Cues on request: The efficacy of Multicue,a computer program for wordfinding therapy

Background: Semantic and word form cues have been shown to have long‐term effects on naming in aphasia. Multicue is a computer program that offers a variety of cues for improving word finding. It stimulates the users' independence by encouraging them to discover themselves which cues are most helpful. Aims: We investigated the effects of Multicue on naming and verbal communication. Methods & Procedures: A total of 18 individuals with aphasia caused by stroke, who had completed intensive impairment‐oriented treatment, were randomised to 10–11 hours of Multicue (n = 8) or no treatment (n = 10). Outcomes & Results: Only the Multicue group improved on the Boston Naming Test. However, mean improvement did not differ significantly between the treated and untreated groups, neither for the BNT (95% CI: ?4.5 to 26.1), nor for the ANELT‐A (95% CI: ?2.4 to 9.4). Conclusions: In the chronic phase of aphasia, following impairment‐oriented treatment, Multicue may have a beneficial effect on word finding in picture naming, but not on verbal communication. The effect of Multicue may be the result either of self‐cueing or of improved access. The lack of generalisation to verbal communication is discussed.     

The impact of linguistic deficits on verbal communication

Background: The verbal communication of persons with aphasia may be disturbed by semantic, phonological, and/or syntactic processing deficits. For those with prominent linguistic-level disorders at least part of aphasia therapy is spent on the main linguistic skills, aimed at improvement of verbal communicative abilities. However, the relationship between these linguistic levels and verbal communication is not straightforward. This is especially true for deficits at the word level: semantic and phonological disorders. Aims: Exploration of the relative impact of semantic and phonological deficits on verbal communicative ability was the aim of the study. The hypothesis was that a lexical semantic deficit has a larger impact on the verbal communicative ability of persons with aphasia than a phonological deficit. Methods & Procedures: A total of 29 persons with aphasia who had both a semantic and phonological deficit were assessed by means of semantic and phonological tasks, and a test of verbal communication (ANELT-A). Semantic measures: Semantic Association Test, Synonym Judgement (receptive tasks), Wordfluency Categories, AAT spontaneous speech: semantics (expressive tasks). Phonological measures: Repetition of words, Repetition of non-words, Wordfluency Letters, AAT spontaneous speech: phonology. Linear regression analyses were performed with the ANELT-A as dependent variable and the semantic and phonological measures as independent variables. Multivariate regression analyses were performed to directly compare the independent contribution of the semantic version of a measure with the phonological version of the same measure. Outcomes & Results: Univariate regression analysis showed that the expressive semantic measures, Wordfluency Categories and AAT semantics, contributed significantly to the prediction of ANELT-A. One phonological measure, Wordfluency Letters, was selected as a significant predictor. However, in the multivariate regression analysis, only the semantic measures appeared to contribute independently to the prediction of the ANELT-A. The contribution of Wordfluency Letters, found in the univariate regression analysis, can be explained by a correlation with its semantic counterpart. Conclusions: These results support the hypothesis that semantic measures contribute more to the prediction of the ANELT-A (Understandability in verbal communication) than phonological measures. The ability to generate semantically correct content words, both in connected speech and in isolation, appears to be decisive for the aphasics' verbal communicative skills. Taking into account the severity of the semantic disorder in relation to other deficits, perhaps the best way to improve verbal communication in persons with both a semantic and a phonological deficit is to address the deficit with the greatest impact: the lexical semantic deficit.     

Topical corticosteroids in psoriasis: strategies for improving safety

Corticosteroids are a mainstay of topical therapy for psoriasis. While efficacious and relatively safe when used carefully, the potential for side effects, notably skin atrophy and adrenal suppression, have been associated with excesses in potency, prolonged or widespread use. The International Psoriasis Council Working Group on Topical Therapy has reviewed the efficacy and safety of topical corticosteroids and recommends strategies for safe, long‐term use of these agents.     

Circadian and sleep disturbances in the elderly

The incidence of disturbed sleep is strongly increased in healthy and demented elderly. Age-related alterations in the circadian timing system appear to contribute strongly to these problems. With increasing age, a lack of input to the suprachiasmatic nucleus (SCN), the biological clock of the brain, may accelerate de-activation of neurons involved in the generation of 24-h rhythm or output of this rhythm. This process appears to be reversible, since supplementation of stimuli that impinge on the SCN can re-activate these neurons and ameliorate disturbances in the sleep–wake rhythm.     

Hyperbilirubinemia, hypocarbia and periventricular leukomalacia in preterm infants: relationship to cerebral palsy

This study comprised 103 preterm infants with a gestational age less than 33 weeks who were born in Tampere University Hospital and who were followed up to two years of age. Sixty-four perinatal variables were compared to ultrasound findings in the neonatal period and neurologic handicap at the age of two years. Duration of hypocarbia (PCO2 < or = 30 mmHg) during the first 72 h and hyperbilirubinemia (the mean level of serum total bilirubin) at three days of age were independently and significantly related to periventricular leukomalacia, but not directly to cerebral palsy. The only perinatal variables related independently and significantly to cerebral palsy at two years of age were periventricular leukomalacia and ventriculomegaly. According to these results, periventricular leukomalacia was the main predictor of cerebral palsy in preterm infants. In addition to hypocarbia, hyperbilirubinemia may also be involved in the pathogenesis of extensive (severe cystic) periventricular leukomalacia.