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.
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