Normative Data and Interrater Reliability of the Design Fluency Test

This study generated normative data for the free and fixed conditions of the Design Fluency Test (DFT; Jones-Gotman & Milner, 1977) and investigated its interrater reliability. Three raters independently scored DFT protocols from 66 normal adults according to criteria that have only recently been published (Jones-Gotman, 1990; see Spreen & Strauss, 1998 for summary). Interrater reliability was good to excellent for novel output scores and perseverative errors, but nameable errors and designs with the incorrect number of lines yielded lower reliability coefficients. Overall, interrater reliability of the DFT appears to be relatively good, especially for the free condition and, therefore, clinical use with adequate normative data may be justified.     

The Child and Adolescent Services Assessment: Interrater Reliability and Predictors of Rater Disagreement

The current study evaluated the interrater reliability of the Child and Adolescent Services Assessment (CASA), a widely used structured interview measuring pediatric mental health service use. Interviews (N?=?72) were randomly selected from a pediatric effectiveness trial, and audio was coded by an independent rater. Regressions were employed to identify predictors of rater disagreement. Interrater reliability was high for items (>?94%) and summary metrics (ICC?>?.79) across service sectors. Predictors of disagreement varied by domain; significant predictors indexed higher clinical severity or social disadvantage. Results support the CASA as a reliable and robust assessment of pediatric service use, but administrators should be alert when assessing vulnerable populations.     

Pupillary escape.

I performed a pupillographic study of pupillary escape to determine its effectiveness in detecting optic nerve and retinal disease. Fourteen patients and 39 normal subjects were included in the study. Only one patient had abnormal pupillary escape, even though 13 patients had relative afferent pupillary defects. Testing for pupillary escape is not a reliable clinical technique.     

Performance Stability and Interrater Reliability of Culturally Adapted 10-Meter Walking Test for Danes with Neurological Disorders

Background: The 10-meter Walking Test (10MWT) is often used to assess people with, e.g., stroke, but often using different procedures. The aims of this study were to translate the 10MWT into Danish, to determine the number of trials needed to achieve performance stability, and to examine the interrater reliability and agreement of the 10MWT in people with neurological disorders. Methods: Translation followed international recommendations, and evaluated in a consecutive sample of 50 people with a neurological disorder. All participants performed 5 timed 10MWT trials (usual speed) with 20-seconds rest intervals between trials, supervised by a physical therapist. A second session was conducted with another physical therapist, separated with a mean (SD) of 2.7 (0.9) hours. The order of raters was randomized and they were blinded to each other's ratings. Repeated measures ANOVA determined performance stability, while ICC1.1, standard error of measurement (SEM), and minimal detectable change (MDC95) determined reproducibility. Results: Participant's improved their 10MWT scores significantly between the first and second trial only. The faster of the 2 trials took a mean of 11.95 (5.40) seconds, and significantly (P < 0.001) faster than the slowest; mean of 12.80 (6.13) seconds. The intraclass correlation coefficient (ICC; 95% confidence interval), SEM, and MDC, based on the fastest of 2 trials, were 0.97 (0.95-0.98), 0.06 m/s, and 0.17 m/s, respectively, and with no systematic between rater's bias. Conclusions: We suggest that the faster of 2 timed trials be recorded for the 10MWT in people with neurological disorders, as we found excellent interrater reliability and low measurement error using this score.     

Lateral Asymmetries of Pupillary Responses

We wanted to learn if pupillary changes induced by looking and attending to stimuli on the right and left are asymmetrical. In humans, there are hemispheric asymmetries in the control of attention-arousal systems. Because attention and arousal may influence pupil size, asymmetric pupillary responses may be seen when looking and attending in different directions. Twelve right-handed, healthy volunteers served as subjects. Using infrared pupillography, we recorded changes of pupillary diameter while subjects were looking and attending to the stimuli on the right and left sides of space. For the one second following a saccade, there are three phasic pupillary responses, an initial constriction (C1) then a dilation (D1), followed by constriction (C2). Evaluation of these three responses revealed right-left asymmetries with more pupil dilation (D1) when looking to the stimulus on the right. Our results suggest that subjects are more aroused when looking to the right than when looking to the left.     

Interrater Reliability of the Todai-shiki Observational Rating Scale (TORS) for Group Psychotherapy of Elderly Patients with Dementia

Background : Various types of psychosocial approaches have been developed in the field of dementia patient care. One of these approaches, reminiscence groups, is often applied in the care setting. We developed the Todai-shiki Observational Rating Scale (TORS) to assess the effectiveness of reminiscence groups, and we examined its interrater reliability in this preliminary study.
Methods : The subjects of the study were nine elderly patients with mild to moderate dementia. The TORS consists of 20 items covering four aspects of the patients' clinical picture: verbal communication, nonverbal communication, attention and interest, and emotion. The intraclass correlation coefficient (ICC) for each item was calculated. The mean ICCs for each item over five sessions were used as a reliable index.
Results : The mean ICCs ranged from 0.53 to 1.00, and averaged 0.83.
Conclusion : This preliminary study suggested that the TORS might be a useful tool to evaluate the effects of group psychotherapy for patients with dementia.     

The Personality Organization Diagnostic Form (PODF): A Preliminary Report on Its Validity and Interrater Reliability

This research provides empirical support to the Personality Organization Diagnostic Form (PODF; Diguer & Normandin, 1996), which is a measure that operationalizes Kernberg's (1996) model of personality organizations. The goals of this study were to examine the PODF's interrater reliability and validity. Results confirmed that reliability ranged from good to excellent. Factor analysis showed that items tended to regroup according to the model, which contributes to the validity of the PODF. Internal consistency, reliability, and correlations with psychiatric severity also indicate moderate to good construct validity. Several suggestions are made to improve the measure, such as adding neurotic items and having Likert-scale items.     

Pupillary function in multiple sclerosis

Eighteen MS patients with visual acuity of 20/30 or better and without recent visual complaints, and 14 age- and sex-matched controls were studied by TV pupillography. The response amplitude and the maximum rate of pupillary constriction or dilation of the light, dark, accommodation and ciliospinal reflexes were unchanged. The latency of the pupillary light response (PLR), however, was prolonged and closely related to walking performance (R = 0.76; p less than 0.001). No relationship was established between PLR latency and previous history of optic neuritis or latency of the VEP. It is concluded that MS patients with preserved visual acuity have only discrete autonomic pupillary disturbances and that the PLR delay is related to disease progression.     

Pupillary abnormalities in congenital neurosyphilis

Pupils in congenital neurosyphilis differ from the classic Argyll-Robertson pupil in acquired cases, and often tend to be large and unreactive. Constriction to pilocarpine in the reported patient would suggest that peripheral parasympathetic damage is responsible for such pupillary findings. Congenital neurosyphilis should be included among the causes of "tonic" pupil.     

Interrater reliability of Alzheimer's disease diagnosis

To determine interrater reliability of dementia diagnosis, 4 physicians experienced in the evaluation of dementia patients applied 3 sets of diagnostic criteria to each of 62 patients, based on a standardized set of medical record information. All patients had undergone similar examinations and follow-up to establish the initial clinical diagnosis (76% had autopsy). Raters were blind to the diagnosis and to follow-up information after the initial evaluation period. This paper presents interrater agreement (kappa values) for a diagnosis of Alzheimer's disease using the American Psychiatric Association diagnostic criteria from the Diagnostic and Statistical Manual (DSM-III), the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for the clinical diagnosis of Alzheimer's disease, and the Eisdorfer and Cohen Research Diagnostic Criteria (ECRDC) for primary neuronal degeneration. The NINCDS showed somewhat higher average interrater reliability (kappa = 0.64) than the DSM-III (kappa = 0.55) and considerably higher interrater reliability than the ECRDC (kappa = 0.37). One rater displayed conspicuously lower levels of interrater reliability than the other 3, especially in DSM-III and ECRDC. This study indicates that interrater reliability of DSM-III and NINCDS criteria are comparable. Documentation of interrater reliability and, if necessary, training to improve reliability is an important consideration in research where different observers are diagnosing dementing illnesses.     

Interrater reliability of the Blessed Dementia Scale

This study examined the interrater reliability of the Blessed Dementia Scale. On consecutive days, two raters, working independently, interviewed each of the caretakers of 47 demented subjects. Interrater reliability of total scale scores was determined by calculation of the Pearson correlation coefficient (r), the intra-class correlation coefficient (ICC), and the limits of agreement (d +/- 2 s). By all three methods of calculation, the interrater reliability of the Blessed Dementia Scale was low.     

Pupillary function in early multiple sclerosis

Autonomic pupillary function was assessed with pupillometry in 95 mildly or moderately disabled patients with multiple sclerosis (MS) and 81 healthy subjects. The parasympathetic pupillary function was measured as initial diameter (mm), time to minimum diameter (seconds), reflex amplitude (mm), relative reflex amplitude (%), and maximal constriction velocity (mm/seconds). To reflect the sympathetic pupillary function maximal redilatation velocity (mm/seconds), and time of 75% of redilatation (seconds) were measured. Of MS patients 85-99% were within the reference values of healthy subjects. In MS patients the effect of age was observed in the initial diameter, reflex amplitude, and time of 75% redilatation. There were no such age related effects in healthy subjects. In age adjusted analysis the initial diameter and time of 75% redilatation differed significantly from healthy controls. Autonomic pupillary functions were not associated with fatigue, visual defect, or bladder disturbance, as measured by Fatigue Severity Scale, Kurtzke's Functional System Scales, Expanded Disability Status Scale, or the Multiple Sclerosis Functional Composite. Our results suggest that both parasympathetic and sympathetic pupillary functions are disturbed already early in the course of MS. However, the disturbance is not severe at this stage of the disease. The dysfunction is age-dependent and thus possibly related to the dimished remyelination capacity of the central nervous system.     

Pupillary dysfunction in myasthenia gravis.

The constriction-dilation cycles of pupils exposed to a stationary, discrete slit-lamp beam were significantly prolonged in 25 myasthenic patients (1,060.4 +/- 45.8 msec) undergoing therapy with steroids, anticholinesterases, or both, compared to normal controls (801.9 +/- 8.6 msec) or subjects receiving steroids for nonneurological disease (860.9 +/- 14.9 msec). The duration of myasthenia correlated with the slowing of the cycle time. Myasthenia gravis may affect ectodermally derived smooth muscle or the autonomic neuromuscular junction or both, and not be restricted to the well-demonstrated alterations of neuromuscular junction in striated muscle of mesodermal origin. Alternatively, prolonged pupillary cycles could be attributed to dysfunction of central pathways of the pupillary light reflex.