Thought disorder in atypical schizophrenia-like psychosis after stroke: analysis of clinical cases

Formal thought disorder refers to disorganized thinking and it represents a hallmark of schizophrenia and psychosis. Psychosis is a rare complication after stroke.

We described two cases of female patients, who developed an atypical schizophrenia-like psychosis post-stroke, characterized by formal thought disorder, hallucinations, and delusion. Cerebrovascular disease affected the right temporal lobe, areas devoted to modulation of higher order cognitive processes.

To date, the relation between stroke and psychosis remain unclear, maybe due to the involvement of a complex brain networks. However, the high impact of this disorder on physical, psychological and social wellbeing suggests the importance of improving specific treatments.     

A technical concept of a computer game for patients with Parkinson's disease – a new form of PC-based physiotherapy

Background: At present, there are no meaningful and sophisticated computer games that simultaneously allow the treatment of movement disorders such as Parkinson's syndrome. In particular, there are no systems to consider the severity of the disease and the physical skills of the patient.

Methods: A computer game using the Microsoft Kinect as markerless sensor for the 3?D recognition of the patient’s movement was developed to support the rehabilitation. The scenario of a basketball game was created after determining that the movement like throwing a ball and the correct posture of the body are important. A study based on system usability was performed with 15 patients to evaluate the system.

Results: The technical feasibility of a computer-assisted training system for supporting patients with Parkinson‘s disease has been demonstrated. No markers on the patient are required for movement detection and allow a user-friendly handling. Regarding the usability study, the patients were accepting of such a system and its at-home use and symptoms like ‘freezing’ and the Pisa syndrome can be treated.

Conclusions: The physiotherapist can be assisted by the developed rehabilitation system. An objective measurement of the patient’s training progress delivers valuable information to adjust the training sessions for every patient individually. Due to its modular character, the system can also be applied to other diseases or sports injuries and offers the basis for further development.     

Differences in Developmental Concerns of Young Children with Autism Spectrum Disorder Across Racial/Ethnic Groups

Purpose: Parents/caregivers of children with autism spectrum disorder (ASD) have varying types of initial concerns regarding their child’s development, which may be culturally bound to parents’ perceptions of their child’s development. This study investigated differences in the types of initial developmental concerns reported by parents or caregivers of different racial/ethnic groups with children in an early intervention program.

Method: This study examined the frequency of endorsement of different types of concerns in African American, Caucasian, and Hispanic families.

Results: No significant differences between racial/ethnic groups were found in the endorsement of concerns related to communication, language/speech, motor, problem behavior, sensory, feeding, prematurity, attention, adaptive functioning, and medical conditions. Racial/ethnic groups differed significantly in their endorsement for social concerns.

Conclusion: Racial/ethnic group differences were confirmed regarding initial developmental concerns related to social behavior, which may be due to cultural beliefs. The implications of these findings on early identification are discussed.     

Facial expression recognition in Alzheimer’s disease: A systematic review

Introduction: It is well established that behavioral variant frontotemporal dementia can impair social and emotional function. However, there is no consensus regarding how Alzheimer’s disease can affect facial expression recognition. We aim to systematically review all the literature addressing this issue over the last 10 years.

Method: We conducted a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for literature was undertaken on 19 September 2017, using Pubmed, SciELO, BIREME, and Thomson Reuters Web of Science electronic databases. The key terms for the search were: Alzheimer’s disease, dementia, and facial expression recognition.

Results: We screened 173 articles, and 22 of them were selected. The most common methodology involved showing participants photographs of people expressing the six basic emotions—fear, anger, sadness, disgust, surprise, and happiness. Results were ambiguous. Among people with mild Alzheimer’s disease, happiness was easier to recognize than the other five basic emotions, with sadness and anger the most difficult to recognize. In addition, the intensity level of the emotions presented seems to be important, and facial expression recognition is related to specific cognitive capacities, including executive function and visuoperceptual abilities. Impairment in facial expression recognition does not appear to be a consistent neuropsychological finding in Alzheimer’s disease.

Conclusions: The lack of standardized assessment instruments and the heterogeneity of the methods and samples used across studies hamper comparisons. Future researches should investigate facial expression recognition through more ecological and standardized methods.     

“I don’t know”: a usage-based approach to familiar collocations in non-fluent aphasia

Background: Familiar collocations (e.g., “it’s alright”) are an important part of everyday conversation. Such word combinations are often retained in speakers with Broca’s aphasia. However, only few investigations have studied the forms and functions of familiar collocations available to speakers with Broca’s aphasia.

Aims: We first apply a frequency-based perspective to word combinations produced by speakers with Broca’s aphasia and their conversation partners (CPs), and compare the frequency characteristics of word combinations in dyadic and non-dyadic speech. Second, we investigate the conversational functions of one prominent familiar collocation, “I don’t know” (IDK).

Methods & Procedures: In the first analysis, speech samples from interactions of nine dyads (each a speaker with Broca’s aphasia and their CP) were examined. Non-dyadic samples were selected from 39 speakers with Broca’s aphasia from AphasiaBank (MacWhinney et al., 2011). The Frequency in Language Analysis Tool (FLAT; Zimmerer & Wibrow, 2015) was used to estimate collocation strength (the degree of association between words in a combination) of well-formed bigrams (two-word combinations) and trigrams (three-word combinations). The second analysis presents a qualitative investigation of uses of IDK in dyadic exchanges.

Outcomes & Results: Analysis 1 revealed that residual trigrams in Broca’s aphasia were more strongly collocated in comparison to language produced by CPs. There was no difference in frequency-based profiles between dyadic and non-dyadic aphasic speech. Analysis 2 indicated that speakers with Broca’s aphasia and CPs used IDK to achieve a variety of communicative functions. However, patterns specific to each participant group were found.

Conclusions: These findings highlight that frequency-based analysis is useful in explaining residual, grammatically well-formed word combinations in Broca’s aphasia. This study provides evidence that IDK can aid turn construction in aphasia.     

Eliciting family concerns and priorities through the Routines-based Interview

Background: Research has demonstrated that having an understanding of families’ everyday routines is important when planning interventions, yet the nature of the information revealed by families about their daily lives has been scarcely documented. The aim of this study was to examine the concerns and priorities of families with a child with a developmental disability elicited through the Routines-based Interview (RBI).

Method: RBIs were conducted by early childhood intervention (ECI) professionals with 16 families with a child aged between 4 months and 5 years. Interviews were audiotaped and transcribed verbatim and analysed using thematic analysis.

Results: Findings revealed that families were concerned about their child’s development and behaviour; made accommodations to everyday routines for their child; and reported priorities for the intervention.

Conclusion: Tools, such as the RBI, are important to generate information that can assist ECI professionals to design interventions that are family-centred, contextualised, and embedded in everyday family life.     

Elementaristic vs. holistic approaches to dissociation of agraphia symptoms following acquired brain damage

Background: Two approaches to the explanation of dissociations of symptoms were established in the history of neuropsychology: through the structural changes and through the changes of activity form. The theoretical origins of these explanations are related to the two methodological traditions in psychology: elementaristic and holistic. In this study, the advantages of the elementaristic and the holistic approach to the explanation of dissociated neuropsychological agraphia symptoms are discussed.

Aims: The goal of our study was to reveal the variability of writing disorders following sensory agraphia depending on performance in writing tasks of different types. We hypothesise that manifestations of psychological disorders in Wernicke’s agraphia vary in different types of writing tasks:

1.1. We expect the dissociated symptoms of Wernicke’s agraphia to vary in tasks that actualise different culturally defined functions of writing;

1.2. Tasks actualising culturally determined functions of writing would lead to specific differences of symptoms in Wernicke’s agraphia compared with the performance on traditional diagnostic tests.

Methods & Procedures: The study involved 29 individuals with Wernicke’s agraphia due to left hemisphere stroke in the basin of the left middle cerebral artery. To identify agraphia symptoms, tasks traditionally applied in neuropsychological diagnostics of writing were used, representing typical cultural-historical functions of writing (communicative, mnestic, and regulatory). Analysis with the Chi-square Friedman test showed that the differences for all types of error rates were statistically significant (p = .001), which allowed the Wilcoxon test for further pairwise comparison ratios of errors in written tasks.

Outcomes & Results: Two approaches to the explanation of dissociations of symptoms have been used – through structural changes (elementaristic approach) and changes of a person’s activity form (holistic approach). The advantages of the holistic approach were the most evident while analysing the significant prevalence of errors in orthography in the regulatory task compared with the task of sentence composition. These tasks did not differ in their structural components, so the elementaristic approach did not explain the resulting dissociation. The explanation of this phenomenon comes from the psychological importance of the cultural function of writing using a permissive psychological strategy.

Conclusions: The holistic approach can be a valuable complement to the more widely utilised elementaristic approach. Despite the fact that a holistic approach is less common in modern clinical neuropsychology, its advantages are evident in the analysis of dissociation symptoms within the same syndrome when performing identical tasks in a set of involved neuropsychological components.     

Childhood trauma affects processing of social interactions in borderline personality disorder: An event-related potential study investigating empathy for pain

Objectives: Patients with borderline personality disorder (BPD) have difficulties in empathising with others and show disturbances in social interactions. Using a ‘Social Interaction Empathy Task’, we found that BPD patients judged neutral and psychologically painful conditions as more painful than healthy subjects. Here, we present the neural correlates underlying these differences in empathy for pain.

Methods: Female BPD patients and healthy controls completed the ‘Social Interaction Empathy Task’ during EEG recording. Event-related potentials (ERP) were analysed for an early anterior component and a late latency positivity. Empathic abilities were assessed using the Interpersonal Reactivity Index and early aversive experiences were measured by the Childhood Trauma Questionnaire (CTQ).

Results: ERPs in the patient group matched the behaviour results and correlated with the level of personal distress and CTQ. In addition, ERPs of patients were predicted by childhood maltreatment and stress.

Conclusions: Taken together, our findings indicate that the observed behavioural differences between patients with BPD and controls might be due to modulatory effects of empathic abilities on the evaluation of pain-related social stimuli, which are supposed to be based on childhood maltreatment.     

Factors affecting rehabilitation and use of upper limb after stroke: views from healthcare professionals and stroke survivors

Background: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb.

Objectives: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke.

Method: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively.

Results: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional–patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional–patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation.

Conclusion: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional–patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.     

Development and feasibility of a sedentary behavior intervention for stroke: a case series

Background and Objective: High levels of sedentary behavior are prevalent among people with stroke and contribute to elevated risk for recurrent stroke. Few interventions reduce sedentary behavior post-stroke. The ABLE intervention aims to reduce sedentary behavior using activity monitoring, activity scheduling, problem-solving, and self-assessment to promote engagement in meaningful daily activities. The purpose of this study was to assess the feasibility (tolerability, acceptability, reliability, safety) of the ABLE intervention after stroke and describe trends in sedentary behavior at baseline and 4 weeks.

Clinical Presentation: Participants (n = 5) who were 6 months to 2 years post-stroke, ambulatory, and reported ≥6 h of daily sitting time.

Intervention: Twelve ABLE intervention sessions (3x/week for 4 weeks) conducted in participants’ homes. The ABLE intervention includes activity monitoring, activity scheduling, self-assessment, and collaborative problem-solving.

Results: All feasibility benchmarks were met for three participants. Two participants met tolerability and safety benchmarks but did not meet acceptability and reliability benchmarks. Variability in feasibility and sedentary behavior outcomes may be related to baseline levels of sedentary behavior and social support.

Conclusions: The ABLE intervention was tolerable and safe. The intervention protocol was refined to enhance reliability and acceptability. Future studies should estimate the effects of the ABLE intervention.     

Effects of stimulus-related variables on mental states recognition in Huntington’s disease

Background: Cognitive abnormalities in Huntington’s Disease (HD) can involve the specific impairment of the social perspective taking as well as difficulties in recognizing others’ mental state many years before the onset of motor symptoms.

Aims: At the scope of assessing how the difficulties in mental state recognition might be an HD early sign before motor symptoms appear, our study was aimed to investigate how the recognition of others’ mental states in HD subjects is moderated by different stimulus related features (gender, difficulty (low, medium, high), and valence (positive, negative, neutral) of the mental states that are to be recognized).

Methods: Subjects with premanifest (n?=?20) and manifest (n?=?40) HD performed the revised ‘Reading the Mind in the Eyes Test’ and were compared with age-matched healthy controls (HC, 40 subjects per cohort).

Results: Our results highlight an early impairment in mental state recognition preceding manifest HD symptoms and a deterioration of these abilities with HD progression. Moreover, we found in HD premanifest subjects an impairment concerning the recognition of negative and neutral mental states, as well as of mental states with moderate recognition difficulty. Finally, we found that participant gender did not influence the performance in recognizing others’ mental states, while all participants recognized mental states displayed by females more accurately than those displayed by males.

Conclusions: We conclude that difficulties in the recognition of complex mental states can be considered as an early sign of HD, before evident behavioral manifestations, and peculiar features of the stimulus influence it.     

Stress experienced by adolescents in school: the importance of personality and interpersonal relationships

Objective: The aim of the investigation was to determine the interrelatedness between personality variables, interpersonal relationships, and stress in adolescents.

Method: The personality of adolescents (variables related to Jung’s theory, self-concept, and egocentrism) and their relationships with teachers and peers as well as stress were measured using a sample of 358 school-going adolescents with an average age of 16.28 years.

Results: Extraverts experienced better relationships with peers. Sensing- and judging-orientated learners had better relationships with teachers. Thinking- and judging-orientated learners experienced less stress. Self-concept correlated positively with interpersonal relationships and negatively with stress while egocentrism correlated negatively with interpersonal relationships and positively with stress. Personality variables (especially self-concept) were the most important variables to explain the variance in stress.

Conclusion: Perceiving-orientated learners who lack structure in their schoolwork experienced more stress and relationship problems with teachers. The enhancement of the adolescents’ self-concept should be a priority to strengthen interpersonal relationships and to lower stress. Adolescent egocentrism should also be addressed, especially in those who overestimate their responsibilities.     

Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting

Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs).

Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa.

Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured.

Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0–30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0–70.0) to 62.5 (IQR 30.0–81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0–7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving.

Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.     

Spiritual care for people with intellectual and developmental disability: An exploratory study

Background: A faith-based (pseudonym, Adam’s House – AH) and a non-faith-based care service (pseudonym, Greenleaves – GL) were explored to find out if and how spiritual support was provided for people with intellectual and developmental disabilities (IDDs).

Method: Six months were spent volunteering within each service and a mixed-methods approach was utilised including applied and ethnographic methods to explore and describe if and how spirituality was embedded within the two services.

Results: Themes found included community of value; homely functional care; and barriers to spiritual care. GL staff tended to provide what we termed “religious spiritual care” while AH staff administered both “religious” and “non-religious” spiritual-based support. This difference may be related to the type of training found only at AH which included spiritual dimensions.

Conclusion: Services could benefit from acknowledging the importance and significance of spiritual care training and education for effective and varied spiritual care for people with IDD who desire such support.     

Significance of speech production errors on cross-linguistic processing in Sepedi-English individuals with bilingual aphasia: a case series analysis

Background: Bilingual aphasia forms a significant part of speech-language pathologists’ (SLP) caseload, globally, and specifically in South Africa. Few tools supporting clinical decision-making are available due to limited understanding of typical and disordered cross-linguistic processing (how the languages interact). Speech errors may provide insight about “hidden” bilingual mechanisms.

Objectives: To determine what speech errors can impart about cross-linguistic processing, as well as, associated language and impairment variables in Sepedi-English individuals with aphasia.

Method: The case series included six participants, purposively selected from three rehabilitation sites in South Africa. Detailed language and clinical profiles were obtained. Participants performed a confrontation naming task in their most dominant (MDL) and less dominant language (LDL). Responses were audio recorded, transcribed, and analyzed for overall accuracy and error type in MDL and LDL; verified by a Sepedi-speaking linguist and a qualified SLP.

Results: (1) No statistically significant differences in MDL-LDL naming accuracy were found, supporting recent literature of simultaneous inter-activation of both languages and shared word retrieval mechanisms. All types of speech errors occurred, and semantic errors were produced most frequently and consistently in each participant’s MDL and LDL. (2) Language proficiency, language recovery patterns, and aphasia type (Broca’s and Anomic) and severity (mild and/or moderate) appeared to be more strongly linked to cross-linguistic processing than Sepedi-English linguistic differences and age of acquisition of both languages.

Conclusions: Participants with bilingual aphasia may use typical cross-linguistic and word retrieval mechanisms, concurring with current theories of bilingualism. Findings are preliminary, warranting investigations of other language tasks, modalities, pairs, and related variables.     

Theory of mind,mental state talk and social relationships in aging: The case of friendship

Objectives: Previous research has shown a decline in Theory of mind (ToM) associated with normal aging. However, very few studies have investigated older people’s ToM using an ecological approach. The present study was designed to fill this gap and examine older people’s frequency of mental state talk (MST) in describing their best friend, together with their performance on a traditional ToM task. In addition, the study examined the association between these two ToM indices and relationships with friends and family members.

Method: Seventy-two healthy older adults (age range 60–79) participated in the study. We measured ToM ability with a classic measure, the Faux Pas task, and selected the Describe-a-friend task to measure MST frequency; social relationships were investigated with the Lubben Social Network Scale. Correlation and regression analyses were performed.

Results: No significant association between MST and scores on the Faux Pas task emerged. In addition, MST (but not Faux Pas scores) significantly predicted friendships (but not family relationships) over and above general cognitive functioning.

Conclusion: These findings show the crucial distinction between possessing an ability and using it in daily life and suggest the need to move toward more ecological measures of older adults’ abilities. In addition, the present results indicate that the spontaneous use of ToM ability, not the ability per se, impacts on older adults’ social relationships.     

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities: A systematic review

Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population.

Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence.

Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control.

Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure “Soles of the Feet”, is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT’s mechanisms of action (e.g., improved interoceptive awareness) is warranted.     

Acute aseptic meningitis during isotretinoin treatment for nodular acne solely presenting with headache: case report and brief review of the literature

Purpose/aim: We describe, in detail, the first case of isotretinoin-induced aseptic meningitis. A brief summary of the literature on drug-induced aseptic meningitis (DIAM) is also presented.

Materials and methods: A 20-year old female patient with probable (Naranjo adverse reaction probability score of 7) DIAM during treatment with isotretinoin therapy for nodular acne solely, presenting with headache. Pseudotumor cerebri was appropriately ruled-out.

Results: Summary of data altogether lead us suggest that isotretinoin triggered DIAM, possible due to a delayed hypersensitivity mechanism type III or IV.

Conclusion: We highlight a quite uncommon cause of DIAM that may be increasing in frequency due to the current increasing use of isotretinoin against nodular acne.     

Predicting confrontation naming item difficulty

Background: Item response theory (IRT; Lord & Novick, 1968) is a psychometric framework that can be used to model the likelihood that an individual will respond correctly to an item. Using archival data (Mirman et al., 2010), Fergadiotis, Kellough, and Hula (2015) estimated difficulty parameters for the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) using the 1-parameter logistic IRT model. Although the use of IRT in test development is advantageous, its reliance on sample sizes exceeding 200 participants make it difficult to implement in aphasiology. Therefore, alternate means of estimating the item difficulty of confrontation naming test items warrant investigation. In a preliminary study aimed at automatic item calibration, Swiderski, Fergadiotis, and Hula (2016) regressed the difficulty parameters from the PNT on word length, age of acquisition (Kuperman, Stadthagen-Gonzalez, & Brysbaert, 2012), lexical frequency as quantified by the Log10CD index (Brysbaert & New, 2009), and naming latency (Székely et al., 2003). Although the model's predictive utility was high, a substantial proportion (20%) of the response time data were missing. Further, only 39% of the picture stimuli from Székely and colleagues (2003) were identical to those on the PNT. Given that the IRT sample size requirements limit traditional calibration approaches in aphasiology and that the initial attempts in predicting IRT difficulty parameters in our pilot study were based on incomplete response time data this study has two specific aims.

Aims: To estimate naming latencies for the 175 items on the PNT, and assess the utility of psycholinguistic variables and naming latencies for predicting item difficulty.

Methods and Procedures: Using a speeded picture naming task we estimated mean naming latencies for the 175 items of the PNT in 44 cognitively healthy adults. We then re-estimated the model reported by Swiderski et al (2016) with the new naming latency data.

Outcomes and Results: The predictor variables described above accounted for a substantial proportion of the variance in the item difficulty parameters (Adj. R² = .692).

Conclusions: In this study we demonstrated that word length, age of acquisition, lexical frequency, and naming latency from neurotypical young adults usefully predict picture naming item difficulty in people with aphasia. These variables are readily available or easily obtained and the regression model reported may be useful for estimating confrontation naming item difficulty without the need for collection of response data from large samples of people with aphasia.