociation between lexical decision and word naming performance shown by these patients is of theoretical importance, and here we present an analysis of processing underlying the lexical decision task. We are able to determine what aspects of performance are affected by acquired aphasics in the lexical decision task. We fit lexical decision data from aphasic patients and from normal readers with a sequential sampling model (the diffusion model) that simultaneously considers reaction time and accuracy. This model provides a powerful means of assessing processes involved in impaired and unimpaired lexical decision. Our results suggest that lexical decision may tap impairments at both a linguistic and a nonlinguistic level. These impairments combine to make patients produce the exaggerated lexical decision reaction times typical of neurolinguistic patients: we demonstrate that patients have compromised decision and nondecision processes but that the quality of the information upon which they base their decisions is not much different from that of unimpaired participants.

Deep dyslexia and semantic errors: a test of the failure of inhibition hypothesis using a semantic blocking paradigm.

Deep dyslexia is an acquired reading disorder that involves the production of semantic errors and the inability to read aloud nonwords successfully. Several explanations for this reading impairment posit multiple loci of damage to account for the various error types produced in deep dyslexia. In contrast, the failure of inhibition hypothesis suggests that damage in the phonological output lexicon alone can explain these errors. Specifically, this hypothesis proposes normal processing via orthographic and phonological reading routes, as well as an intact semantic system. However, slowed or reduced inhibitory connections result in the failure to suppress spuriously activated neighbours in the phonological output lexicon, where neighbourhood can be defined in terms of phonology, orthography, or semantics. Given a failure to inhibit semantically related candidates, semantic reading errors occur. Important to the test of this hypothesis is that it evolves several predictions that are contrary to performance observed in the normal population. In particular, semantic errors are predicted to be greater in conditions where words are blocked according to semantic category than in random presentations. In addition, a semantic interference effect is expected. The results of semantic blocking were consistent with these predictions and lend support to the failure of inhibition hypothesis.

Word associations in deep dyslexia.

Deep dyslexia is an acquired reading disorder resulting in the production of semantic errors during oral reading and an inability to read aloud nonwords. Several researchers have postulated that patients with deep dyslexia have both phonological and semantic access impairments but the data supporting these claims are not convincing. In fact, the hallmark feature of deep dyslexia--the semantic errors--strongly implies that these patients can access semantic information from printed words. We test the integrity of the semantic system in two such patients through auditory and visual word association tasks. The data support the notion that semantics remains intact and that the disorder and associated errors arise through a selection impairment related to failure of inhibitory connections in the phonological lexicon.