Effective communication is essential for successful rehabilitation, especially in patients with traumatic brain injury (TBI). The authors examined the prevalence and characteristics of auditory dysfunction in patients with TBI who were admitted to a Department of Veterans Affairs TBI inpatient unit before and after the onset of Operation Iraqi Freedom (OIF). In order to delineate the characteristics of the auditory manifestations of patients who had sustained blast-related (BR) TBI, we reviewed the medical records of 252 patients with TBI and categorized them according to admission date, either before (Group I, n = 102) or after (Group II, n = 150) the onset of OIF. We subdivided Group II into non-blast-related (NBR) and BR TBI; no subjects in Group I had BR TBI. We found that admissions for TBI have increased 47% since the onset of OIF. In Group I, 28% of patients with TBI complained of hearing loss and 11% reported tinnitus. In Group II-NBR (n = 108), 44% complained of hearing loss and 18% reported tinnitus. In Group II-BR (n = 42), 62% complained of hearing loss and 38% reported tinnitus. Sensorineural loss was the most prevalent type of hearing loss in Group II-BR patients. In light of the high prevalence of hearing loss and tinnitus in this growing population of returning soldiers, we need to develop and implement strategies for diagnosis and management of these conditions.

Combining high-density scalp EEG recordings with a sensitive analog measure of short-term memory’s fidelity, we characterized the temporal dynamics of intentional ignoring, and related those dynamics to the intrusion of task-irrelevant information. On each trial of the task, two study Gabors were briefly presented in succession. A green or red disc preceding each Gabor signified whether that Gabor should be remembered or ignored, respectively. With cue-stimulus intervals of 300, 600, or 900 ms presented in separate sessions, we found that the onset of posterior, pre-stimulus alpha oscillations varied with the length of the interval. Although stimulus onset time was entirely predictable, the longer the cue-stimulus interval, the earlier the increase in pre-stimulus alpha power. However, the alpha-band modulation was not simply locked to the cue offset. The temporal envelopes of posterior alpha-band modulation were strikingly similar for both cued attending and cued ignoring, and differed only in magnitude. This similarity suggests that cued attending includes suppression of task irrelevant, spatial processing. Supporting the view that alpha-band oscillations represent inhibition, our graded measure of recall revealed that when the stimulus to be ignored appears second in the sequence, peri-stimulus alpha power predicted the degree to which that irrelevant stimulus distorted subsequent recall of the stimulus that was to be remembered. These results demonstrate that timely deployment of attention-related alpha-band oscillations can aid short-term memory by filtering out task-irrelevant information.

Persistent problems after traumatic brain injury: The need for long-term follow-up and coordinated careTraumatic brain injury (TBI) is one of the leading causes of death and long-term disability in the United States [1]. Survivors of TBI experience various problems, including physical, cognitive, emotional, and community integration issues. Established in 1992, the Defense and Veterans Brain Injury Center (DVBIC) coordinates nine healthcare centers-two civilian, three military, and four Department of Veterans Affairs (VA) sites-that provide evidence-based treatment, education, and research on TBI (www.dvbic.org). Patients with TBI who are admitted to regional medical centers within the DVBIC network receive multidisciplinary assessment and rehabilitation by experts in physiatry (physical medicine and rehabilitation [PM&R]), neurology, neuropsychology, psychiatry, and other allied health professions. After discharge, DVBIC patients are also advised to return for onsite, 3-day comprehensive follow-up evaluations at 1 and 2 years postinjury.To determine the prevalence of a constellation of problems faced by the TBI patients admitted to our Palo Alto VA facility, we performed an extensive chart review on 138 patients who had sustained closed head injuries. These patients were enrolled in the DVBIC program at the Palo Alto VA from 1993 to 2003 and ranged in age from 18 to 76 (median = 27). Of these patients, 71 percent returned for either the 1 or 2 year follow-up at the Palo Alto site and 49 percent returned for both follow-ups. Compared with the patients who returned for both follow-ups, those who missed one or both follow-ups had more emotional symptoms at baseline (mean = 3.2 vs 2.4 symptoms/patient, p < 0.005) but fewer cognitive impairments (4.2 vs 5.9 impairments/patient, p < 0.001). The two groups did not differ significantly in age or the frequency of physical symptoms at baseline (4.4 vs 4.6, p = 0.5).The present analysis focused on those who returned for both follow-ups. We evaluated the patients' problems in four areas: physical, cognitive, emotional, and community integration, using standardized neurocognitive tests and structured clinical interviews. Physical problems were mainly documented by the physiatrist and included pain, motor weakness, gait abnormality, seizure, dizziness, and fatigue. Cognitive deficits were primarily measured by the neuropsychologist and included deficits in attention/concentration, processing speed, memory, problem-solving, executive organization, and safety judgment. Emotional issues, mainly identified by the psychiatrist, included depressed mood, anxiety, posttraumatic distress, suicidal ideation, irritability, and disinhibition. Community integration issues, primarily evaluated by the occupational therapist, included problems with self-care, money management, employment, community accessibility, recreational activities, and adjustment to limitations.As Figure 1 demonstrates, 90 percent or more of TBI patients had at least one problem in each category at baseline, i.e., dur...

Background DDX3X syndrome is a recently identified genetic disorder that accounts for 1–3% of cases of unexplained developmental delay and/or intellectual disability (ID) in females, and is associated with motor and language delays, and autism spectrum disorder (ASD). To date, the published phenotypic characterization of this syndrome has primarily relied on medical record review; in addition, the behavioral dimensions of the syndrome have not been fully explored. Methods We carried out multi-day, prospective, detailed phenotyping of DDX3X syndrome in 14 females and 1 male, focusing on behavioral, psychological, and neurological measures. Three participants in this cohort were previously reported with limited phenotype information and were re-evaluated for this study. We compared results against population norms and contrasted phenotypes between individuals harboring either (1) protein-truncating variants or (2) missense variants or in-frame deletions. Results Eighty percent (80%) of individuals met criteria for ID, 60% for ASD and 53% for attention-deficit/hyperactivity disorder (ADHD). Motor and language delays were common as were sensory processing abnormalities. The cohort included 5 missense, 3 intronic/splice-site, 2 nonsense, 2 frameshift, 2 in-frame deletions, and one initiation codon variant. Genotype–phenotype correlations indicated that, on average, missense variants/in-frame deletions were associated with more severe language, motor, and adaptive deficits in comparison to protein-truncating variants. Limitations Sample size is modest, however, DDX3X syndrome is a rare and underdiagnosed disorder. Conclusion This study, representing a first, prospective, detailed characterization of DDX3X syndrome, extends our understanding of the neurobehavioral phenotype. Gold-standard diagnostic approaches demonstrated high rates of ID, ASD, and ADHD. In addition, sensory deficits were observed to be a key part of the syndrome. Even with a modest sample, we observe evidence for genotype–phenotype correlations with missense variants/in-frame deletions generally associated with more severe phenotypes.

We tested 8- and 10-month-old infants’ Visual Working Memory (VWM) for object-location bindings — what is where — with a novel paradigm, Delayed Match Retrieval, that measured infants’ anticipatory gaze responses (using a Tobii T120 eye tracker). In an inversion of Delayed-Match-to-Sample tasks and with inspiration from the game Memory, in test trials, three face-down virtual ‘cards’ were presented. Two flipped over sequentially (revealing, e.g., a swirl pattern and then a star), and then flipped back face-down. Next, the third card was flipped to reveal a match (e.g. a star) to one of the previously seen, now-face-down cards. If infants looked to the location where the (now face-down) matching card had been shown, this was coded as a correct response. To encourage anticipatory looks, infants subsequently received a reward (a brief, engaging animation) presented at that location. 10-month-old infants performed significantly above chance, showing that their VWM could hold object-location information for the two cards. Overall, 8-month-olds’ performance was at chance, but they showed a robust learning trend. These results corroborate previous findings (Kaldy & Leslie, 2005; Oakes, Ross-Sheehy, & Luck, 2006) and point to rapid development of VWM for object-location bindings. However, compared to previous paradigms that measure passive gaze responses to novelty, this paradigm presents a more challenging, ecologically relevant test of VWM, as it measures the ability to make online predictions and actively localize objects based on VWM. As well, this paradigm can be readily scaled-up to test toddlers or older children without significant modification.

We examined differences in regional brain activation during tests of executive function in individuals with Hoarding Disorder (HD), Obsessive Compulsive Disorder (OCD), and healthy controls (HC) using functional magnetic resonance imaging (fMRI). Participants completed computerized versions of the Stroop and Go/No-Go task. We found that during the conflict monitoring and response inhibition condition in the Go/No-Go task, individuals with HD had significantly greater activity than controls in the anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC). HD also exhibited significantly greater right DLPFC activity than OCD. We also observed significant differences in activity between HD and HC and between HD and OCD in regions (ACC, anterior insula, orbitofrontal cortex (OFC), and striatum) involved in evaluating stimulus-response-reward associations, or the personal and task-relevant value of stimuli and behavioral responses to stimuli. These results support the hypothesis that individuals with HD have difficulty deciding on the value or task relevance of stimuli, and may perceive an abnormally high risk of negative feedback for difficult or erroneous cognitive behavior.

Abstract-The conflicts in Iraq andAfghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population. We summarize the following features of this interdisciplinary program: (1) sequential assessment, from initial traumatic brain injury screening throughout our catchment area to evaluation by the PNS clinic team, and (2) clinical evaluation results for the first 62 clinic patients. In summary, this population shows a high prevalence of postconcussion symptoms, posttraumatic stress, poor cognitive performance, head and back pain, auditory and visual symptoms, and problems with dizziness or balance. An anonymous patient feedback survey, which we used to fine-tune the clinic process, reflected high satisfaction with this new program. We hope that the lessons learned at one site will enhance the identification and treatment of veterans with polytrauma across the country.

Attentional control enables us to direct our limited resources to accomplish goals. The ability to flexibly allocate resources helps to prioritize information and inhibit irrelevant/distracting information. We examined developmental changes in visual working memory (VWM) fidelity in 4- to 7-year-old children and the effects that a distracting non-target object can exert in biasing their memory representations. First, we showed that VWM fidelity improves from early childhood to adulthood. Second, we found evidence of working memory load on recall variability in children and adults. Next, using cues to manipulate attention, we found that older children are able to construct a more durable memory representation for an object presented following a non-target using a pre-cue (that biases encoding before presentation) compared with a retro-cue (that signals which item to recall after presentation). In addition, younger children had greater difficulties maintaining an item in memory when an intervening item was presented. Lastly, we found that memory representations are biased toward a non-target when it is presented following the target and away from a non-target when it precedes the target. These bias effects were more pronounced in children compared with adults. Together, these results demonstrate changes in attention over development that influence VWM memory fidelity.