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Biomedical subjects

R M Ruff

Publications and source records attributed to R M Ruff.

At least 37 records · Page 2Linked to original sources
PubMed1990

Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.

The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.

Adolescent↗
PubMed1990

Neuropsychological sequelae of exposure to the chlorinated hydrocarbon solvents trichloroethylene and trichloroethane.

Reports in the literature concerning the acute neurobehavioral effects of trichloroethylene (TCE) and trichloroethane (TCA) conflict as to whether or not cognitive deficits ensue. Our study of two patients acutely exposed to low concentrations of TCE suggests that (a) acute, low-dose exposures are sufficient to produce the mild to moderate impairments in psychomotor speed, attention and memory also reported after chronic exposures; (b) these memory impairments may be characterized by storage and/or retrieval difficulties; (c) the neural damage produced by TCE exposure is likely to be diffuse, but temporal lobe structures supporting memory may be more sensitive to TCE exposure than other brain structures; and (d) even brief exposures can lead to prolonged, but not necessarily chronic mild to moderate cognitive impairment. In a third case, exposed to trichloroethane (TCA), the neuropsychological profile suggests that this substance has few, if any, neurobehavioral effects at low concentrations.

Journal Article↗
PubMed1989

Motivational effects on neuropsychological functioning: comparison of depressed versus nondepressed individuals.

The neuropsychology of depression was examined in terms of organic and motivational hypotheses. Thirty medication-free depressed outpatients (selected according to Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association, 1980] criteria for major depression) and 30 nondepressed normal controls were evaluated with a variety of neuropsychology measures. Prior to testing, subjects were assigned randomly to either a motivated or nonmotivated condition. A task measuring level of motivation demonstrated efficacy of the two motivation conditions. A 2 x 2 (Diagnosis x Motivational Level) multivariate analysis of variance of all the dependent measures revealed a significant main effect for depression, but no effect for motivation and no interaction. Univariate analyses demonstrated that the depressed group was impaired on visuospatial short-term memory and learning and on verbal learning. The finding of neuropsychological deficit in depressed subjects was not attributable to motivational factors. The problems with conceptualizing depression as a right-hemisphere dysfunction are discussed.

Depressive Disorder↗
PubMed1989

Selective Reminding Tests: a normative study of verbal learning in adults.

Verbal learning was assessed according to the Selective Reminding Test (SRT) in order to establish normative data and to provide a comparison with measures of immediate attention, verbal IQ, and verbal memory. The 392 subjects, stratified by sex (202 women, 190 men), age (4 groups: 16-70 years), and education (3 groups), were free of conflicting pathologies. Learning curves were established on centiles (75, 50, 25, 5). Sex differences favoring women were found in percent of finishers (those who reached criterion), and at all percentile levels of acquisition. Data were analyzed for group differences in performance on the SRT and related concurrent measures, but sex differences were not found on the VIQ or immediate attention tests. Also, assumptions of age and education stratification were not confirmed. However, those who completed the task were better able to form associational strategies than those who were unable to finish. The present data indicate that it is important to use detailed norms by gender and criterion level if clinical interpretations are to be valid.

Adolescent↗
PubMed1988

The efficacy of structured memory retraining in a group comparison of head trauma patients.

Empirically proven mnemonic techniques from the literature were assembled into a comprehensive treatment program for brain injured clients. Twenty head injured subjects with mild to moderate neuropsychological impairments were matched on the variables of age, sex, years of formal premorbid education, and elapsed time since insult. These patients were then randomly assigned to either the control or experimental remediation group. Both groups attended a six-week program and were blind as to what type of treatment they were receiving. Each followed identical daily schedules where the experimental group received the formal memory remediation and the controls received treatment focusing on psychosocial issues. Both groups improved on the neuropsychological memory measures over the course of the study. The experimental group did not improve significantly more than did the control group; however, once the groups were subdivided according to the severity of neuropsychological functioning at intake, significant treatment effects were observed. More specifically, only those patients with mild residual impairments seemed to benefit from rehabilitative efforts, and those with more moderate deficits did not respond to treatment. Clinical implications and future research are discussed.

Clinical Trial↗
PubMed1987

Neurobehavioral outcome following minor head injury: a three-center study.

The majority of hospital admissions for head trauma are due to minor injuries; that is, no or only transient loss of consciousness without major complications and not requiring intracranial surgery. Despite the low mortality rate following minor head injury, there is controversy surrounding the extent of morbidity and the long-term sequelae. The authors postulated that consecutively admitted patients who fulfilled research diagnostic criteria for minor head injury and who were carefully screened for antecedent neuropsychiatric disorder and prior head injury would exhibit subacute cognitive and memory deficits that would resolve over a period of 1 to 3 months postinjury. To evaluate this hypothesis, the neurobehavioral functioning of 57 patients was compared within 1 week after minor head injury (baseline) and at 1 month postinjury with that of 56 selected control subjects at three medical centers. Quantified tests of memory, attention, and information-processing speed revealed that neurobehavioral impairment demonstrated at baseline by all means of measurement generally resolved during the first 3 months after minor head injury. Although nearly all patients initially reported cognitive problems, somatic complaints, and emotional malaise, these postconcussion symptoms had substantially resolved by the 3-month follow-up examination. The data suggest that a single uncomplicated minor head injury produces no permanent disabling neurobehavioral impairment in the great majority of patients who are free of preexisting neuropsychiatric disorder and substance abuse.

Adolescent↗
PubMed1987

Construct validity of the San Diego Neuropsychological Test Battery.

A group of 259 normal adults were administered the San Diego Neuropsychological Test Battery. Factor analysis of the SDNB supported the construct validity of the battery according to a Luria-based functional systems assessment approach. Using expert ratings to interpret the obtained factor loadings, the following factors were identified: (a) arousal, (b) mnestic processes, (c) complex intelligence, and (d) planning. A second factor analysis of the SDNB, using a sample of 100 schizophrenic and head injured cases, achieved a factor structure very similar to that of the normal sample, offering further empirical support for a functional assessment approach with clinical populations. The clinical factor analysis yielded slightly different proportions of variance contributed by the test measures and two planning factors. The results are discussed as they relate to Luria's qualitative analysis of cortical organization applied to a quantitative methodology.

Journal Article↗
PubMed1986

Automatic detection vs controlled search: a paper-and-pencil approach.

A new measure of selective attention was presented to 259 normal volunteers. The test was derived from earlier work which emphasized the importance of controlling the distracting conditions using a selective-attention paradigm. In the present study a paper-and-pencil, digit-cancellation format was introduced and the data documented a significant dissociation between tasks analogous to controlled search and automatic detection, two theoretically important aspects of selective attention. Presented is a discussion of similarities and differences of the new measure and classical methods of discriminating between controlled search and automatic detection and the potential significance of this discrimination in clinical neuropsychological investigations.

Adolescent↗
PubMed1986

On the consistency of the MMPI in borderline personality disorder.

14 patients diagnosed as having Borderline Personality Disorder were examined on two separate occasions with the MMPI. Results strongly suggest that, as a group, borderline patients are quite consistent responders on the MMPI under test-retest conditions (1 to 58 mo.). The frequency distribution of scale elevations and code types was also examined which showed the often-noted heterogeneity of profile code types within this population. Thus, a note of caution is advised for those investigators who assume that a prototypical borderline MMPI profile exists. Specifically, considerable heterogeneity is seen among this sample of patients with respect to a two-point coding strategy, and individual codes change over time.

Adult↗
PubMed1986

Impaired verbal and figural fluency after head injury.

Previous research has found that verbal fluency is reduced in head-injured patients and in patients with focal damage to the frontal lobes. The present study compares a task of verbal associative fluency with a new measure of nonverbal, or figural, fluency that focuses on speed of producing unique designs and accounting for perseverative tendencies. Using results from 35 head-injured patients and 50 normals, we found that both verbal and figural fluency are compromised following brain trauma. Consistent with previous research, patients with severe head injuries were more impaired than patients with moderate head injuries. The discussion focuses on those cognitive factors that might influence verbal or figural fluency.

Journal Article↗
PubMed1985

Orthodontic treatment and tongue surgery in a class III open-bite malocclusion. A case report.

Cases such as this are a real challenge to clinical orthodontists. They require patience as well as proper diagnosis and treatment planning. The orthodontist must also help the patient psychologically by treating the teeth and surrounding structures and by treating the patient as an individual. It is the feeling of both the Author and the Plastic surgeon in this case, Dr. Fernando Ortiz Monasterio, that this type of surgery would be successful in most non-pathological macroglossia cases. It appears that the sutured areas might be said to develop more dense epithelial tissue, not allowing the tongue to expand and readapt so readily to the position of the teeth in the mandibular arch. This is indicated in the present case, as is demonstrated by the decrease in width of the mandibular arch from the first molar area to the anterior part of the mouth. It should be noted that orthognathic surgery was not as widely used at the time that this patient was studied and treated as it is today. If this case had presented for the first time this year, it is likely that the treatment plan of most orthodontists would have combined orthognathic and tongue surgery, with orthodontics to lessen trauma to the supporting structures of the teeth from the extreme and complicated mechanics which would have to be used in treatment. The psychological aspects of this case were of tremendous importance; the treatment results have undoubtedly changed his life completely (Fig. 10). Once unable to speak clearly with his oversize tongue, he has since gone on to complete his education and is now a successful orthodontist.

Adult↗
PubMed1985

Audiospatial integration.

A method to examine audiospatial integration was developed through studies of normal and brain-injured patients. The method used a sound source sequentially outlining a spatial pattern within an array of 100 loudspeakers. For 48 subjects tested with this method, the presence or absence of visual cues had no effect in audiospatial processing. Eye movements also did not match the perceived sound patterns. Significantly higher hit rates were obtained by placing the panel of loudspeakers in front, behind or above the subject rather than on the left or right. These differences were observed with involuntary but not with voluntary head-fixation. Theoretical concepts of audiospatial processing are discussed.

Acoustic Stimulation↗
PubMed1985

Verbal fluency and figural fluency in bright children.

Intellectually bright children in Grades 2, 4, and 6 from one school and adults were assessed on measures of verbal and on a new measure of figural fluency. Consistent with previous research, age-dependent performance was observed on both fluency tasks. Analysis of covariance with motor speed as the covariate reduced the F ratio for the figural task, although age-related significant differences persisted. Results suggest that age-related improvement of performance on fluency measures with intellectually bright subjects differs from that for intellectually average subjects. Hypotheses are also advanced regarding the proposed reliable figural-fluency task as preferable to previously employed nonverbal measures, suggesting a more valid dissociation of function. These preliminary findings encourage further research on the age- and IQ-related aspects of verbal and figural fluency.

Adult↗
PubMed1984

MMPI characteristics of borderline personality inpatients.

MMPI (Form R) profiles of psychiatric inpatients (N = 45) meeting DSM-III criteria for borderline personality disorder were compared with chronic schizophrenic inpatients (N = 48) and with inpatients with acute psychotic illness (N = 20). Profile shape was similar among the three groups, although the borderline sample showed significantly higher elevations on four of the 10 clinical scales--Depression, Hysteria, Psychopathic Deviate, and Psychasthenia--when compared to the chronic schizophrenic cohorts. The borderline sample showed only one significant deviation on the clinical scales when compared to the acute psychotic sample as evidenced by a higher elevation on the Psychopathic Deviate scale. Clinically, the borderline MMPI responses suggest features of irritability, hostility, and resentfulness. On the validity scales, the borderline sample showed a significantly lower score on the L scale when compared to both comparison groups, although all of the groups' L scale scores were within conventional limits. While significant differences between groups did not emerge on the F scale, the borderline sample attained a clinically elevated score suggestive of weakened ego defenses and unconventional thinking. Analysis was also performed of a composite measure of psychoticism probability (the Goldberg Index) between groups. While the borderline and acute psychotic samples showed Goldberg indices suggestive of increasing likelihood for psychotic illness, the chronic schizophrenic group yielded a Goldberg Index significantly greater than both of the other groups, thus confirming the validity of the hypothesis. Finally, the MMPI borderline profiles were also compared to previously published norms of borderline outpatients and veteran borderline inpatients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Deficits in auditory-spatial integration of sequentially presented patterns due to cortical lesions.

Groups of patients with cortical lesions were subjected to a uniquely developed procedure to test auditory-spatial perception. The stimuli were comprised of a sound source, which sequentially outlined a pattern within a 10 X 10 matrix of loudspeakers. Simple sound patterns, which "moved" across the loudspeaker array only once or twice, were equally well identified by the control group and the various patient groups. However, the more complex patterns, which outlined the contour of alphabetical letters, resulted in significantly lowered identification rates for the patient groups with lesions in the right posterior, left posterior and left temporal lobes. As a control measure, visual-spatial tasks were administered, and lower performance rates were found for the left and right posterior groups. The differences and similarities between auditory spatial and visual-spatial processing are discussed.

Auditory Perception↗
PubMed1982

Spatial mapping of two-dimensional sound patterns presented sequentially.

Man's spatial perception was investigated on the basis of acoustic input in the extrapersonal frame of reference. Sounds from a two-dimensional loudspeaker array outlined sequentially the contours of various digits. The underlying mechanisms involved in this auditory-spatial task were analyzed according to alterations in the vertical and horizontal spread of the patterns. The results demonstrated that two-dimensional sound patterns are identified mainly but not only on the basis of their horizontal spread. Differences between visual and auditory pattern perception are discussed in the context of supramodal spatial functions, and the present findings are linked to their neuropsychological application.

Adult↗