Biomedical subjects

Heather G Belanger

Publications and source records attributed to Heather G Belanger.

10 recordsLinked to original sources

PubMed2006

Executive control and learning pattern on the CVLT.

We evaluated a 23 year-old man after recovery from encephalitis. In contrast to the expected pattern of increasingly better acquisition across the 5 learning trials of the California Verbal Learning Test (CVLT-2), he produced a "J-shaped" curve (Trials 1-5: 8,6,6,9,11). Because he also demonstrated excessive levels of proactive interference as well as poor divided attention, we hypothesized that his atypical learning pattern was due to a build-up of proactive interference secondary to executive dyscontrol. Using a large sample of 4462 healthy adult men, we identified four groups exhibiting various learning patterns. We found that a learning pattern similar to this patient (i.e., a drop after trial 1 followed by recovery) was rare (1.1% of the sample). Individuals with this learning pattern demonstrated increased perseverative responses, as well as greater difficulty maintaining cognitive set on the Wisconsin Card Sorting Test, decreased attentional control on the Paced Auditory Serial Addition Test, and greater levels of proactive interference on the CVLT. Taken together, the results of the study suggest that an early drop, followed by a recovery in learning trial performance, is associated with executive dyscontrol.

Adult↗

PubMed2006

Mechanism-of-injury approach to evaluating patients with blast-related polytrauma.

Civilians and military personnel alike are increasingly being exposed to explosives in war zones and other regions of political conflict and, consequently, they are suffering associated blast-related polytrauma (multiple complex injuries). Although acute, emergency-based medical care for patients with blast-related trauma has been well described, postacute clinical management--which is of greatest interest to primary care physicians and rehabilitation specialists--has not been well discussed or researched. The authors offer a description of the common injuries seen in patients with blast-related polytrauma, as well as a conceptual model of a potential evaluation and treatment strategy in the postacute setting. Although medical evaluation of a patient typically proceeds in a sequential manner based on primary symptoms, the authors advocate a parallel approach to patient evaluation based on mechanism (cause) of injury. Such an approach relies on knowledge of the typical physical and psychological sequelae associated with a particular mechanism of injury to guide patient assessment and treatment. The authors highlight the mechanism-of-injury approach used with patients who have blast-related polytrauma at the Veterans Health Administration's (VHA) Veterans Affairs Medical Center in Tampa, Fla, site of one of the VHA's four Polytrauma Rehabilitation Centers.

Case Management↗

PubMed2005

Assessing motor and cognitive regulation in AD, MCI, and controls using the Behavioral Dyscontrol Scale.

The objective of this study was to evaluate the utility of the Behavioral Dyscontrol Scale (BDS) as a measure of behavioral regulation in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Two patients groups (n=40 MCI and 40 AD) recruited from a memory clinic and an elderly control (EC) group (n=40) recruited from the community were administered a battery of neuropsychological tests including the BDS and a measure of functioning of activities of daily living (ADLs). Results of ROC analyses revealed that performance on the BDS discriminated between the AD group and the MCI and EC groups but did not discriminate between the MCI and EC groups. Performance on the BDS was an independent predictor of ADLs in patient groups after controlling for the effects of performance on a memory measure.

Activities of Daily Living↗

PubMed2005

Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis.

There continues to be debate about the long-term neuropsychological impact of mild traumatic brain injury (MTBI). A meta-analysis of the relevant literature was conducted to determine the impact of MTBI across nine cognitive domains. The analysis was based on 39 studies involving 1463 cases of MTBI and 1191 control cases. The overall effect of MTBI on neuropsychological functioning was moderate (d = .54). However, findings were moderated by cognitive domain, time since injury, patient characteristics, and sampling methods. Acute effects (less than 3 months postinjury) of MTBI were greatest for delayed memory and fluency (d = 1.03 and .89, respectively). In unselected or prospective samples, the overall analysis revealed no residual neuropsychological impairment by 3 months postinjury (d = .04). In contrast, clinic-based samples and samples including participants in litigation were associated with greater cognitive sequelae of MTBI (d = .74 and .78, respectively at 3 months or greater). Indeed, litigation was associated with stable or worsening of cognitive functioning over time. The implications and limitations of these findings are discussed.

Brain Injuries↗

PubMed2005

Long-term neuropsychological outcomes following mild traumatic brain injury.

Mild traumatic brain injury (MTBI) is common, yet few studies have examined neuropsychological outcomes more than 1 year postinjury. Studies of nonreferred individuals with MTBI or studies with appropriate control groups are lacking, but necessary to draw conclusions regarding natural recovery from MTBI. We examined the long-term neuropsychological outcomes of a self-reported MTBI an average of 8 years postinjury in a nonreferred community-dwelling sample of male veterans. This was a cross-sectional cohort study derived from the Vietnam Experience Study. Three groups matched on premorbid cognitive ability were examined, those who (1) had not been injured in a MVA nor had a head injury (Normal Control; n = 3214), (2) had been injured in a motor vehicle accident (MVA) but did not have a head injury (MVA Control; n = 539), and (3) had a head injury with altered consciousness (MTBI; n = 254). A MANOVA found no group differences on a standard neuropsychological test battery of 15 measures. Across 15 measures, the average neuropsychological effect size of MTBI compared with either control group was -.03. Subtle aspects of attention and working memory also were examined by comparing groups on Paced Auditory Serial Addition Test (PASAT) continuation rate and California Verbal Learning Test (CVLT) proactive interference (PI). Compared with normal controls, the MTBI group evidenced attention problems in their lower rate of continuation to completion on the PASAT (odds ratio = 1.32, CI = 1.0-1.73) and in excessive PI (odds ratio = 1.66, CI = 1.11-2.47). Unique to the MTBI group, PASAT continuation problems were associated with left-sided visual imperceptions and excessive PI was associated with impaired tandem gait. These results show that MTBI can have adverse long-term neuropsychological outcomes on subtle aspects of complex attention and working memory.

Adult↗

PubMed2005

The neuropsychological impact of sports-related concussion: a meta-analysis.

There is increasing interest in the potential neuropsychological impact of sports-related concussion. A meta-analysis of the relevant literature was conducted to determine the impact of sports-related concussion across six cognitive domains. The analysis was based on 21 studies involving 790 cases of concussion and 2014 control cases. The overall effect of concussion (d = 0.49) was comparable to the effect found in the non-sports-related mild traumatic brain injury population (d = 0.54; Belanger et al., 2005). Using sports-concussed participants with a history of prior head injury appears to inflate the effect sizes associated with the current sports-related concussion. Acute effects (within 24 hr of injury) of concussion were greatest for delayed memory, memory acquisition, and global cognitive functioning (d = 1.00, 1.03, and 1.42, respectively). However, no residual neuropsychological impairments were found when testing was completed beyond 7 days postinjury. These findings were moderated by cognitive domain and comparison group (control group versus preconcussion self-control). Specifically, delayed memory in studies utilizing a control group remained problematic at 7 days. The implications and limitations of these findings are discussed.

Athletic Injuries↗

PubMed2003

Patient dignity in persons with spinal cord injury.

Technology is changing the way nurses provide patient care in spinal cord injury. A key nursing concern is the impact of technology-assisted caregiving tasks (TACT) on the patients' sense of dignity. Despite frequent use of the term dignity in discussing treatment of persons with disabilities, there is a dearth of empirical research related to this topic. In particular, there have been few attempts to define the construct for the purposes of valid measurement. The purpose of this article is, therefore, to critically review the relevant literature on patient dignity with an aim toward eventual development and validation of a Dignity Assessment Tool.

Attitude of Health Personnel↗

PubMed2002

The lateralized stroop: a meta-analysis and its implications for models of semantic processing.

The prevailing theory in the literature concerning the lateralization of Stroop effects involves a speed of processing account (see ). Because the left hemisphere (LH) demonstrates an overall advantage relative to the right hemisphere (RH) on most verbal tasks, interference effects are hypothesized to be greater in the LH than in the RH. Inspection of the data, however, reveals that many studies find no difference in magnitude of Stroop interference between the hemispheres. Given findings within the lateralized semantic priming literature, this is not surprising. A meta-analysis on a subset of lateralized Stroop experiments was conducted to determine whether or not the LH produces significantly more interference than the RH in this paradigm. Based on a number of exclusionary criteria, a total of 19 different studies were included, representing a potential 26 effect size estimates of differential interference. The effect size representing interference using congruent conditions as the baseline (d+=.06) reveals that there is no significant difference between the hemispheres in magnitude of the Stroop interference effect. The LH interference effect was d+=.73, which is significant. Likewise, the RH interference effect, d+=.67, was significant. In summary, while there was no significant difference between the hemispheres, each hemisphere, when examined independently, did exhibit significant within hemisphere interference effects. These findings are presented in light of the lateralized semantic priming literature.

Brain↗

PubMed2002

The Key Behaviors Change Inventory and executive functioning in an elderly clinic sample.

The Key Behaviors Change Inventory (KBCI) was developed to assess executive, behavioral, and emotional functioning following brain insults and to track the course of recovery. The purpose of this study was to investigate, in an elderly memory disorder clinic sample, the convergent and discriminant validity of the KBCI by examining the relationships between various measures of executive functioning and the KBCI scales that theoretically relate to executive functions. The KBCI was administered to the caregivers of 97 consecutive patients who came to a memory disorders clinic seeking services. The KBCI scales of Inattention, Apathy, Unawareness of Problems, and Communication Problems were significantly correlated with cognitive measures of executive functioning but not with measures of memory, visuospatial abilities or global cognitive functioning. In contrast, KBCI scales of Interpersonal Difficulties, Somatic Difficulties, and Emotional Adjustment were not related to any cognitive measures, either executive or nonexecutive. Contrary to predicted findings, the Impulsivity Scale was not associated with cognitive measures of executive functioning. This lack of relationship most likely reflects the failure to include executive measures of orbitofrontal functioning in this study. Results provide convergent and discriminant validity support for the KBCI. The KBCI may be a useful tool for assessing and tracking the executive, behavioral, and emotional sequelae of neurologic disorders.

Adaptation, Psychological↗

PubMedDate not supplied

Utility of mechanism-of-injury-based assessment and treatment: Blast Injury Program case illustration.

While medicine typically proceeds in a sequential fashion based on primary symptoms, sometimes relying on a parallel, mechanism-of-injury-based approach is advantageous, particularly when the mechanism of injury is associated with a variety of known sequelae. A mechanism-of-injury-based approach relies on knowledge of the typical sequelae associated with that mechanism of injury to guide assessment and treatment. Thus, it represents an active, rather than passive, case-finding approach. This article describes an example of a mechanism-of-injury-based program, namely, a Blast Injury Program at the James A. Haley Veterans Hospital in Tampa, Florida. Case examples illustrate the utility of this approach with regard to more comprehensive assessment and treatment, as well as the possibility for secondary prevention.

Adult↗