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PubMed1999

Language-related cognitive declines after left temporal lobectomy in children.

Presented is a case series demonstrating that clinically significant language-related cognitive declines not detected by intelligence quotient (IQ) testing occur after left temporal lobectomy in school-aged children. In this series, comprehensive preoperative and postoperative neuropsychologic evaluations were completed in eight school-aged patients who underwent temporal lobectomy (five left, three right) for temporal lobe epilepsy. Mean age at surgery was 13 years, 11 months +/- 2 years, 1 month. Testing included measurement of IQ, verbal learning, naming, visual memory, sight word recognition, reading comprehension, and calculation. All five left temporal lobectomy patients demonstrated significant language-related cognitive declines on postoperative neuropsychologic testing, including deficits in verbal IQ (one patient), verbal learning (four patients), naming (one patient), and reading comprehension (one patient). These deficits were clinically evident in four of the five left temporal lobectomy patients, leading to declines in educational performance. IQ testing alone did not reliably identify these deficits. No significant declines were found after surgery in three right temporal lobectomy patients. Average or high preoperative functioning may have predisposed patients to postoperative deficits in this series, whereas magnetic resonance imaging or pathologic abnormalities did not protect against postoperative deficits. Outcome studies of temporal lobectomy in childhood should use comprehensive neuropsychologic testing to identify cognitive deficits.

Adolescent↗

PubMed1996

Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group.

PURPOSE: To learn the long-term outcome of ciliary ablation with diode laser contact transscleral cyclophotocoagulation (TSCPC) in eyes with recalcitrant, severe glaucoma. METHODS: Twenty-seven eyes of 27 patients with medically and surgically uncontrollable glaucoma and no previous ciliary ablation enrolled in this study. After baseline measurements and informed consent, the authors performed contact TSCPC. There were 14 pseudophakic, 7 aphakic, and 6 phakic eyes; 15 of these had primary open angle glaucoma and the remainder had various secondary or open- or closed-angle glaucomas. Median follow-up was 19 months (range, 6 weeks to 27 months). Initially after laser surgery, glaucoma medications were continued, except for a 2-week interruption of miotics; the ophthalmologist later adjusted medications in accordance with the patient's status. The authors define failure of TSCPC in two ways, based on IOP measurements during two consecutive study examinations 6 weeks or more after intervention or at the final examination: (1) less than 20% intraocular pressure (IOP) reduction from baseline, and (2) either less than 20% reduction of IOP from baseline or IOP greater than 22 mmHg. RESULTS: For 27 eyes, the baseline IOP (mean +/- standard deviation) was 36.4 +/- 12.4 mmHg (range, 20-70 mmHg). The mean IOP at last examination was 20.3 +/- 8.7 mmHg. With failure definition 1, the cumulative probability of success was 84% at 1 year and 62% at 2 years. With failure definition 2 the cumulative probability of success was 72% at 1 year and 52% at 2 years. At the last examination, 19 eyes (70%) had visual acuity improved within one line of visual acuity at eligibility. One of these eyes, with light perception vision at entry, declined to no light perception. Three eyes (11%) lost two lines of vision and five (19%) lost three or more lines. CONCLUSIONS: Contact diode laser TSCPC yields long-term improvement of IOP and preservation of visual acuity in a substantial proportion of eyes with severe, medically uncontrolled glaucoma.

Adult↗

PubMed1998

Prediction of verbal memory loss in individuals after anterior temporal lobectomy.

PURPOSE: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre- to postoperative memory decline using only information available preoperatively. METHODS: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined. RESULTS: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (> or =90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. CONCLUSIONS: The derived regression equations can accurately predict verbal memory decline on a list-learning task in approximately 50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.

Age Factors↗

PubMed2026

Not just when, but how: An exploratory dual-control approach to video feedback in motor learning.

The present study provides exploratory evidence for a novel dual-control paradigm. It examines whether combining temporal over video feedback timing with learner-controlled interactive playback functions (pause, slow-motion, rewind) would enhance motor skill acquisition beyond temporal autonomy alone. Sixty-four novice adults were randomly assigned to one of four conditions: Full Control (self-controlled timing + interactive replay), Partial Control (self-controlled timing + non-interactive replay), Yoked Full Control (externally controlled timing + interactive replay), or Yoked Partial Control (externally controlled timing + non-interactive replay). Motor accuracy (Radial Error), movement consistency (Bivariate Variable Error), technical execution, and self-efficacy were assessed at pre-test, 24-h retention, and 72-h retention following two acquisition sessions on a dart-throwing task (120 trials total). The Full Control group demonstrated the greatest and most durable learning gains across all outcomes. The Group × Time interaction was significant across all dependent variables (η2ₚ ranging from 0.140 to 0.234), with Full Control demonstrating superior retention at both 24 and 72 h relative to other groups (though differences relative to Partial Control were more pronounced at 72-h retention). Critically, the Yoked Full Control group showed comparatively weaker outcomes despite access to the same interactive playback functions. These findings suggest that interactive video tools may be most useful when learners can regulate both when feedback is accessed and how it is inspected. Theoretical and practical implications for the design of learner-centered video feedback systems are discussed.

Humans↗

PubMedDate not supplied

Characteristics of the learner: children and adolescents.

PURPOSE: The purposes of this paper are to (1) review the literature on educational interventions for children and adolescents; (2) determine what kinds of interventions have been studied, how effective they are, and their outcomes; and (3) develop recommendations for further research in the field. METHODS: An integrative literature review approach was used. Articles were included in this review if they met the criteria of being an empirical study reporting results of an intervention whose primary subjects were children with type 1 diabetes and/or their families, and published between 1980 and January 1, 1999. Of the 59 articles identified, 41 met these criteria. RESULTS: The majority of the studies focused on adolescents. Results suggested that traditional educational interventions are successful in increasing knowledge but less successful in increasing quality of life or improving metabolic control. Psychosocial and family interventions (coping skills training) have been more successful in both quality-of-life and metabolic outcomes. CONCLUSIONS: There is much work to be done to strengthen our understanding of what works under what conditions. More studies of younger children, minority youth, and families are needed using well-controlled experimental designs with adequate samples.

Adaptation, Psychological↗

PubMed1994

Advances in hepatitis D virus biology and disease.

Studies over the last decade have defined the natural history and diagnostic features of hepatitis D. Whereas hepatitis D encompasses a wide spectrum of clinical manifestations, patients usually have severe and progressive liver disease. In areas of high endemicity such as Italy, hepatitis D accounts for a significant proportion of requests for liver transplantation. Research interest is now focused on the underlying mechanisms of HDV pathogenesis and identification of the specific interactions of HDV/HBV/host that influence the clinical outcome. Much has been learned about the virology of HDV and its interactions with its helper, HBV. However, little is known about the host response to HDV infection and whether certain immune responses to HDV gene products can modulate the disease course, although there has been some evidence in an animal model that this might be the case. The unique characteristics of HDV replication, eg, autocatalytic self-cleavage and editing of the viral RNA, may influence the disease course and the heterogeneity of HDV genome sequence found in various geographic settings may in part account for the spectrum of disease outcomes by influencing the efficiency of any number of complex interactions. Fortunately, in vitro and in vivo experimental systems are available to address many of these issues and, indeed, further research may identify specific and novel targets for therapeutic intervention. Current medical therapy for hepatitis D is unsatisfactory. The only drug of proven benefit, recombinant interferon, brings relief to only a small proportion of hepatitis D patients. Other antiviral drugs have failed in clinical trials, although studies with some drugs are currently in progress. Fortunately, liver transplantation provides a valid option, because HDV reinfection of the graft occurs much less frequently than does HBV reinfection of HBV transplants and can be adequately prevented by the administration of anti-HBs immunoglobulin. Because of the critical contribution of HBV to the life cycle of HDV, universal immunization against HBV infection represents the ultimate solution for the eradication of hepatitis D. Mass vaccination for HBV and other public health measures for the control of blood-borne pathogens have already resulted in a dramatic decrease in hepatitis D in Italy.

Antigens, Viral↗

PubMed1999

[Concentrating on weaknesses or compensating by strengths? Comparison of 2 strategies for remediation of children with comprehensive reading-spelling disorder].

Our study compares the efficiency and acceptance of two different methods of treating dyslexia in children. The first method addresses the most commonly encountered deficits in sequential processing. It relies primarly upon the "Kieler Lese-Rechtschreibaufbau". The second proceeds from the child's relative resources with regard to simultaneous processing as described by Kaufman. Training materials are those prescribed by Kaufman. Normally gifted primary school third-graders were trained in two groups (n = 13 and n = 12) and achieved a mean SIF score of SW = 101 on the K-ABC. As expected, the children scored significantly lower on the SED scale (SW = 95) than on the SGD scale (SW = 105). At the beginning of the respective training program their spelling ability fell 1.5 SD below the class mean. One year of regular weekly one-hour training according to the simultaneous processing method was significantly more successful than training in sequential processing, whereas girls improved significantly more than boys regardless of the method used. Acceptance of the methods did not vary. This result requires careful consideration and should be replicated in younger samples such as first- and second-graders in the early stages of learning to read and write, and/or in children whose dyslexia is more severe than that encountered in the current sample. It underscores that determination of an adequate method of remediation entails more than the mere identification of the underlying deficits.

Child↗

PubMed1993

Phacoemulsification during the learning curve: risk/benefit analysis.

To assess prospectively the complications and outcomes in a single-surgeon series during the phacoemulsification learning curve a prospective analysis of 400 phacoemulsification procedures in 358 patients was carried out. The main outcome measures were capsular tear, vitreous and nuclear loss, best corrected post-operative visual acuity and refractive cylinder. Capsular tears occurred in 6.3% of phacoemulsification procedures, with vitreous loss in 1.5%. One nucleus was lost into the vitreous. Best corrected visual acuity, including pre-existing pathology, was 6/9 or better in 83.6% of eyes. There was 1 dioptre or less change of astigmatism from pre-operative to 6 weeks in 91% of eyes. It is concluded that phacoemulsification with careful patient selection can be a safe procedure even during the learning curve.

Aged↗

PubMed1999

The effects of NMDA-induced retrohippocampal lesions on performance of four spatial memory tasks known to be sensitive to hippocampal damage in the rat.

Four separate cohorts of rats were employed to examine the effects of cytotoxic retrohippocampal lesions in four spatial memory tasks which are known to be sensitive to direct hippocampal damage and/or fornix-fimbria lesions in the rat. Selective retrohippocampal lesions were made by means of multiple intracerebral infusions of NMDA centred on the entorhinal cortex bilaterally. Cell damage typically extended from the lateral entorhinal area to the distal ventral subiculum. Experiment 1 demonstrated that retrohippocampal lesions spared the acquisition of a reference memory task in the Morris water maze, in which the animals learned to escape from the water by swimming to a submerged platform in a fixed location. In the subsequent transfer test, when the escape platform was removed, rats with retrohippocampal lesions tended to spend less time searching in the appropriate quadrant compared to controls. Experiment 2 demonstrated that the lesions also spared the acquisition of a working memory version of the water maze task in which the location of the escape platform was varied between days. In experiment 3, both reference and working memory were assessed using an eight-arm radial maze in which the same four arms were constantly baited between trials. In the initial acquisition, reference memory but not working memory was affected by the lesions. During subsequent reversal learning in which previously baited arms were now no longer baited and vice versa, lesioned animals made significantly more reference memory errors as well as working memory errors. In experiment 4, spatial working memory was assessed in a delayed matching-to-position task conducted in a two-lever operant chamber. There was no evidence for any impairment in rats with retrohippocampal lesions in this task. The present study demonstrated that unlike direct hippocampal damage, retrohippocampal cell loss did not lead to a general impairment in spatial learning, implying that the integrity of the retrohippocampus and/or its interconnection with the hippocampal formation is not critical for normal hippocampal-dependent spatial learning and memory. This outcome is surprising for a number of current hippocampal theories, and suggests that other cortical as well as subcortical inputs to the hippocampus might be of more importance, and further raises the question regarding the functional significance of the retrohippocampal region.

Animals↗

PubMed2005

Neuropsychological prediction of recovery in late-onset major depression.

OBJECTIVES: To assess antidepressant response in late-onset major depression in relation to neuropsychological domains: attention, memory and planning. METHODS: A neuropsychological battery was administered in 30 medication-free patients with late-onset major depression, who were then included in a 12-week antidepressant treatment regimen within a 12-month follow-up period. Logistic regression was used to define a predictive model of recovery. RESULTS: Eighteen patients were classed as remitters and seven as non-remitters. The 'indexrem' refers to the results of a logistic regression from verbal learning and planning and had a global predictive power of 84%. CONCLUSIONS: Our study suggests that the balance between verbal learning (memory) and planning (executive function)-both related to the dorsolateral prefrontal cortex-could predicts recovery.

Age of Onset↗

PubMedDate not supplied

The effect of context on skill acquisition and transfer.

OBJECTIVE: A major concern of occupational therapy is the identification of context characteristics that optimize performance. The purpose of this study was to examine the effect of context on skill acquisition and transfer. METHOD: Forty college students without disabilities (12 men, 28 women) were randomly assigned to the task of learning to use chopsticks in either a natural or a simulated context. Each participant practiced 60 trials in an acquisition phase on 1 day and was tested on a transfer task 24 hr after the acquisition phase. Their performances in the acquisition and transfer phases were measured with the variables of success rate and reaching kinematics. RESULTS: The natural context elicited significantly larger improvement of success rate in the acquisition phase and a significantly higher success rate in the transfer phase than the simulated context. No major difference was found in kinematic variables between the two contexts. CONCLUSION: These results suggested the use of natural contexts to facilitate the outcome of motor skill learning.

Adult↗

PubMed1983

Long-term outcome of hyperactive children.

A review of outcome studies of hyperactive children suggests that they experience significant academic, social, and conduct difficulties during adolescence, and that social, emotional, and impulse problems persist into young adulthood for the majority. While some hyperactive children were found to be functioning normally as adults, a troublesome minority were experiencing severe psychiatric or antisocial problems.

Achievement↗

PubMed1985

Decision making under uncertainty: a comparison of simple scalability, fixed-sample, and sequential-sampling models.

The purpose of this article is to investigate the learning and memory processes involved in decision making under uncertainty. In two different experiments, subjects were given a choice between a certain alternative that produced a single known payoff and an uncertain alternative that produced a normal distribution of payoffs. Initially this distribution was unknown, and in the first experiment it was learned through feedback from past decisions, whereas in the second experiment it was learned by observing sample outcomes. In the first experiment, a response deadline was used to limit the amount of time available for making a decision. In the second experiment, an observation cost was used to limit the number of samples that could be purchased. The mean and variance of the uncertain alternative and the value of the certain alternative were factorially manipulated to study their joint effects on choice probability, choice response time (Experiment 1), and number of observations purchased (Experiment 2). Algebraic-deterministic theories developed for decision making with simple gambles fail to explain the present results. Two new models are developed and tested--fixed- and sequential-sampling models--that attempt to describe the learning and memory processes involved in decision making under uncertainty.

Adult↗

PubMed2004

Word learning can be achieved without feedback: implications for aphasia therapy.

PURPOSE: Children acquire new words through exposure, without the necessity for explicit feedback by caregivers. In aphasia therapy, feedback to the patient is considered an important asset even though the empirical base demonstrating superior learning with online feedback is lacking. The present study examined if healthy adults and patients with chronic aphasia can acquire a new lexicon by intense frequency of exposure alone. METHODS: We compared learning rates with "frequency of exposure alone" (no-feedback condition: n=19 healthy adults; two patients with chronic Broca's and Wernicke's aphasia, respectively) with a condition where subjects additionally received online feedback (feedback condition; n=19). The learning principle was higher statistical co-occurrences of "correct" picture-pseudoword pairings as compared to "incorrect" pairings. In the feedback condition, immediate online feedback on the correctness of respective choices was additionally provided. RESULTS: Both healthy groups successfully acquired the vocabulary. Feedback led to a slight initial acceleration of learning but did not improve latency to peak performance or long-term retention of lexical knowledge. These findings show that high frequency interactive exposure is a potent word learning mechanism in adults and that feedback is not crucial. This is further corroborated by our successful training of two patients with chronic aphasia without online feedback. CONCLUSIONS: Our findings demonstrate that word re-learning in aphasia could benefit from maximizing on the frequency of exposure and exploiting the therapeutic principle of "massed practice", which has been successful in physical rehabilitation after stroke. Additionally, economizing on feedback may prevent patients becoming discouraged by continuous confrontation with their deficits.

Adult↗

PubMed1993

Gender differences in locus of control scores for students with learning disabilities.

The present investigation examined gender differences on locus of control scores for students with learning disabilities. Scores from two measures of locus of control, the adult version of the Nowicki-Strickland Internal-External Scale and the Intellectual Achievement Responsibility Questionnaire, were compared for 77 boys (M age = 16.3 yr., M IQ = 89.5) and 27 girls (M age = 16.4 yr. and M IQ = 91.2). As groups were of unequal sizes, differences between scores were assessed by an analysis of unweighted means, creating a single harmonic mean and homogeneous subsets for all tests. Significant differences were found by gender on the Nowicki-Strickland inventory. On all assessments girls' means were more external than boys'. These results are discussed in light of recent findings concerning gender and positive adult outcomes for learners with learning disabilities and in relation to gender stereotyping and discrimination.

Adolescent↗

PubMedDate not supplied

What we know about translating comprehension-strategies instruction research into practice.

Research on the implementation of comprehension-strategies instruction is discussed briefly. The particular focus is on the challenges educators have encountered in translating research-based strategies instruction into workable, school-based interventions and, ultimately, into classroom practice. The research outcomes reviewed here are consistent with Gersten, Vaughn, Deshler, and Schiller's (this issue) analysis, except that the present authors are a bit more sanguine about the fact that, in some settings, substantial progress already has been made in translating researcher-developed instruction into effective classroom instruction. Moreover, it is encouraging that there is a large body of research that is ready to be applied.

Child↗

PubMed1998

Acute-phase neurologic complications of Haemophilus influenzae type b meningitis: association with developmental problems at school age.

The purposes of this study were to describe the incidence of acute-phase neurologic complications in a sample of 126 children with Haemophilus influenzae type b meningitis, and to determine if these complications were associated with higher rates of learning and behavior problems at school age. Risks were assessed by comparing rates of adverse psychoeducational outcomes in the 53 children in the sample with complications to corresponding outcome rates in the 67 children who were free of neurologic complications and who did not have abnormal electroencephalograms (EEGs) or computed tomographic (CT) scans. Comparisons were made by means of logistic regression analysis. Twenty-nine children (23% of the sample) had seizures, 16 (13%) were comatose or obtunded, 15 (12%) had sensorineural hearing loss, 8 (6%) had hemiparesis, and 7 (6%) had cranial nerve deficits other than hearing loss. Relative to children without complications, those with complications had higher rates of grade repetition and substandard performance on neuropsychological and achievement testing. Adverse outcomes, however, consisted primarily of more subtle cognitive and learning problems; only two of the children in the sample obtained prorated IQ scores below 70. Sequelae were associated with persistent neurologic deficits and bilateral hearing loss, as well as with transient symptoms including seizures, coma, and hemiparesis. While study findings argue against adverse consequences for the vast majority of children treated for this disease, the results clarify learning and behavior outcomes and indicate which children are at greatest risk.

Adolescent↗

PubMedDate not supplied

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients.

Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Adult↗