This investigation aimed to determine whether right brain damage affects everyday communication function. W -f i v e subjects with right hemisphere brain damage W~I V evaluated by a family member on the 16 items of the Communicative Effectiveness hdex (Lomas et al., 1989) plus 5 additional items, at 1,3,6, and 12 months poststmk. Performance on a set of clinical communication measures indicated dear communication impairment to be pTesent in 23 of these subjects. For these 23 subjects, reduction in communication ability from pstmke level was usually judged by family members to be minimal, but at least 25% identified impairment in aspects of discourse such as c0nveIsationa.I participation, topic and refem~cing, in following cbxtiom, understanding writing, and communicating emotions. The family membed assessments indicated improvement in communication skills up to the &month stage, followed by reduction to a level not significantly different from the l-month ratings. clinical assessments showed steady impmvement throughout, with statistically sigxuficant changes be tween 1 and 12 months and 1 and 6 months. Correlation between family and clinical assessment was sigruficant only at the %month point.Family member assessment is a potentially important source of information about ~turalistic communication fundion. To increase its usefulness, future developments in methodology must include the means of gauging the reliability of proxy reports.
compatible with the results of Brown and Riggilo1'2 with the non-selective drug sotalol. The only published findings that totally disagree with these results are those of Walter et al.15 They showed that propranolol had no significant effect on the blood glucose levels after insulin administration. This trial is not strictly comparable, however, since it was performed after a five-day fast, and by this time liver glycogen stores, a readily available source of glucose, would have been exhausted. Abramson et al2 partly disagreed with the above results. They found that the initial hypoglycaemic effect of the insulin was not potentiated by propranolol but confirmed that the return to normoglycaemia was significantly delayed.Both supposedly cardioselective beta-adrenergic receptor blocking agents used in this trial potentiated the initial hypoglycaemic effect of the insulin in the same way as propranolol, but only metoprolol significantly delayed the return to normoglycaemia. There are no other published results on the effect of these two drugs on blood glucose levels and comparison must therefore be made with the only other experiment in which selective beta-adrenergic receptor blockade was used. When Baird and Carter14 gave oral practolol and tolamolol to rats these drugs did not significantly potentiate the hypoglycaemic effect of insulin one hour after administration. Only when given intraperitoneally in very high doses did practolol have a possible potentiating effect. Unfortunately, no information was given on the return of blood glucose levels towards normal, but Barnett,16 using the same drug in man, did not show any delayed normoglycaemia after insulin. Recently both products have been almost completely withdrawn from clinical practice.These results were obtained in healthy volunteers and are therefore not strictly applicable to patients with diabetes mellitus. A similar trial in diabetics should therefore be undertaken to determine with certainty the safety of such drugs in the condition.
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