Bernadette Ska

Agrammatism in Sentence Production without Comprehension Deficits: Reduced Availability of Syntactic Structures and/or of Grammatical Morphemes? A Case Study

A French-speaking patient with Brocas aphasia--following a left-hemisphere lesion involving the sylvian region but sparing Brocas area--is presented. Like G. Miceli, A. Mazzuchi, L. Menn, and H. Goodglasss (1983, Brain and Language, 19, 65-97) case 2, this patient produces agrammatic speech in the absence of any comprehension deficit. Unlike Micelis patient, though, agrammatic speech can be observed in all sentence production tasks (from spontaneous speech to repetition, oral reading, and writing) whereas production of individual words--be they open class or closed class--is almost always intact. On the basis of extensive (psycho)linguistic testing, it is argued that this patients deficit is not central and not crucially syntactic (at least) at the level of knowledge but seems to disrupt specifically those (automatic?) processes responsible for both retrieval and production of free-standing grammatical morphemes whenever they have to be inserted into phrases and sentences.

Development of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)

This studys purpose was to develop a clinical instrument designed to evaluate user satisfaction with assistive technology devices. This paper describes the methodology used to develop the instrument entitled the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Based on the theoretical and practical foundations of assistive technology as well as on the concept of satisfaction, preliminary versions of the instrument were created and examined by a panel of team participants. After the panels recommendations were incorporated, a pretest of the revised instrument was conducted and the final French version of QUEST emerged. The originality of QUEST lies in its inter-activeness and user-directed approach to assessing satisfaction with assistive technology. From a set of 27 variables, the user is asked to indicate the degree of importance he/she attributes to each of the satisfaction variables and then to rate his/her degree of satisfaction with each of the variables considered (quite or very) important. While QUEST remains a clinical instrument undergoing pilot testing, it holds much promise in our quest for a reliable and valid means of assessing assistive technology outcome from the users perspective.

Comparative Study of Oral and Written Picture Description in Patients with Alzheimer's Disease

Oral and written picture descriptions were compared in 22 patients with Alzheimers disease (AD) and 24 healthy elderly subjects. AD patients had a significant reduction of all word categories, which, similarly to controls, was more pronounced in written than in oral texts. They also reported fewer information units than controls, but without task difference. At the syntactic level, written descriptions of AD subjects were characterized by a diminution of subordinate clauses and a reduction of functors. More grammatical errors were present in written descriptions by AD and control subjects. AD and control groups produced an equivalent number of semantic errors in both tasks. However, in oral description, AD patients had more word-finding difficulties. In sum, AD descriptions were always shorter and less informative than control texts. Additionally, written descriptions of AD patients appeared shorter and more syntactically simplified than, but as informative as oral descriptions. Whereas no phonemic paraphasias were observed in either group, AD patients produced many more graphemic paragraphias than controls produced. Furthermore, written descriptions had more irrelevant semantic intrusions. Thus, as compared to oral descriptions, written texts appeared to be a more reliable test of semantic and linguistics difficulties in AD.

Item Analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)

The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) is an outcomes assessment tool designed to measure satisfaction with assistive technology in a structured and standardized way. The purpose of this article is to present the results of an analysis of the 24 items comprising QUEST and to explain how a subset of items demonstrating optimal measurement performance was selected. The criteria against which the items were measured were general acceptability, content validity, contribution to internal consistency, test–retest stability, and sensitivity. The items that ranked best in terms of these measurement properties were submitted to factorial analysis in order to complete the item selection. The first series of analyses reduced the item pool approximately by half, and the second series of analyses led to the final selection of 12 items. Factor analysis results suggested a bidimensional structure of satisfaction with assistive technology related to the assistive technology device (eight items) and services (four items). The 12-item revised version that will result from this study should prove to be a reliable and valid instrument for measuring outcomes in the field of assistive technology.

Short-Term Changes in and Predictors of Participation of Older Adults After Stroke Following Acute Care or Rehabilitation

Background. Stroke can lead to restrictions in participation in daily activities and social roles. Although considered an important rehabilitation outcome, little is known about participation after stroke and its predictors, and about the differences associated with the types of services provided following stroke. Objective . The aims of this study were 1) to follow and compare changes in participation of older adults discharged home after stroke from acute care or postacute rehabilitation, and 2) to identify the best predictors of participation after stroke from physical, cognitive, perceptual, and psychological ability measures taken shortly after discharge. Methods. Level of participation in daily activities and social roles of 197 older adults who had a stroke was evaluated at 2 to 3 weeks (T1), 3 months (T2), and 6 months (T3) after being discharged home from acute care (n = 86) or rehabilitation (n = 111). Physical, cognitive, perceptual, and psychological abilities were assessed at T1. Results. A significant increase in participation was found over time for both groups, mainly in the first 3 months. The best predictors of participation differed between the groups and between the daily activities and social roles domains. Walking and acceptance of the stroke or fewer depressive symptoms were the best predictors of the level of participation after stroke. Conclusions . Participation was not optimal at discharge because it continued to increase after the return home. The importance of psychological factors in participation after stroke is undeniable. Many predictors are amenable to interventions.

Heterogeneity in the Cognitive Profile of Normal Elderly

An increasing number of studies point to the fact that distinct cognitive subgroups may be identified among subjects with dementia of the Alzheimer type (DAT). Although such heterogeneity could be the expression of neuropsychological, genetic, or epidemiological factors, the identification of neuropsychological subtypes in DAT could also reflect the existence of cognitive subgroups in a normal aged population. In the present study, the existence of neuropsychological subgroups was sought from among 81 volunteers aged between 55 and 84 years. Subjects were given a neuropsychological battery addressing various aspects of cognitive functioning. Results show that six subgroups could be identified among this population. Subgroups differ primarily in their overall degree of performance. Qualitative differences in cognitive performance are also present, mostly when subgroups which exhibit poor overall performance are considered. Consequently, the presence of such heterogeneity in normal elderly should be taken into account in any attempt to identify neuropsychologically based subgroups in early dementia of the Alzheimer type.

The Profile of Executive Functioning in Amnestic Mild Cognitive Impairment: Disproportionate Deficits in Inhibitory Control

Amnestic mild cognitive impairment (aMCI) represents a group of individuals who are highly likely to develop Alzheimers disease (AD). Although aMCI is typically conceptualized as involving predominantly deficits in episodic memory, recent studies have demonstrated that deficits in executive functioning may also be present, and thorough categorization of cognitive functioning in MCI may improve early diagnosis and treatment of AD. We first provide an extensive review of neuropsychology studies that examined executive functioning in MCI. We then present data on executive functioning across multiple sub-domains (divided attention, working memory, inhibitory control, verbal fluency, and planning) in 40 aMCI patients (single or multiple domain) and 32 normal elderly controls (NECs). MCI patients performed significantly worse than NECs in all 5 sub-domains, and there was impairment (>1.0 SD below the mean of NECs) in all sub-domains. Impairment on each test was frequent, with 100% of MCI patients exhibiting a deficit in at least one sub-domain of executive functioning. Inhibitory control was the most frequently and severely impaired. These results indicate that executive dysfunction in multiple sub-domains is common in aMCI and highlights the importance of a comprehensive neuropsychological evaluation for fully characterizing the nature and extent of cognitive deficits in MCI.

Conversational abilities in patients with right hemisphere damage

Abstract Research on the conversation of subjects with right hemisphere damage has hitherto used tasks too far removed from natural communication. Referential communication is proposed as a means to investigate RHD verbal communication impairments. The RHD patient is asked to instruct a research associate, situated on the other side of a screen, on how to display a series of a priori unnamed visual stimuli in the order in which they appear on his/her page. This exercise is repeated several times in succession. Some RHD patients do not have any problems but others are observed to have referential and/or more qualitative difficulties (similar to RHD conversational impairments). This heterogeneity is discussed within the framework provided by Joanette, Goulet and Daoust (1991).

Line orientation judgment in normal elderly and subjects with dementia of Alzheimer's type

Ninety-five normal controls divided into three subgroups (55-64 yrs, 65-74 yrs, and 75-84 yrs) and 11 subjects with early dementia of Alzheimers type (DAT) were given a line orientation judgment task (Benton, Varney, & Hamsher, 1978). No difference appeared between the three control subgroups in global score but the difference between controls and DAT subjects was significant. However, some DAT subjects had a global score overlapping the scores of controls. Error types were also analyzed. Results of this analysis showed that some errors appeared in all subjects, normal and DAT, while others were specific to DAT subjects. It was speculated that these error types were a manifestation of a deeper visuospatial deficit, revealing a major problem of the DAT in spatial organization. Thus, this study suggests that an analysis of the error types observed in the line orientation judgment task may be helpful in differentiating normal elderly from early DAT.

Selective impairment of transitive gestures: An unusual case of apraxia

Abstract We describe the case of a 74-year-old man with selective apraxia for transitive gestures (gestures of object use) following a left temporo-parietal infarction. We document his neuropsychological progress over 2 years and assess his praxic abilities according to the best-developed cognitive model of praxis. Strikingly, PF was unable to pantomime transitive gestures in every test modality (verbal command, imitation, photographs of objects and handling actual tools), but could still execute symbolic (e.g. salute) and meaningless gestures. He was able to discriminate and recognize transitive gestures as well as controls. His praxic impairment has persisted through the years in the absence of dementia. His inability to use tools cannot be accounted for on the basis of a visual agnosia, impaired language comprehension or a classic ideomotor apraxia. Such a selective deficit of transitive gestures is incompatible with the cognitive model proposing that the production of all meaningful gestures (symbolic...