Concussion in contact sports: Reliable change indices of impairment and recovery

This paper reports a follow-up study to an article on the sensitivity of three tests of speed of information processing to impairment after concussion (Hinton-Bayre, Geffen, BL McFarland, 1997). Group analyses showed that practice effects can obscure the effects of concussion on information processing, thereby making the assessment of functional impairment and recovery after injury unreliable. A Reliable Change Index (RCI) was used to assess individual variations following concussion. It was found that 16 of the 20 concussed professional rugby league players were impaired 1-3 days following injury. It was also demonstrated that 7 players still displayed cognitive deficits at 1-2 weeks, before returning to preseason levels at 3-5 weeks. The RCI permits comparisons between different tests, players, and repeated assessments, thereby providing a quantitative basis for decisions regarding return to play.

Using the Reliable Change Index Statistic to Analyze Developmental Changes in Infants at Risk for Autism Spectrum Disorder

Longitudinal studies of the development of autism spectrum disorders (ASD) provide an understanding of which variables may be important predictors of an ASD. The objective of the current study is to apply the reliable change index (RCI) statistic to examine whether the Parent Observation of Early Markers Scale (POEMS) is sensitive to developmental change, and whether these changes can be quantified along a child’s developmental trajectory. Ninety-six children with older siblings with autism were followed from 1-36 months of age. Group-based RCI analysis confirms that the POEMS is capable of detecting significant changes within pre-defined diagnostic groups. Within-subject analysis suggests that ongoing monitoring of a child at-risk for an ASD requires interpretation of both significant intervals identified by the RCI statistic, as well as the presence of repeated high (i.e., >70) scores. This study provides preliminary evidence for a reasonably sensitive and specific means by which individual change can be clinically monitored via parent report.

Assessment of statistical change criteria used to define significant change in neuropsychological test performance following cardiac surgery

Objective: This paper compares four techniques used to assess change in neuropsychological test scores before and after coronary artery bypass graft surgery (CABG), and includes a rationale for the classification of a patient as overall impaired. Methods: A total of 55 patients were tested before and after surgery on the MicroCog neuropsychological test battery. A matched control group underwent the same testing regime to generate test–retest reliabilities and practice effects. Two techniques designed to assess statistical change were used: the Reliable Change Index (RCI), modified for practice, and the Standardised Regression-based (SRB) technique. These were compared against two fixed cutoff techniques (standard deviation and 20% change methods). Results: The incidence of decline across test scores varied markedly depending on which technique was used to describe change. The SRB method identified more patients as declined on most measures. In comparison, the two fixed cutoff techniques displayed relatively reduced sensitivity in the detection of change. Conclusions: Overall change in an individual can be described provided the investigators choose a rational cutoff based on likely spread of scores due to chance. A cutoff value of ≥20% of test scores used provided acceptable probability based on the number of tests commonly encountered. Investigators must also choose a test battery that minimises shared variance among test scores.

Defining a role for the subthalamic nucleus within operative theoretical models of subcortical participation in language

Objective:To investigate the effects of bilateral, surgically induced functional inhibition of the subthalamic nucleus (STN) on general language, high level linguistic abilities, and semantic processing skills in a group of patients with Parkinson’s disease. Methods:Comprehensive linguistic profiles were obtained up to one month before and three months after bilateral implantation of electrodes in the STN during active deep brain stimulation (DBS) in five subjects with Parkinson’s disease (mean age, 63.2 years). Equivalent linguistic profiles were generated over a three month period for a non-surgical control cohort of 16 subjects with Parkinson’s disease (NSPD) (mean age, 64.4 years). Education and disease duration were similar in the two groups. Initial assessment and three month follow up performance profiles were compared within subjects by paired t tests. Reliability change indices (RCI), representing clinically significant alterations in performance over time, were calculated for each of the assessment scores achieved by the five STN-DBS cases and the 16 NSPD controls, relative to performance variability within a group of 16 non-neurologically impaired adults (mean age, 61.9 years). Proportions of reliable change were then compared between the STN-DBS and NSPD groups. Results:Paired comparisons within the STN-DBS group showed prolonged postoperative semantic processing reaction times for a range of word types coded for meanings and meaning relatedness. Case by case analyses of reliable change across language assessments and groups revealed differences in proportions of change over time within the STN-DBS and NSPD groups in the domains of high level linguistics and semantic processing. Specifically, when compared with the NSPD group, the STN-DBS group showed a proportionally significant (p

Redefining functional models of basal ganglia organisation: Role for the posteroventral pallidum in linguistic processing?

Traditionally the basal ganglia have been implicated in motor behavior, as they are involved in both the execution of automatic actions and the modification of ongoing actions in novel contexts. Corresponding to cognition, the role of the basal ganglia has not been defined as explicitly. Relative to linguistic processes, contemporary theories of subcortical participation in language have endorsed a role for the globus pallidus internus (GPi) in the control of lexical-semantic operations. However, attempts to empirically validate these postulates have been largely limited to neuropsychological investigations of verbal fluency abilities subsequent to pallidotomy. We evaluated the impact of bilateral posteroventral pallidotomy (BPVP) on language function across a range of general and high-level linguistic abilities, and validated/extended working theories of pallidal participation in language. Comprehensive linguistic profiles were compiled up to 1 month before and 3 months after BPVP in 6 subjects with Parkinson's disease (PD). Commensurate linguistic profiles were also gathered over a 3-month period for a nonsurgical control cohort of 16 subjects with PD and a group of 16 non-neurologically impaired controls (NC). Nonparametric between-groups comparisons were conducted and reliable change indices calculated, relative to baseline/3-month follow-up difference scores. Group-wise statistical comparisons between the three groups failed to reveal significant postoperative changes in language performance. Case-by-case data analysis relative to clinically consequential change indices revealed reliable alterations in performance across several language variables as a consequence of BPVP. These findings lend support to models of subcortical participation in language, which promote a role for the GPi in lexical-semantic manipulation mechanisms. Concomitant improvements and decrements in postoperative performance were interpreted within the context of additive and subtractive postlesional effects. Relative to parkinsonian cohorts, clinically reliable versus statistically significant changes on a case by case basis may provide the most accurate method of characterizing the way in which pathophysiologically divergent basal ganglia linguistic circuits respond to BPVP.

Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities

This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities. Families were randomly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills (SSTP-E), standard parent training intervention alone (SSTP-S) or waitlist control (WL) condition. At post-intervention, both programs were associated with lower levels of observed negative child behavior, reductions in the number of care-giving settings where children displayed problem behavior, and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. Gains attained at post-intervention were maintained at 1-year follow-up. Both interventions produced significant reductions in child problem behavior, with 67% of children in the SSTP-E and 77% of children in the SSTPS showing clinically reliable change from pre-intervention to follow-up. Parents reported a high level of satisfaction with both interventions.

Investigating the relationship between competence and patient outcome with CBT

Little is understood about the relationship between therapist competence and the outcome of patients treated for common mental health disorders. Understanding the relationship between competence and patient outcome is of fundamental importance to the dissemination and implementation of Cognitive Behavioural Therapy (CBT). The current study extends existing literature by exploring the relationship between CBT competence and patient outcome in routine clinical practice within the framework of the British Government’s Improving Access to Psychological Therapies (IAPT) programme. Participants comprised 43 therapists treating 1247 patients over a training period of one year. Results found little support of a general association between CBT competence and patient outcome; however significantly more patients of the most competent therapists demonstrated a reliable improvement in their symptoms of anxiety than would be expected by chance alone, and fewer experienced no reliable change. Conversely, significantly more patients treated by the least competent therapists experienced a reliable deterioration in their symptoms than would be expected. The implications of these results for the dissemination and implementation of CBT are discussed.

Habilidades sociais em portadores de anomalia da diferenciação sexual

O termo Habilidades Sociais (HS) é usado para designar um conjunto de repertórios comportamentais que envolvem interações sociais satisfatórias. A maioria dos estudos publicados sobre essa temática inclui a participação de crianças e adolescentes, abordando situações em ambiente escolar. Poucos são os estudos voltados para a área de saúde, e, até o momento, não foram localizadas pesquisas sobre HS realizadas com indivíduos portadores de Anomalia da Diferenciação Sexual (ADS). Esta anomalia se caracteriza pela malformação na genitália e/ou pela disfunção das gônadas, ocasionando características sexuais secundárias não correspondentes ao sexo de criação. Estudos clínicos realizados com indivíduos portadores de ADS têm destacado a ocorrência de déficits em habilidades sociais nesses indivíduos, caracterizados pela fuga-esquiva de situações sociais aversivas. Neste trabalho, pretendeu-se caracterizar o repertório comportamental correspondente a HS em indivíduos com ADS atendidos no ambulatório de um programa especializado de um hospital da rede pública de Belém, por meio de dois estudos complementares. No primeiro, foi realizado um estudo com delineamento transversal, com o objetivo de caracterizar comportamentos correspondentes a HS em indivíduos com ADS. Participaram 9 adultos com mais de seis meses em tratamento. Foram utilizados: Roteiro de Entrevista, Protocolo para análise de prontuário e Inventário de Habilidades Sociais - IHS. Os resultados sugerem que os participantes apresentam déficit de habilidades sociais em todos os fatores do IHS em menor ou maior grau, de maneira que poderiam se beneficiar com um treinamento de habilidades sociais como parte do tratamento, por se tratar de uma técnica que visa à superação e/ou redução dos déficits por eles apresentados. No segundo, foi realizado um estudo com delineamento de sujeito único, com o objetivo de verificar os efeitos do uso de treino em automonitoramento na instalação de comportamentos correspondentes a HS. Participou uma adulta com diagnóstico de ADS selecionada dentre os que participaram do Estudo 1. O procedimento de intervenção ocorreu por meio de entrevistas semanais, de acordo com as seguintes etapas: (1) Contrato: assinatura do Termo de Consentimento Livre e Esclarecido e agendamento de entrevista; (2) Avaliação: levantamento da linha de base dos comportamentos correspondentes à HS, elaboração da hierarquia dos comportamentos que indicaram déficit segundo as normas de análise do IHS e treino em registro de automonitoração; (3) Intervenção: leitura de um texto sobre habilidades sociais, apresentação da lista de direitos humanos básicos, aplicação do Questionário Construcional de Goldiamond adaptado e treino em registro de automonitoramento; (4) Re-avaliação das HS: reaplicação do IHS; (5) Follow-up: avaliação da manutenção dos ganhos obtidos com o estudo; e (6) Encerramento: entrevista devolutiva para explanação dos resultados do estudo ao participante. Os resultados sugerem que a intervenção promoveu o desenvolvimento de HS na participante, haja vista a interpretação da evolução da participante apresentada de acordo com a variação do Escore Z e da representação gráfica de significância clínica e mudança confiável.

Intervenção em habilidades sociais com uma criança com síndrome de Down

Studies show that children with Down’s syndrome have deficits in social skills, which can interfere in their social interactions and also in their academic performance. The aim of this study was to analyze the clinical significance and reliable change in repertory of social skills of a child with Down’s syndrome, from interventions in the clinic, at home and at school. A seven year old girl with Down’s Syndrome who had frequented the first year of regular school, her parents and her teacher participated in this study. They were attending in a Center of Applied Psychology, of a public university in São Paulo State. Before and after the intervention parents and teacher answered the Rating System Social Skills (SSRS). The intervention with the child had been conducted for six months, through playful activities in weekly meetings. It was discussed various topics related to social skills with parents and teacher in biweekly and monthly meetings. The results were analyzed using JT method. With parents, comparing the two assessments conducted, the data pointed to positive change reliable for four of the six skills assessed. Of the five skills assessed by the teacher, one of them was not in the clinical level since the first application. The other two went from clinical to non-clinical level, featuring reliable positive change. The study showed the importance of pre and post measures in case study, enabling the assessment of the effects of the intervention performed on the various factors of social skills. Further studies with larger populations may ratify the data obtained.

Impact of pallidotomy on physiological articulation function and speech intelligibility in Parkinsons disease

The objective of this study was to evaluate the effects of posteroventral pallidotomy on perceptual and physiological measures of articulatory function and speech intelligibility in Parkinson disease (M). The study examined 11 participants with M who underwent posteroventral pallidotomy Physiological measures of hp and tongue function. and perceptual measures of speech intelligibility were obtained prepallidotomy and 3 months postpallidotomy. The participants with PD were also assessed on the Unified Parkinsons Disease Rating Scale (UPDRS Part III) In addition, the study included a group of 16 participants with PD who did not undergo pallidotomy and a group of 30 nonneurologically impaired participants. Analyses of physiological articulatory function and speech intelligibility did not reveal corresponding improvements in motor speech function as observed in general limb motor function postpallidotomy. Overall, individual reliable change analyses revealed that the majority of surgical PD participants demonstrated no reliable change on perceptual and physiological measures of articulation. The cur rent study revealed preliminary evidence that articulatury function and speech intelligibility did not change following posteroventral pallidotomy in a group of individuals with PD.

Test-retest reliability and practice effects of a rapid screen of mild traumatic brain injury

Test-retest reliabilities and practice affects of measures from the Rapid Screen of Concussion (RSC), in addition to the Digit Symbol Substitution Test (Digit Symbol), were examined. Twenty five male participants were tested three times; each testing session scheduled a week apart. The test-retest reliability estimates for most measures were reasonably good, ranging from .79 to .97. An exception was the delayed word recall test, which has had a reliability estimate of .66 for the first retest, and .59 for the second retest. Practice effects were evident from Times 1 to 2 on the sentence comprehension and delayed recall subtests of the RSC, Digit Symbol and a composite score. There was also a practice effect of the same magnitude found from Time 2 to Time 3 on Digit Symbol, delayed recall and the composite score. Statistics on measures for both the first and second retest intervals, with associated practice affects, are presented to enable the calculation of reliable change indices (RCI). The RCI may be used to assess any improvement in cognitive functioning after mild Traumatic Brain Injury.

Psychometric assessment of recovery from mild traumatic brain injury

The Rapid Screen of Concussion (RSC) is a brief psychometric test battery, designed to provide a functional criterion to aid clinical diagnosis of mild traumatic brain injury (mTBI). The present research aimed to examine the utility of this instrument for assessing recovery after mTBI. Three studies were conducted. In Study 1, Discriminant Function Analysis was performed to determine how well the RSC differentiated uninjured controls (N¼16), from mTBI patients (N¼22) and moderate to severe TBI patients (N¼14), several months post-injury. As predicted, moderate to severe TBI patients achieved lower scores than the mTBI and control groups. The RSC also successfully differentiated between each of the diagnostic groups, yielding an overall correct classification rate of 75%. Study 2 examined the predictive utility of the RSC in the mTBI sample (N¼22). Acute injury performance on the RSC was correlated with post-injury scores at an average of 5.5 months post-injury. Statistically significant partial correlation coefficients (r¼0.53r¼0.80) were found for each of the subtests, showing that low acute RSC scores were predictive of poor recovery scores on the RSC after mTBI. In the third study, Reliable Change Indices were calculated on the RSC subtests to examine individual patterns of recovery from mTBI. While 17 of the 23 participants made a significant improvement on their acute injury DSST scores (74%), only 13 of 25 made a significant improvement on the Rapid Sentence Judgement Test (52%), highlighting differential recovery of function, and challenging the notion of full recovery from mTBI within 3 months. These overall results offer support for the construct and predictive validity of the RSC and demonstrate that inexpensive tests of brain function may be useful for managing mTBI acutely for prognosis.

PULSATILITY INDEX CHANGE OF BRACHIAL ARTERY SHOWS BETTER REPRODUCIBILITY THAN FLOW-MEDIATED VASODILATION

We aim to evaluate intra- and interobserver reproducibility of brachial artery flow-mediated dilation (FMD) and of pulsatility index change (PI-C) 1 min after a 5-min forearm compression in pregnant women. Flow-mediated dilation and PI-C were assessed in 31 healthy pregnant women in 3 consecutive days, by two observers. A broader range of response to the stimulus was observed for PI-C (-58.99%-86.71%) than FMD (2.38%-27.01%). The intraclass correlation coefficients were higher for PI-C than for FMD (intra = 0.90 vs. 0.69, p = 0.047; inter = 0.94 vs. 0.61, p = 0.007). Therefore, PI-C measurements were more reliable than FMD. However, studies comprising of subjects with cardiovascular risk factors relating FMD and PI-C become necessary to validate this method for the study of endothelial dysfunction. (E-mail: wpmartins@gmail.com) (C) 2010 World Federation for Ultrasound in Medicine & Biology.

Reconstructing historical forest cover change in the Lower Amazon floodplains using the LandTrendr algorithm

ABSTRACTThe Amazon várzeas are an important component of the Amazon biome, but anthropic and climatic impacts have been leading to forest loss and interruption of essential ecosystem functions and services. The objectives of this study were to evaluate the capability of the Landsat-based Detection of Trends in Disturbance and Recovery (LandTrendr) algorithm to characterize changes in várzeaforest cover in the Lower Amazon, and to analyze the potential of spectral and temporal attributes to classify forest loss as either natural or anthropogenic. We used a time series of 37 Landsat TM and ETM+ images acquired between 1984 and 2009. We used the LandTrendr algorithm to detect forest cover change and the attributes of "start year", "magnitude", and "duration" of the changes, as well as "NDVI at the end of series". Detection was restricted to areas identified as having forest cover at the start and/or end of the time series. We used the Support Vector Machine (SVM) algorithm to classify the extracted attributes, differentiating between anthropogenic and natural forest loss. Detection reliability was consistently high for change events along the Amazon River channel, but variable for changes within the floodplain. Spectral-temporal trajectories faithfully represented the nature of changes in floodplain forest cover, corroborating field observations. We estimated anthropogenic forest losses to be larger (1.071 ha) than natural losses (884 ha), with a global classification accuracy of 94%. We conclude that the LandTrendr algorithm is a reliable tool for studies of forest dynamics throughout the floodplain.