A role for D-aspartate oxidase in schizophrenia and in schizophrenia-related symptoms induced by phencyclidine in mice

Increasing evidence points to a role for dysfunctional glutamate N-methyl-D-aspartate receptor (NMDAR) neurotransmission in schizophrenia. D-aspartate is an atypical amino acid that activates NMDARs through binding to the glutamate site on GluN2 subunits. D-aspartate is present in high amounts in the embryonic brain of mammals and rapidly decreases after birth, due to the activity of the enzyme D-aspartate oxidase (DDO). The agonistic activity exerted by D-aspartate on NMDARs and its neurodevelopmental occurrence make this D-amino acid a potential mediator for some of the NMDAR-related alterations observed in schizophrenia. Consistently, substantial reductions of D-aspartate and NMDA were recently observed in the postmortem prefrontal cortex of schizophrenic patients. Here we show that DDO mRNA expression is increased in prefrontal samples of schizophrenic patients, thus suggesting a plausible molecular event responsible for the D-aspartate imbalance previously described. To investigate whether altered D-aspartate levels can modulate schizophrenia-relevant circuits and behaviors, we also measured the psychotomimetic effects produced by the NMDAR antagonist, phencyclidine, in Ddo knockout mice (Ddo^−/−), an animal model characterized by tonically increased D-aspartate levels since perinatal life. We show that Ddo^−/− mice display a significant reduction in motor hyperactivity and prepulse inhibition deficit induced by phencyclidine, compared with controls. Furthermore, we reveal that increased levels of D-aspartate in Ddo^−/− animals can significantly inhibit functional circuits activated by phencyclidine, and affect the development of cortico–hippocampal connectivity networks potentially involved in schizophrenia. Collectively, the present results suggest that altered D-aspartate levels can influence neurodevelopmental brain processes relevant to schizophrenia.     

Improving evidence‐based practice in rehabilitation: Introducing PsycBITETM

Background: Clinicians face significant obstacles in their access to evidence for the efficacy of different communicative and cognitive treatments after brain impairment. These include the need to search across diverse journals and different clinical conditions to find potential treatments and the lack of easily accessible standards by which to evaluate the methodological rigour of treatment studies once found.

Aims: We aimed to address these issues by developing a freely available, user‐friendly database of all relevant treatment trials for psychologically based disorders that arise from brain impairment.

Methods & Procedures: PsycBITE^TM (http://www.psycbite.com) was developed as an internet‐based database and was officially launched in 2004. Included on PsycBITE^TM are all trials that have been published that evaluate treatment for any communication, cognitive, or psychological disorder arising from any form of acquired brain impairment in children (above the age of 5 years) and adults. PsycBITE^TM also provides a rating for the methodological rigour of each trial using the previously established PEDro scale (Maher, Sherrington, Herbert, Moseley, & Elkins, 2003 Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M. and Elkins, M. 2003. Reliability of the PEDro scale for rating quality of randomized controlled trials.. Physical Therapy, 83: 713–721. [PubMed], [Web of Science ®] , [Google Scholar]) for randomised controlled trials (RCT) and non‐RCT group comparisons. A PsycBITE^TM rating scale for single case experimental studies is still under development. This report overviews the database, its contents, and the methodology by which papers are selected for inclusion.

Outcomes & Results: As of June 2005 there are 1167 treatment studies listed on PsycBITE^TM with prospective searches being conducted on a regular basis. The highest proportion of studies report treatments for communication disorders followed by behavioural problems and memory. Ratings of the randomised controlled trials, group comparisons, and single case studies are available for a proportion of papers and are being updated continuously.

Conclusions: PsycBITE^TM is an invaluable resource for clinicians and researchers interested in an evidence‐based practice approach to treatment. It is a free, fast, and effective way of accessing and evaluating treatments for communicative and cognitive disorders following brain impairment.     

Hippocampal Volume and Shape Analysis in an Older Adult Population

This report presents a manual segmentation protocol for the hippocampus that yields a reliable and comprehensive measure of volume, a goal that has proven difficult with prior methods. Key features of this method include alignment of the images in the long axis of the hippocampus and the use of a three-dimensional image visualization function to disambiguate anterior and posterior hippocampal boundaries. We describe procedures for hippocampal volumetry and shape analysis, provide inter- and intra-rater reliability data, and examine correlates of hippocampal volume in a sample of healthy older adults. Participants were 40 healthy older adults with no significant cognitive complaints, no evidence of mild cognitive impairment or dementia, and no other neurological or psychiatric disorder. Using a 1.5 T GE Signa scanner, three-dimensional spoiled gradient recalled acquisition in a steady state (SPGR) sequences were acquired for each participant. Images were resampled into 1 mm isotropic voxels, and realigned along the interhemispheric fissure in the axial and coronal planes, and the long axis of the hippocampus in the sagittal plane. Using the BRAINS program (Andreasen et al., 1993 Andreasen , N. C. , Cizadlo , T. , Harris , G. , Swayze , V. , O'Leary , D. S. , et al. . ( 1993 ). Voxel processing techniques for the antemortem study of neuroanatomy and neuropathology using magnetic resonance imaging . Journal of Neuropsychiatry , 5 , 121 – 130 . [Google Scholar]), the boundaries of the hippocampus were visualized in the three orthogonal views, and boundary demarcations were transferred to the coronal plane for tracing. Hippocampal volumes were calculated after adjusting for intracranial volume (ICV). Intra- and inter-rater reliabilities, measured using the intraclass correlation coefficient, exceeded .94 for both the left and right hippocampus. Total ICV-adjusted volumes were 3.48 (±0.43) cc for the left hippocampus and 3.68 (±0.42) for the right. There were no significant hippocampal volume differences between males and females (p > .05). In addition to providing a comprehensive volumetric measurement of the hippocampus, the refinements included in our tracing protocol permit analysis of changes in hippocampal shape. Shape analyses may yield novel information about structural brain changes in aging and dementia that are not reflected in volumetric measurements alone. These and other novel directions in research on hippocampal function and dysfunction will be facilitated by the use of reliable, comprehensive, and consistent segmentation and measurement methods.     

Protein kinase C delta modulates endothelial nitric oxide synthase after cardiac arrest

We previously showed that inhibition of protein kinase C delta (PKCδ) improves brain perfusion 24 hours after asphyxial cardiac arrest (ACA) and confers neuroprotection in the cortex and CA1 region of the hippocampus 7 days after arrest. Therefore, in this study, we investigate the mechanism of action of PKCδ-mediated hypoperfusion after ACA in the rat by using the two-photon laser scanning microscopy (TPLSM) to observe cortical cerebral blood flow (CBF) and laser Doppler flowmetry (LDF) detecting regional CBF in the presence/absence of δV1-1 (specific PKCδ inhibitor), nitric oxide synthase (NOS) substrate (L-arginine, L-arg) and inhibitor (N^ω-Nitro-L-arginine, NLA), and nitric oxide (NO) donor (sodium nitroprusside, SNP). There was an increase in regional LDF and local (TPLSM) CBF in the presence of δV1-1+L-arg, but only an increase in regional CBF under δV1-1+SNP treatments. Systemic blood nitrite levels were measured 15 minutes and 24 hours after ACA. Nitrite levels were enhanced by pretreatment with δV1-1 30 minutes before ACA possibly attributable to enhanced endothelial NOS protein levels. Our results suggest that PKCδ can modulate NO machinery in cerebral vasculature. Protein kinase C delta can depress endothelial NOS blunting CBF resulting in hypoperfusion, but can be reversed with δV1-1 improving brain perfusion, thus providing subsequent neuroprotection after ACA.     

Using voice recognition software to treat dysgraphia in a patient with conduction aphasia

Background: Augmentative and alternative communication (AAC) has primarily been utilised for motor speech deficits or as an aid for communicating basic needs in the acute stages of aphasia rehabilitation. However, AAC strategies can be employed for individuals with aphasia across a wide range of severity levels and at different stages of recovery. For individuals with chronic impairments in language, voice recognition software can further enhance communication by providing an alternative means for written expression.

Aims: To investigate the functional and linguistic effects of a treatment program that used voice recognition software to improve written communication in an individual with chronic aphasia.

Methods & Procedures: A 65-year-old woman with conduction aphasia participated in a prospective case study. During baseline testing the individual was evaluated on measures of language (i.e., Boston Diagnostic Aphasia Examination, 3rd edition, Goodglass, Kaplan, & Baressi, 2001 Goodglass, H., Kaplan, E. and Barresi, B. 2001. Boston Diagnostic Aphasia Examination, 3rd, Baltimore, MD: Lippincott Williams & Wilkins.  [Google Scholar]; Boston Naming Test, Kaplan, Goodglass, & Weintraub, 2001 Kaplan, E., Goodglass, H. and Weintraub, S. 2001. Boston Naming Test, 2nd, Philadelphia, PA: Lippincott Williams & Wilkins.  [Google Scholar]), computer skills, and functional communication (i.e., ASHA FACs, Frattali et al., 1995 Frattali, C., Thompson, C. K., Holland, A. L., Wohl, C. B. and Ferketic, M. K. 1995. American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults, Rockville, MD: American Speech-Language-Hearing Association.  [Google Scholar]; Quality of Communication Life Scales, Paul et al., 2004 Paul, D., Frattali, C., Holland, A., Thompson, C., Caperton, C. and Slater, S. 2004. Quality of Communication Life Scale (ASHA QCL), Rockville, MD: American Speech-Language-Hearing Association.  [Google Scholar]). A cursory examination of the oral peripheral structure was administered. Treatment consisted of 10 one-hour sessions of training on the Dragon NaturallySpeaking^© Program. Following treatment, measures of language, computer skills, quality of life, and functional communication were re-administered. Further, to evaluate if skills in written expression could be utilised to communicate via e-mail, a distance-learning program was implemented.

Outcomes & Results: Findings revealed that, with intensive instruction, the participant was able to independently access the computer and the Dragon NaturallySpeaking^© Program. At the conclusion of the treatment phase, functional writing abilities approximated spoken communication. Some minor changes in reading, repetition, and conversation were suggested on formal and informal assessment measures. The participant made substantial gains in using the program in her activities of daily living, but only achieved minor success in demonstrating her skills during distance learning.

Conclusions: The potential benefits of AAC devices may change throughout the course of recovery from aphasia. New technologies may facilitate gains in communication in individuals with aphasia throughout their lifespan. This study demonstrated that intensive training in the use of voice recognition software can enhance functional writing in an individual with chronic aphasia. Although marked progress in written expression was achieved, transfer of skills for use on the Internet was limited. Clinical management should include assessment of various assistive technologies across different modalities of communication for people at different stages of recovery from aphasia.     

Non-Suicidal Self-Injury Elevates Suicide Risk among United States Military Personnel with Lifetime Attempted Suicide

Military psychiatric inpatients with and without a lifetime history of non-suicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Data were derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011 Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia–suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. doi:10.1176/appi.ajp.2011.10111704[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.     

Altered behavioural and neurochemical profile of L-DOPA following deuterium substitutions in the molecule

In Parkinson's disease patients, a prolonged half-life of dopamine formed from l-DOPA may reduce the risk of developing l-DOPA-induced side-effects. Deuterium substitutions in the l-DOPA molecule are expected to yield dopamine with an altered half-life because C–D bonds are more stable than C–H bonds. Therefore we tested, in the rat, the neurochemical and behavioral effects of different types of l-DOPA with deuterium substitutions at the α-carbon and/or the β-carbon. By means of microdialysis, we found that l-DOPA with 3 deuterium substitutions (D3-l-DOPA) enhanced dopamine output in the striatum more effectively than l-DOPA and all the other deuterium variants. Moreover, D3-l-DOPA produced a more pronounced stimulation of locomotor activity in reserpinized rats compared to conventional l-DOPA. In contrast β,β-D2-l-DOPA was less effective than l-DOPA in raising striatal dopamine levels and was ineffective at restoring locomotor activity in reserpinized rats. These results demonstrate that the introduction of deuterium at different positions in the l-DOPA molecule dramatically changes its behavioral and neurochemical profile and suggest that l-DOPA treatment of Parkinson's disease may be improved in this way.     

Personality Affects Memory Performance and Psychological Well-Being in Investigative Interviews: A Therapeutic Jurisprudential Approach

Therapeutic jurisprudence (TJ) aims to execute legal procedures in ways that promote the psychological well-being (PWB) of the individuals involved. This experimental study investigates the impact of personality on interviewees' memory performance and PWB from a TJ perspective. PWB was defined by state anxiety (STAI-S) and sense of coherence (SOC). Interviewees' personalities were assessed using the 10-item short version of the Big Five Inventory (Rammstedt, B., &; John, O. P. (2007) Rammstedt, B., &; John, O. P. (2007). Measuring personality in one minute or less: A 10-item short version of the Big Five Inventory in English and German. Journal of Research in Personality, 41, 203–212. doi: 10.1016/j.jrp.2006.02.001[Crossref], [Web of Science ®] , [Google Scholar]. Measuring personality in one minute or less: a 10-item short version of the Big Five Inventory in English and German. Journal of Research in Personality, 41, 203–212) and State–Trait Anxiety Inventory (STAI-T; Spielberger, C. D., Gorsuch, R., Lushene, P. R. Vagg, P. R., &; Jacobs, G. A. (1983) Spielberger, C. D., Gorsuch, R., Lushene, P. R. Vagg, P. R., &; Jacobs, G. A. (1983). State–Trait Anxiety Inventory for Adults. Palo Alto, CA: Consulting Psychologists Press.[Crossref] , [Google Scholar]. State–Trait Anxiety Inventory for Adults. Palo Alto, CA: Consulting Psychologists Press]. Participants (N = 146) were assigned to undergo either humanitarian rapport interviews or non-rapport interviews. Each group underwent one exposure (computer simulation) and two interviews separated by a 6-month interval. Regression analysis showed that neuroticism (N), openness to experience (O) and extraversion (E) predicted interviewees' memory performance; N and O were moderated by interview style. Moreover, E and agreeableness (A) predicted higher SOC and lower STAI-S, that is, increased PWB, whereas N predicted lower SOC and elevated levels of STAI-S, that is, lower PWB. In Interviews I and II, STAI-T and a non-rapport approach were a stronger predictor of lower SOC. The results are discussed from a TJ perspective.     

When nouns and verbs degrade: Facilitating communication in semantic dementia

Background: Little is known about how to maintain communicative effectiveness in semantic dementia as the disease progresses from impairment in word retrieval to a loss of conceptual knowledge.

Aim: The purpose of this study is twofold. The first objective is to characterise communicative effectiveness using a modified framework derived from Chapman and Ulatowska (1997 Chapman, S. B. and Ulatowska, H. K. 1997. “Discourse in dementia: Consideration of consciousness.”. In Language structure, discourse and the access to consciousness, Edited by: Stamenov, M. I. 155–188. Philadelphia: John Benjamin Publishing Company.  [Google Scholar]) that integrates two components: codification of ideas (falling on a continuum from verbal to nonverbal and generative to automatic forms) and functions of communication (imaginative, heuristic, informative, personal, interactional, regulatory, and instrumental). The second objective is to outline principles of a discourse intervention that focuses on communicative effectiveness.

Method & Procedures: The participant was Mr Bobby V, a man with semantic dementia. His communication abilities were characterised at diagnosis and 24 months later using the framework of communicative effectiveness, based on discourse samples, clinical observation, and caregiver report. From the time of diagnosis, Bobby V received discourse intervention, which focused on maintaining his communication abilities using all available communication resources. We outline principles of discourse intervention in semantic dementia based on our experience of delivering individual and group intervention to Bobby V.

Outcomes and Results: The communicative effectiveness framework described here could be used to characterise communication skills, set therapy goals, and monitor progress in semantic dementia. Discourse intervention likely facilitated Bobby V's continued success in maintaining communication despite progressive loss of nouns and verbs.

Conclusions: Targeting conversational effectiveness in terms of communicative functions offers a promising and ecologically valuable intervention for people with semantic dementia, as it allows individuals with this form of dementia to connect meaningfully with people in their immediate surroundings well into the later stages of the disease.     

Agrammatic patterns in Alzheimer's disease: Evidence from tense,agreement, and aspect

Background: Little research has been conducted on functional categories in probable Alzheimer's disease (pAD). Furthermore, the findings are contradictory, since some studies report ceiling performance on tense and/or subject–verb agreement (Kaprinis & Stavrakaki, 2007 Kaprinis, S. and Stavrakaki, S. 2007. Morphological and syntactic abilities in patients with Alzheimer's disease. Brain and Language, 103: 59–60. doi:10.1016/j.bandl.2007.07.044[Crossref], [Web of Science ®] , [Google Scholar]; Kavé & Levy, 2003 Kavé, G. and Levy, Y. 2003. Sensitivity to gender, person and tense inflection by persons with Alzheimer's disease. Brain and Language, 87: 267–277. doi:10.1016/S0093-934X(03)00106-8[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), whereas others report morphosyntactic deficits and agrammatic profiles (e.g., Altmann, Kempler, & Andersen, 2001 Altmann, L. G. P., Kempler, D. and Andersen, E. S. 2001. Speech errors in Alzheimer's disease: Reevaluating morphosyntactic preservation. Journal of Speech, Language, and Hearing Research, 44: 1069–1082. doi:10.1044/1092-4388(2001/085)[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).

Aims: This study investigates the ability of Greek-speaking pAD individuals to produce and judge subject–verb agreement, tense, and aspect. Given pAD individuals have working memory limitations (e.g., Baddeley, 1996 Baddeley, A. 1996. Exploring the central executive. The Quarterly Journal of Experimental Psychology, 49: 5–28. doi:10.1080/713755608[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]), and given the differential processing demands of agreement, tense and aspect (e.g., Fyndanis, Varlokosta, & Tsapkini, 2012a Fyndanis, V., Varlokosta, S. and Tsapkini, K. 2012a. Agrammatic production: Interpretable features and selective impairment in verb inflection. Lingua, 122: 1134–1147. doi:10.1016/j.lingua.2012.05.004[Crossref], [Web of Science ®] , [Google Scholar]), pAD participants are expected to perform better on agreement than on tense/aspect. Based on the hypothesis that reference to the past is computationally more demanding than reference to the future/present (e.g., Bastiaanse et al., 2011 Bastiaanse, R., Bamyaci, E., Hsu, C-J., Lee, J., Yarbay Duman, T. and Thompson, C. K. 2011. Time reference in agrammatic aphasia: A cross-linguistic study. Journal of Neurolinguistics, 24: 652–673. doi:10.1016/j.jneuroling.2011.07.001[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), a within-tense dissociation is expected to emerge. Further, on the assumption that unmarked values of functional categories are less demanding than marked values (e.g., Lapointe, 1985 Lapointe, S. 1985. A theory of verb form use in the speech of agrammatic aphasics. Brain and Language, 24: 100–155. doi:10.1016/0093-934X(85)90100-2[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), the imperfective (unmarked) aspect is expected to be better preserved than the perfective (marked) aspect.

Methods & Procedures: Ten Greek-speaking mild pAD individuals and six healthy controls participated in a sentence completion task, a grammaticality judgement task, and a sentence–picture matching task. Non-parametric tests were used for analysis of results.

Outcomes & Results: PAD participants were found to be significantly more impaired in aspect compared to tense and agreement, in both production and grammaticality judgement/comprehension. Agreement was found significantly better preserved than tense in production. Similar patterns of performance have been attested in agrammatism (e.g., Fyndanis et al., 2012a Fyndanis, V., Varlokosta, S. and Tsapkini, K. 2012a. Agrammatic production: Interpretable features and selective impairment in verb inflection. Lingua, 122: 1134–1147. doi:10.1016/j.lingua.2012.05.004[Crossref], [Web of Science ®] , [Google Scholar]). Reference to the past and reference to the future did not dissociate, whereas the imperfective aspect was found to be significantly more impaired than the perfective aspect in production.

Conclusions: PAD participants' better performance on producing agreement, compared to tense/aspect, is accounted for in terms of the differential demands these categories pose on the processing system. Agreement is computationally less demanding than tense/aspect, because the former involves processing of grammatical information only, whereas the latter involve processing and integration of grammatical and extralinguistic/conceptual information. The preponderance of tense over aspect is attributed to the subjectivity of the latter, which renders it either a category “difficult” to test, or a computationally more demanding condition. The results also show that reference to the past is as demanding as reference to the future. The hypothesis that unmarked values are easier than marked ones is not supported by our data.     

Importance of health-related quality of life for persons with aphasia,their significant others,and SLPs: Who do we ask?

Background: Outcomes that support improved health-related quality of life (HRQL) are increasingly identified as desirable products to aphasia intervention. Although domain importance has been examined for survivors of stroke, little research evidence exists indicating what particular HRQL domains are or are not important to persons with aphasia (PwA).

Aims: The study aimed to determine if persons with mild, moderate, and severe aphasia, their respective speech-language pathologists (SLPs) and respective significant others (SOs) attribute similar importance rankings to different domains and overall HRQL.

Method & Procedures: This study was a prospective, observational, non-randomised group design. The Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39; Hilari, Byng, Lamping, & Smith, 2003a Hilari, K., Byng, S., Lamping, D. and Smith, S. 2003a. Stroke and Aphasia Quality of Life Scale – 39 (SAQOL-39). Evaluation of acceptability, reliability, and validity, 34: 1944–1950.  [Google Scholar]) and the Quality of Communication Life scale (Paul et al., 2004 Paul, D., Frattali, C., Holland, A., Thompson, C., Caperton, C. and Slater, S. 2004. Quality of Communication Life Scale, Rockville, MD: ASHA.  [Google Scholar]) were administered to 24 PwA, their treating SLPs (n?=?7), and SOs (n?=?24). Importance ratings on a 5-point Likert scale were obtained for each scale item. Severity of aphasia was determined by expressive ability resulting in by chance assignment of eight participants per severity group.

Outcomes & Results: The SAQOL-39 physical domain was the only HRQL domain to be statistically significant with a significant group main effect, F(2, 21)?=?4.057, p < .05. The SLP and SO significantly correlated with each other for importance of HRQL, but not with the PwA who had no significant correlations with the importance ratings made by the SO or the SLP on the SAQOL-39 and QCL. A total of 43% of variance in the overall importance ratings by PwA was accounted for by age, R² ?=?.434, F(1, 22)?=?16.89, p < .01.

Conclusions: Seeking importance ratings of HRQL domains from persons with mild, moderate, and severe aphasia may result in development of treatment goals more relevant to the PwA. Assessment of multiple HRQL domains is necessary to understanding priorities PwA place on rehabilitation outcomes across the continuum of care. Consideration for severity assignments beyond impairment-based assessments is discussed.     

Applicability of MEGA♪ to Sexually Abusive Youth With Low Intellectual Functioning

The study explored the predictive validity of Multiplex Empirically Guided Inventory of Ecological Aggregates for Assessing Sexually Abusive Children and Adolescents (Ages 4 to 19) (MEGA^?; Miccio-Fonseca, 2006b Miccio-Fonseca, L. C. 2006a. Multiplex Empirically Guided Inventory of Ecological Aggregates for Assessing Sexually Abusive Children and Adolescents (Ages 4 to 19): MEGA^?, San Diego, CA: Author.  [Google Scholar]), a comprehensive developmentally sensitive risk assessment outcome tool. MEGA^? assesses risk for coarse sexual improprieties and/or sexually abusive behavior in male and female youth ages 4 to 19 years (adjudicated and nonadjudicated), including youth with low (i.e., borderline) intellectual functioning. MEGA^? has 4 distinct risk scales with robust internal consistency reliability on cross-validation: Risk Scale (0.81), Protective Scale (0.78), Estrangement Scale (0.79), and Persistent Sexual Deviancy Scale (0.74). Sexual recidivism in cross-validation (N?=?1,056) was 8.4%, defined as sexually related probation or parole violation (formal or informal). ROC analysis for Risk Scale demonstrated MEGA^? has good predictive validity (AUC = .71, 95% CI of .62–.80, p < .001). Youth with low intellectual functioning scored significantly higher on the Risk Scale and Persistent Sexual Deviancy Scale, highlighting the importance of accurately assessing these youth.     

The Prevalence of Behavior Problems Among People with Intellectual Disability Living in Community Settings

With the desegregation processes of services for people with intellectual disability (ID) that is taking place in most Western countries there is a need for more knowledge related to the prevalence of behavior problems among people living in community settings. This study investigates the prevalence of behavior problems among 140 adolescents and adults with ID living in 5 municipalities in Norway using the Aberrant Behavior Checklist (Aman & Singh, 1986 Aman, M. G. and Singh, N. N. 1986. Aberrant Behavior Checklist: Manual, East Aurora, NY: Slosson Educational Publications.  [Google Scholar], 1994 Aman, M. G. and Singh, N. N. 1994. Aberrant Behavior Checklist-Community: Supplementary manual, East Aurora, NY: Slosson Educational Publications.  [Google Scholar]). Twenty percent of the sample were reported to show severe behavior disorder or “challenging behavior,” and this gives a prevalence for challenging behavior of 63.6 people per 100,000 base population. On the average, people showing challenging behavior had 7 behaviors rated as severe problems. A total of 60 participants were reported to have moderate or severe behavior problems, giving a prevalence for moderate and severe behavior problems of 136.3 per 100,000 base population. There were more people with profound ID and more people with autism in the group with challenging behavior and more people with Down syndrome in the group with mild or no problems. Those with severe behavior problems were perceived to be significantly less satisfied with their life situation than people without severe behavior problems. Challenging behavior seems to have a significant negative impact on the quality of life of people with ID. The results of this and other studies of challenging behavior among individuals with ID who live in areas with different service structures, using base population information, are important for analyzing the impact of reforms and different service systems on the life quality and well-being of people with ID.     

Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales

Background: Considerable attention has been given to the nature of communication impairments of individuals with TBI (Coelho, 2007 Coelho, C. A. 2007. Management of discourse deficits following traumatic brain injury: Progress, caveats, and needs. Seminars in Speech & Language, 28(2): 122–135.  [Google Scholar]; Ylvisaker, Turkstra, & Coelho, 2005 Ylvisaker, M., Turkstra, L. S. and Coelho, C. 2005. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical implications. Seminars in Speech & Language, 26: 256–267. [Crossref], [PubMed] , [Google Scholar]). However, there have been few data focusing on the way communication partners deal with the often distressing sequelae of TBI.

Aims: This study reports inter- and intra-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions.

Method & Procedures: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. A total of 10 casual and 10 purposeful TBI interactions were independently rated by two raters to establish inter-rater reliability and by one rater on two separate occasions to determine intra-rater reliability.

Outcomes & Results: Excellent inter-rater agreement was established on the MSC (ICC?=?0.85–0.97) and the MPC (ICC?=?0.84–0.89). Intra-rater agreement was also strong (MSC: ICC?=?0.80–0.90; MPC: ICC?=?0.81–0.92). Over 90% of all ratings scored within 0.5 on a 9-point scale.

Conclusions: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programmes.     

Indirect versus direct feedback in computer-based Prism Adaptation Therapy

Prism Adaptation Therapy (PAT) is an intervention method in the treatment of the attention disorder neglect (Frassinetti, Angeli, Meneghello, Avanzi, & Ladavas, 2002 Frassinetti, F., Angeli, V., Meneghello, F., Avanzi, S. and Ladavas, E. 2002. Long-lasting amelioration of visuospatial neglect by prism adaptation. Brain, 125: 608–623. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Rossetti et al., 1998 Rossetti, Y., Rode, G., Pisella, L., Farne, A., Li, L.Boisson, D. 1998. Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature, 395(6698): 166–169. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). The aim of this study was to investigate whether one session of PAT using a computer-attached touchscreen would produce similar after-effects to the conventional box normally used in PAT.

In four experiments, 81 healthy subjects and 7 brain-injured patients diagnosed with neglect were subjected to a single session of PAT under two conditions: (1) using the original box, and (2) using a computer-based implementation of PAT. The session of PAT included a pre-exposure step involving pointing at 30 targets without feedback; an exposure step involving pointing at 90 targets with prism goggles and feedback; and a post-exposure step involving pointing at 60 targets, with no goggles and no feedback.

The results indicate that the expected similarity in the after-effect produced by the two conditions seems to occur only if subjects receive feedback on pointing precision by seeing their fingertip during the exposure step. Attempts to provide feedback indirectly via icons on the computer screen failed to produce the expected size in the after-effect. The findings have direct implications for computer-based treatment of visuospatial disorders in the future and computer-assisted rehabilitation in general.     

High‐tech AAC and severe aphasia: Candidacy for TouchSpeak (TS)

Background: Increasingly, computerised communication aids are used by people with severe, chronic aphasia. Although the candidacy for these devices is relatively unknown, it has been hypothesised that cognitive deficits have a negative impact on the functional use of Augmentative and Alternative Communication (AAC). Deficits of executive functioning are assumed to be particularly important, but other functions, such as memory and semantic processing, may also be relevant. In a previous study (van de Sandt‐Koenderman, Wiegers, Wielaert, Duivenvoorden, & Ribbers, in press van de Sandt‐Koenderman, M., Wiegers, J., Wielaert, S. M., Duivenvoorden, H. J. and Ribbers, G. M. in press. A computerised communication aid in severe aphasia: An exploratory study.. Disability and Rehabilitation,  [Google Scholar]) we reported the functional effect of TouchSpeak (TS), a computerised communication aid, in a group of stroke patients with severe aphasia. The successful participants showed different levels of proficiency. Some were able to use the system independently and creatively in many situations, some used it independently for trained situations, and others remained partner dependent in using TS.

Aims: To find factors associated with the functional success of TS in people with severe aphasia, focusing on memory, executive functioning, semantic processing, and communication skills.

Methods & Procedures: The data of 30 patients with severe aphasia were analysed retrospectively. All were trained to use TS in two self‐chosen communicative situations. Four outcome levels were differentiated: no use, dependent use, independent use, and extensive use of TS. Pre‐training assessment included memory, executive functioning, semantic processing, and communication skills. The four outcome groups were compared regarding age, time post onset, gender, and aphasia type. The role of the cognitive variables was analysed with univariate ANCOVAs with contrast analysis, with correction for age, gender, aphasia type, or time post onset in case of significant differences between the groups on these variables.

Outcomes & Results: Seven participants were classified as extensive users of TS, five were independent TS users, and five were partner dependent. In 13 cases there was no functional use of TS. Extensive users were younger than the other outcome groups. Independent of this age effect, there was an effect of semantic processing; the no‐use group scored significantly lower on semantics than all other groups.

Conclusions: Only a minority of patients with severe aphasia may be expected to become independent, flexible users of high‐tech AAC. The finding that functional success was related to semantic processing is clinically important. Prospective studies are needed to support the predictive value of semantic processing for high‐tech AAC use. The importance of intact executive functioning is not supported in this study. The broad concept of “executive functioning” needs to be studied in more detail in relation to aphasia.     

The Walking Corsi Test (WalCT): A Normative Study of Topographical Working Memory in a Sample of 4- to 11-Year-Olds

We report normative data on topographical working memory collected through the Walking Corsi Test (WalCT; Piccardi et al., 2008 Piccardi, L. , Iaria, G. , Ricci, M. , Bianchini, F. , Zompanti, L. , & Guariglia, C. (2008). Walking in the Corsi test: Which type of memory do you need? Neuroscience Letters , 432 , 127–131.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) for developing a standard administration procedure to be used in clinical and educational practice. A total of 268 typically developing Italian children aged 4–11 years performed both WalCT and Corsi Block-Tapping Test (CBT; Corsi, 1972 Corsi, P. M. (1972). Human memory and the medial temporal region of the brain . McGill University, Montreal: Unpublished doctoral dissertation. [Google Scholar]) a well-known visuo-spatial memory test. WalCT has already been validated in adults, demonstrating sensitivity in detecting topographical memory deficits even in individuals who have no other memory impairments. Our results showed that age, but not sex, affected performances. Both girls and boys had a larger span on the CBT than the WalCT. The youngest group did not differ in performing WalCT and CBT, but from 5.6 years of age children performed better on CBT than WalCT, suggesting that memory in reaching space develops before topographical memory. Only after 5 years of age do children learn to process specifically topographical stimuli, suggesting that this happens when their environmental knowledge becomes operational and they increase environmental independence. We also discuss the importance to introduce WalCT in the clinical assessment.