A systematic review of tests to predict cerebral palsy in young children

Aim

This systematic review evaluates the accuracy of predictive assessments and investigations used to assist in the diagnosis of cerebral palsy (CP) in preschool‐age children (<5y).

Method

Six databases were searched for studies that included a diagnosis of CP validated after 2 years of age. The validity of the studies meeting the criteria was evaluated using the Standards for Reporting Diagnostic Accuracy criteria. Where possible, results were pooled and a meta‐analysis was undertaken.

Results

Nineteen out of 351 studies met the full inclusion criteria, including studies of general movements assessment (GMA), cranial ultrasound, brain magnetic resonance imaging (MRI), and neurological examination. All studies assessed high‐risk populations including preterm (gestational range 23–41wks) and low‐birthweight infants (range 500–4350g). Summary estimates of sensitivity and specificity of GMA were 98% (95% confidence interval [CI] 74–100%) and 91% (95% CI 83–93%) respectively; of cranial ultrasound 74% (95% CI 63–83%) and 92% (95% CI 81–96%) respectively; and of neurological examination 88% (95% CI 55–97%) and 87% (95% CI 57–97%) respectively. MRI performed at term corrected age (in preterm infants) appeared to be a strong predictor of CP, with sensitivity ranging in individual studies from 86 to 100% and specificity ranging from 89 to 97% There was inadequate evidence for the use of other predictive tools.

Summary

This review found that the assessment with the best evidence and strength for predictive accuracy is the GMA. MRI has a good predictive value when performed at term‐corrected age. Cranial ultrasound is as specific as MRI and has the advantage of being readily available at the bedside. Studies to date have focused on high‐risk infants. The accuracy of these tests in low‐risk infants remains unclear and requires further research.     

Ultrasound diagnosis of bony nerve entrapment: Case series and literature review

Introduction: Nerve entrapment due to osseous callus formation is a rare complication after bone fracture. Electrodiagnostic studies and routine radiographic imaging often fail to demonstrate the pathology. The diagnosis is difficult and is often made incidentally upon surgical exploration. Nerve ultrasonography has not been used routinely to assess such lesions. Methods: We report 5 cases of nerve entrapment in osseous callus after fractures that occurred in 2011 and 2012. The diagnosis was made by ultrasound (US). We then performed a review of the relevant literature. Conclusions: US is becoming an invaluable tool for diagnosing peripheral nerve entrapments. The current cases suggest that nerve US should be strongly considered as an adjunctive diagnostic tool for nerve palsies developing after trauma. Muscle Nerve 48 : 445–450, 2013     

Production and integrated training of adjectives in three individuals with nonfluent aphasia

Background: Current research in theoretical linguistics, experimental psychology, and clinical aphasiology suggests that adjective training may facilitate unique aspects of language production and functional communication in persons with aphasia. Although considerable research has been devoted to treatments targeting nouns and verbs, there has been relatively little treatment research directed towards adjectives.

Aims: The goal of this study was to further investigate the viability of adjective training in aphasia by applying an integrated treatment approach targeting adjective production in the context of single word, sentence, and discourse levels of communication. Specific objectives were to quantify baseline adjective production, acquisition of target structures, and treatment generalisation effects.

Method: A single-participant multiple-baseline design was used to evaluate treatment effects in three individuals with nonfluent chronic aphasia. A battery of experimental measures and standardised tests was also administered pre- and post-treatment to assess baseline performance and generalisation effects extending to adjectives, other parts of speech, sentence processing, and discourse production.

Outcomes & Results: Two of the three participants acquired the target structures and maintained criterion performance levels 1 month after treatment. In spite of differences in baseline performance and responsiveness to treatment, all three participants demonstrated significant gains on standardised measures of language production.

Conclusions: Findings add to existing literature supporting the viability of adjective training for individuals with aphasia. Participant characteristics and treatment factors that may contribute to variable outcomes are also discussed.     

An experimental analysis of acquisition,generalisation, and maintenance of naming behaviour in a patient with anomia

This paper examines the effects of a cueing hierarchy on naming in a patient with anomic aphasia. Using a single‐subject multiple baseline design across behaviors, the patient was trained to produce single inanimate nouns while generalization was tested to semantically related nouns matched for frequency of occurrence. Results showed successful acquisition and maintenance of trained words, but no generalization to untrained words. These data indicate that generalization does not occur as a natural by‐product of successful treatment and suggest, as pointed out by Baer, Wolf, and Risley (1968 Baer, D. M., Wolf, N. M. and Risley, T. R. 1968. Some current dimensions of applied behavior analysis.. Journal of Applied Behavior Analysis, 1: 91[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), that “generalization should be programmed rather than expected or lamented”.     

Online priming of agent and patient thematic roles and related verbs in younger and older adults

Background: Online priming studies have found that verbs (e.g., arrest) provide immediate access to typical agents (e.g., policeman) and patients (e.g., criminal) by generating expectancies from a verb to its related thematic roles and vice versa. These findings have contributed significantly to theories of thematic roles. However, these investigations and theoretical implications have been limited to young adults. Investigating verb–thematic role processing in older adults is important for understanding the semantic system in normal ageing, which aids in assessment, characterisation, and treatment of disorders that affect semantic processing in older adults.

Aims: The current study investigates verb–thematic role priming in young adults and extends the investigation to older adults. It was predicted that both groups would show priming effects but that the older adult group would have slower reaction times overall.

Methods & Procedures: Using a lexical decision task with a short stimulus onset asynchrony (250 ms), the current study investigated bidirectional agent–verb and patient–verb priming of younger and older adults.

Outcomes & Results: Consistent with our predictions, the younger participants exhibited bidirectional priming for agent–verb pairs and patient–verb pairs in the participant and item analyses. The older adults also showed priming for patient–verb pairs, but unexpectedly they did not exhibit priming for agent–verb pairs. Reaction times for the older participants were slower than the reaction times for the younger participants in all conditions.

Conclusions: Neither participant nor methodological factors readily explain the unexpected results. Theoretical explanations for the findings are explored.     

Cerebrospinal fluid biomarkers in Alzheimer’s disease, vascular dementia and ischemic stroke patients: a critical analysis

Vascular factors are thought to contribute to the development of disease pathology in neurodegenerative dementia such as Alzheimer’s disease (AD). Another entity, called vascular dementia (VaD), comprises a less defined group of dementia patients having various vascular diseases that especially emerge in the elderly population and require valid options for examination and differential diagnosis. In the context of a retrospective study, we analyzed the cerebrospinal fluid (CSF) biomarkers t-tau, p-tau and Aß42 of a total of 131 patients with AD (n = 47), mild cognitive impairment (MCI) (n = 22), VaD (n = 44) and stroke (n = 18). We found a remarkable alteration in CSF biomarker profile in AD, VaD and in acute ischemic events. CSF profile in AD patients was altered in a very similar way as in stroke patients, without statistical differences. In stroke, increase depend largely on size and duration after the initial event. Total tau levels were useful to differ between VaD and stroke. Aß42 decreased in a similar way in AD, VaD and stroke and had a trend to lower levels in MCI but not in controls.     

Inhibition and executive functioning in Type A and ADHD boys

The present study was aimed at clarifying the standing of Type A behavior, as measured by behavioral observations, relative to Attention Deficit Hyperactivity Disorder (ADHD), using measures of inhibitory control and executive functioning. The study sample included 20 boys exhibiting Type A behavior, 21 boys exhibiting Type B behavior and 14 boys diagnosed with ADHD, ranging in age from 7 to 12 years. The results of the present study showed that the Type A children differed from Type B children on two time-related variables, response latency and reaction time, in accordance with the view of Type As as time-urgent and impatient. Furthermore, in comparisons with the ADHD group, the Type A boys were found to be superior on several performance tasks, such as Go/no-go omissions, time reproduction, story recall and memory for sequences of hand movements, although similarities between Type A and ADHD boys were evidenced in terms of response latency and reaction time. In other words, although Type A boys were similar to ADHD boys in terms of overt displays of time-urgency and impatience, Type As do not display deficits with regard to executive functioning, of the kind often found when ADHD children are compared with normal controls. It may thereby be concluded that Type A behavior and hyperactivity/ADHD appear to be well differentiated except with regard to what may be interpreted as impatience. Speculations concerning differing origins of overtly similar characteristics of Type A behavior and ADHD should be considered in future research.     

Oropharyngeal dysphagia may occur in late-onset Pompe disease,implicating bulbar muscle involvement

Late-onset Pompe disease (presenting after 12 months of age) often presents with limb-girdle and respiratory weakness, but oropharyngeal dysphagia has not been reported previously. A retrospective review of all late-onset Pompe disease patients evaluated in the neuromuscular clinic at Duke University Medical Center from 1999–2010 was performed. Twelve patients were identified and 3 had symptoms of oropharyngeal dysphagia. The medical record was reviewed, including the results of electromyography, videofluroscopic swallow examinations, and motor speech examination including instrumental assessment of lingual force with the Iowa Oral Performance Instrument. Oropharyngeal dysphagia was mild in two cases and severe in one. One of the two patients with mild severity demonstrated oral stage swallow signs; in the other, residual material was observed in the area of the cervical esophagus. In the patient with severe oropharyngeal dysphagia, both the oral and pharyngeal stages of swallowing were affected with penetration and aspiration documented. The degree of swallowing impairment appeared to correlate with overall physical strength and function. Oropharyngeal dysphagia may occur in patients with late-onset Pompe disease, implicating bulbar muscle involvement. Screening for symptoms of dysphagia may help reduce morbidity and mortality, while improving understanding of the late-onset Pompe disease phenotype. Further studies, including examination of the relationship between lingual weakness and oropharyngeal dysphagia, are warranted.