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Biomedical subjects

N Helm-Estabrooks

Publications and source records attributed to N Helm-Estabrooks.

At least 19 recordsLinked to original sources
PubMed2001

Development of the pediatric test of brain injury.

OBJECTIVE: The Pediatric Test of Traumatic Brain Injury (PTBI) (currently in its research edition) is a tool for assessing the cognitive-linguistic skills of school-aged children and adolescents in acute care and rehabilitation settings after traumatic brain injury. Development of the PTBI was motivated by the fact that, to date, no standardized test has been available to assess the full range of cognitive-linguistic impairments associated with pediatric brain injury. In this article we describe how the research edition of the PTBI was developed, provide rationale for the areas of assessment, discuss a plan for standardization, and illustrate its use with three children with TBI. DESIGN: The PTBI was constructed to sample the attention, memory, language, reading, writing, metalinguistic, and metacognitive skills that are particularly at risk in pediatric brain injury and that are relevant to the general education curriculum. MATERIAL: The test material for the PTBI was selected on the basis of clinical and experimental evidence that children and adolescents with TBI demonstrate a wide range of cognitive and language deficits. These first appear in the early stages of recovery and often persist but change over time. CONCLUSION: Our goal is to standardize the PTBI so it can be used to establish baseline behaviors and track cognitive-linguistic recovery.

Accidents, Traffic↗
PubMed1999

Frequency of perseveration in normal subjects.

Although perseveration is a recognized sign of disturbed brain function, it also occurs in normal individuals. Determination of the frequency of perseveration in normal subjects would enable clinicians to use perseveration as a marker of possible pathology. The purpose of this study was to document the extent of perseveration in normal young and older subjects. Thirty young normal individuals between the ages of 20 and 35 years and 30 older normal individuals between the ages of 60 and 75 years were given four tasks on which perseveration has been reported in brain-damaged individuals. Four percent of all responses were perseverative. No age or gender effects on frequency were observed. Of the four neuropsychological tasks, the Modified Wisconsin Card Sorting Test elicited the greatest number of perseverations.

Adult↗
PubMed1998

Sudden onset of "stuttering" in an adult: neurogenic or psychogenic?

A 30-year-old woman hit her head during an automobile accident and was admitted to the hospital. One week later magnetic resonance imaging (MRI) showed a right frontal/parietal lesion. Among the behavioral sequelae were mild ataxia with trunkal instability and dysfluent speech accompanied by prominent shaking of the right leg, face and neck tension, and facial twitching. The speech-language pathologist thought the patient was not aphasic but rather was stuttering and treated her for about a month with pacing and "easy onset" techniques to which she showed fair response. The diagnostic question in this case is whether the stuttering was the result of the brain damage (neurogenic) or of the stressful events she had experienced (psychogenic). In this article we review her case and the process we used in arriving at an "expert" opinion.

Accidents, Traffic↗
PubMed1993

Evolution of severe aphasia in the first two years post onset.

In this longitudinal recovery study of severe aphasia, subjects were tested five times at 6-month intervals with the Boston Assessment of Severe Aphasia (BASA), for a period of 2 years post onset. The majority of subjects had global aphasia (n = 17), but five had severe Wernicke's aphasia, and two had other varieties of severe aphasia. Significant improvements in communicative functions were noted for up to 18 months post onset, but the greatest improvement occurred in the first 6 months post onset. Most subjects did not change aphasia classification during the 2-year period. Initial individual BASA cluster (subtest) scores were less accurate than the 6-month scores in the prediction of later BASA Total scores. Cluster scores obtained at 6 months post onset could reliably predict BASA Total scores at 24 months post onset.

Adult↗
PubMed1989

The relationship between limb apraxia and the spontaneous use of communicative gesture in aphasia.

This study investigated the relationship between limb apraxia, as assessed by a formal clinical test, and the production of spontaneous communicative gesture, as measured by a newly designed rating scale--the Nonvocal Communication Scale (NCS). Subjects were aphasic adult males with cerebrovascular lesions of the left hemisphere. The performance of aphasic patients on the praxis test and the NCS was independent of demographic, neuroanatomic, linguistic, or cognitive variables, except for global aphasics who were low-scoring across the board. There was a significant positive correlation, however, between praxis ability and spontaneous gestural communication. Clinical implications of these findings are discussed.

Anomia↗
PubMed1989

Severe nonfluency in aphasia. Role of the medial subcallosal fasciculus and other white matter pathways in recovery of spontaneous speech.

The relationship between location and extent of lesion on CT scan and limitation in spontaneous speech was examined. The severity of spontaneous speech ranged from cases with no speech or only verbal stereotypies (first major group) to those with reduced, hesitant, poorly articulated, agrammatic speech (nonfluent Broca's aphasia, second major group). CT scan analysis revealed no single neuroanatomical area that contained an extensive lesion which could be used to discriminate the most severe cases from the least severe. The two groups were separable, however, on the basis of the CT scan when the extent of the lesion in two subcortical white matter areas were combined: (1) the most medial and rostral portion of the subcallosal fasciculus plus (2) the periventricular white matter near the body of the lateral ventricle, deep to the lower motor/sensory cortex area for the mouth. The most rostral portion of the medial subcallosal fasciculus, located in the lateral angle of the frontal horn (extremely deep to Broca's area), contains projections from the cingulate gyrus (area 24) and the supplementary motor area, to the caudate nucleus. We suggest that one explanation for the more severe limitation in spontaneous speech in the first group is the extensive white matter lesion in these two subcortical pathways had interrupted a large number of connections for (1) initiation and preparation of speech movements, and limbic aspects of speech (lesions in the medial subcallosal fasciculus), and (2) motor execution and sensory feedback for spontaneous speech (lesions in periventricular white matter deep to the motor/sensory cortex area for the mouth). Extensive lesion in only one of these two white matter pathway areas, alone was not sufficient to produce long-lasting severe limitation in spontaneous speech and could not be used to discriminate the two groups on the basis of the CT scans. The patients with less severe limitation in spontaneous speech (nonfluent Broca's aphasia) had less extensive lesion within these two white matter areas combined, and had interrupted a smaller number of these subcortical connections. The sites of the lesions in subcortical white matter in CT scans in Broca's original case who could only produce a verbal stereotypy are similar to those in our first group with the most severe limitation in spontaneous speech. The presence or absence of hemiplegia was not related to severity or recovery of spontaneous speech. Careful examination of lesion extent in these two areas of subcortical white matter on CT scanning appears to be relevant in predicting potential for recovery of spontaneous speech in some stroke patients.

Adult↗
PubMed1988

Pharmacotherapy for aphasia.

Selected features of aphasia may reflect disruption of specific neurotransmitter systems. Pharmacotherapy focused on these aphasic symptoms may improve language performance following stroke. We attempted to restore speech fluency in a patient with long-standing transcortical motor aphasia by treating his symptoms of hesitancy and impaired initiation of speech with bromocriptine. During therapy his language performance improved substantially, due to reduced latency of response, decreased paraphasias, and increased naming ability. After cessation of drug therapy his language returned to baseline.

Aphasia↗
PubMed1987

Relationship between lesion extent in 'Wernicke's area' on computed tomographic scan and predicting recovery of comprehension in Wernicke's aphasia.

This study investigated the relationship between severity of auditory comprehension in Wernicke's aphasia and amount of temporal lobe damage within Wernicke's area (posterior two thirds of superior temporal gyrus region) as well as the total temporoparietal lesion size. There was a highly significant correlation between comprehension and the amount of temporal lobe lesion in Wernicke's area. There was no significant correlation between comprehension and the total temporoparietal lesion size. Patients with damage in only half or less than half of Wernicke's area had good comprehension at six months after the onset of stroke. Patients with damage in more than half of Wernicke's area had poor comprehension even one year after the onset of stroke. Additional anterior-inferior temporal lobe lesion extension into the middle temporal gyrus area was associated with particularly poor recovery.

Aged↗
PubMed1987

Treatment of aphasic perseveration (TAP) program. A new approach to aphasia therapy.

We have devised a new approach to the therapy of aphasia. Rather than focus on rehabilitation of linguistic errors, we treat perseveration, which may be an integral component of the aphasic symptoms. In this report we provide key elements of our Treatment of Aphasic Perseveration (TAP) technique, and the successful use of this method with three aphasic patients.

Aphasia↗
PubMed1986

Stuttering: disappearance and reappearance with acquired brain lesions.

Despite 60 years of study, the brain mechanisms for stuttering are unknown. In an effort to shed light on these mechanisms, we studied two cases in which the fluency of speech changed after brain damage in adulthood. The first, an ambidextrous man, ceased to stutter after a head injury. The second, a converted left-handed man, experienced recurrence of childhood stuttering after a stroke.

Adolescent↗
PubMed1986

Aphasia treatment delivered by telephone.

Telephone delivery of speech and language treatment programs may be an effective supplement to the more traditional face-to-face delivery. This report describes the response of a nonfluent aphasic patient who, at 11 years postonset, was treated over the telephone using a hierarchically structured syntax treatment program. Examination of pre- and posttreatment performance on the Northwestern Syntax Screening Test and the Boston Diagnostic Aphasia Examination Cookie Theft Description showed improvement on both dependent variables. The results support the use of telephone therapy with patients who are unable to attend clinic sessions because of geographic inaccessibility or transportation problems.

Adult↗
PubMed1985

CT scan lesion localization and response to melodic intonation therapy with nonfluent aphasia cases.

The purpose of this retrospective study was to investigate the relationship between CT scan lesion localization and good or poor response to Melodic Intonation Therapy (MIT) as measured by pre- and post-MIT treatment scores. The four good response (GR) cases improved in speech characteristics ratings for Phrase Length and Grammatical Form on the Boston Diagnostic Aphasia Examination; the four poor response (PR) cases showed no improvement. The GR cases had lesions which involved Broca's area and/or white matter deep to it plus large superior lesion extension into periventricular white matter deep to the lower motor cortex area for face. These GR cases had no large lesion in Wernicke's area and no lesion in the temporal isthmus or the right hemisphere. The PR cases, however, had bi-lateral lesions or lesion including Wernicke's area or the temporal isthmus.

Adult↗
PubMed1985

Empty speech in Alzheimer's disease and fluent aphasia.

Fourteen measures of empty speech during a picture description task were examined in four subject groups--patients with Alzheimer's dementia, Wernicke's aphasias, anomic aphasias, and normal controls--to discover if these groups could be distinguished on the basis of their discourse. Patients with Alzheimer's dementia were distinguished from patients with Wernicke's aphasia by producing more empty phrases and conjunctions, whereas patients with Wernicke's aphasia produced more neologisms, and verbal and literal paraphasias. The demented patients shared many empty speech characteristics with patients with anomic aphasia. Naming deficits, as measured by confrontation naming tasks, did not correlate with empty discourse production. Our findings may be useful clinically for distinguishing these different patient groups.

Adult↗