Biomedical subjects

Margaret B Pulsifer

Publications and source records attributed to Margaret B Pulsifer.

6 recordsLinked to original sources

PubMed2007

Cognitive prognosis of patients with tuberous sclerosis complex.

To assess cognitive outcome in patients with tuberous sclerosis complex (TSC) and identify predictive risk factors, we reviewed records of 107 patients who underwent comprehensive neuropsychiatric evaluation. Fifty-seven percent of patients with TSC had normal-range IQ/developmental quotient (DQ). Cognitive outcome was strongly associated with refractory seizures and TSC2 mutation. In TSC, IQ/DQ is bimodally distributed, and more than half of individuals are in the normal range.

Adolescent↗

PubMed2004

Effects of central nervous system residua on cochlear implant results in children deafened by meningitis.

BACKGROUND: This study explored factors associated with speech recognition outcomes in postmeningitic deafness (PMD). The results of cochlear implantation may vary in children with PMD because of sequelae that extend beyond the auditory periphery. OBJECTIVE: To determine which factors might be most determinative of outcome of cochlear implantation in children with PMD. DESIGN: Retrospective chart review. SETTING: A referral center for pediatric cochlear implantation and rehabilitation. SUBJECTS: Thirty children with cochlear implants who were deafened by meningitis were matched with subjects who were deafened by other causes based on the age at diagnosis, age at cochlear implantation, age at which hearing aids were first used, and method of communication used at home or in the classroom. MAIN OUTCOME MEASURE: Speech perception performance within the first 2 years after cochlear implantation and its relationship with presurgical cognitive measures and medical history. RESULTS: There was no difference in the overall cognitive or postoperative speech perception performance between the children with PMD and those deafened by other causes. The presence of postmeningitic hydrocephalus, however, posed greater challenges to the rehabilitation process, as indicated by significantly smaller gains in speech perception and a predilection for behavioral problems. By comparison, cochlear scarring and incomplete electrode insertion had no impact on speech perception results. CONCLUSIONS: Although the results demonstrated no significant delay in cognitive or speech perception performance in the PMD group, central nervous system residua, when present, can impede the acquisition of speech perception with a cochlear implant. Central effects associated with PMD may thus impact language learning potential; cognitive and behavioral therapy should be considered in rehabilitative planning and in establishing expectations of outcome.

Child↗

PubMed2004

Intelligence and school readiness in preschool children with prenatal drug exposure.

This prospective, longitudinal study examined factors affecting intelligence and school readiness in children 4-5 years of age with prenatal cocaine/opiate exposure. Intelligence and school readiness scores were not significantly different for the drug-exposed group (N = 104) than for unexposed, demographically matched controls (N = 35), although both groups scored slightly below average. Caregivers of drug-exposed children scored significantly lower in intelligence and reading achievement than caregivers of controls; both were below average. Caregiver reading scores accounted for the largest variance in both child intelligence and school readiness; for school readiness, birth weight also contributed but was less important in the model. Neither prenatal drug exposure nor continuing caregiver drug use was significant in the regression analyses. The relationship between child scores and caregiver reading achievement is consistent with studies showing the importance of a stimulating, supportive home environment, and suggests interventions to foster caregiver literacy skills and facilitate caregiver-child cognitive interactions such as reading to the child.

Adult↗

PubMed2004

The cognitive outcome of hemispherectomy in 71 children.

PURPOSE: Long-term neuropsychological outcome was studied in 71 patients who underwent hemispherectomy for severe and intractable seizures at The Johns Hopkins Hospital between 1968 and 1997 and who agreed to participate. Seizures were due to cortical dysplasias (n = 27), Rasmussen syndrome (n = 37), or vascular malformations or strokes (n = 7). Both presurgical and follow-up results are available and reported for 53 patients. METHODS: Patients and caretakers were interviewed, and patients were administered standard measures of intelligence, receptive and expressive language, visual-motor skills, adaptive/developmental functioning, and behavior. RESULTS: Mean age at surgery was 7.2 years. At follow-up, on average 5.4 years after surgery, 65% are seizure free, 49% are medication free, and, of those responding, none rated quality of life as worse than before surgery. Mean IQ was in the 70s for Rasmussen and vascular patients and in the 30s for cortical dysplasia patients. Language and visual-motor skills were consistent with IQ. For Rasmussen patients only, language was significantly more impaired for left than for right hemispherectomy, both before surgery and at follow-up. Adaptive skills were mildly impaired, with greatest impairment in the physical domain. Cognitive measures typically changed little between surgery and follow-up, with IQ change <15 points for 34 of 53 patients; of the remainder, 11 declined and eight improved. Behavior was free of major problems, but social interactions and activities were limited. CONCLUSIONS: The most significant predictor of cognitive skills at follow-up was etiology, with dysplasia patients scoring lowest in intelligence and language but not in visual-motor skills. Regardless of etiology, most patients showed only moderate change in cognitive performance at follow-up.

Child↗

PubMed2003

Developmental, audiological, and speech perception functioning in children after cochlear implant surgery.

OBJECTIVES: To examine changes in audiological, speech perception, and developmental functioning subsequent to cochlear implantation in children with severe to profound hearing impairment, and to identify factors related to those changes. DESIGN: Prospective, longitudinal analysis to compare functioning of pediatric patients who underwent cochlear implantation before and 1 year after surgery. SETTING: Outpatient pediatric cochlear implantation program in an academic institution (The Listening Center, The Johns Hopkins University School of Medicine, Baltimore, Md). Patients Forty consecutive pediatric patients between 1(1/2) and 9 years of age who received a cochlear implant between April 1, 1996, and August 31, 1998, and who also underwent psychological, audiological, and speech perception evaluations immediately before and 1 year after implantation. MAIN OUTCOME MEASURE: Scores on the Bayley Scales of Infant Development-Second Edition, Stanford-Binet Intelligence Scale-Fourth Edition, Developmental Profile II, Child Behavior Checklist, speech perception categories, and audiological pure-tone thresholds. RESULTS: Mean (SD) duration of hearing impairment was 37.78 (27.94) months, mean (SD) age at surgery was 50.72 (27.66) months. Significant improvements were found 1 year after surgery in audiological, speech perception, and developmental functioning, but not in nonverbal intelligence or behavior. Greater benefits in audiological and developmental functioning were associated with younger age (<48 months) at implantation. CONCLUSIONS: Patients showed significant improvement in audiological status, overall developmental functioning, and speech perception skills in a short time after surgery. Greatest improvement in speech perception was for children with the least initial impairment, and greatest developmental gains were associated with young age at implantation.

Age Factors↗

PubMed2003

Comparison of intelligence, school readiness skills, and attention in in-utero drug-exposed and nonexposed preschool children.

Children with in-utero drug exposure (IUDE) may be at risk for poor neurodevelopmental outcomes. The objective of this study was to determine the association between IQ, school readiness skills, and self-regulation behavior in IUDE children (n=103) and non IUDE-exposed children (n=33) at age 4 years. Mean IQ or school readiness scores did not significantly differ by IUDE exposure; however, both groups scored approximately 1 standard deviation below the mean for both IQ and school readiness skills. The IUDE group earned a significantly higher mean score (thereby performing poorer) than the nonexposed group on focusing and inattentive behavior. Factors associated with poor school readiness skills for all children (IUDE exposed and nonexposed) were not attending a preschool program and lower caregiver education level. Assuring high-risk children are identified and referred for early intervention services as well as treated for inattention behavior is crucial for their academic success.

Attention↗