Caterina Pistarini

Verb–Noun Double Dissociation in Aphasic Lexical Impairments: The Role of Word Frequency and Imageability

Neurolinguistic studies have provided important evidence regarding the organization of lexical representations and the structure of underlying conceptual knowledge; in particular, it has been shown that the retrieval of verbs and nouns can be damaged selectively. Dissociated lexical damage is proof of an independent mental organization of lexical representations and/or of the underlying processes. The aim of the present study is to estimate the rate of dissociated impairments for nouns and verbs on a large sample of mild to moderate aphasic patients and to investigate the mechanisms underlying such phenomena. In addition, the authors wished to verify to what degree the impairment for nouns and verbs is related to a specific type of language disorder. A confrontation naming task for verbs and nouns was administered to 58 aphasic patients. The major lexical (word frequency and age of acquisition) and semantic variables (familiarity and imageability of the underlying concept) were considered for each noun and verb used in the task. Verbs were distinguished by major functional classes (transitive, intransitive, and ergative verbs). The data collected from this task were analyzed twice: (i) as a group study comparison of major aphasic subgroups and (ii) as a multiple single case study to evaluate the differences on the naming of verbs and nouns and the effect of the lexical semantic variables on each individual patient. The results confirm the existence of dissociated naming impairments of verbs and nouns. Selective impairment of verbs is more frequent (34%) than that of nouns (10%). In many cases, the dissociated pattern of naming impairment disappeared when the effect of the concomitant variables (word frequency and imageability) was removed, but in approximately one-fifth of the cases the noun or verb superiority was preserved. Noun superiority emerged in five of six agrammatic patients. Both the naming of verbs (n = 9) or of nouns (n = 6) could be impaired selectively in fluent aphasic patients. The results lend support to the hypothesis of an independent mental organization of nouns and verbs, but a substantial effect of imageability and word frequency suggests an interaction of the naming impairment with underlying lexical and semantic aspects.

The mental representation of Verb–Noun compounds in Italian: Evidence from a multiple single-case study in aphasia

This study seeks information on the mental representation of Verb-Noun (VN) nominal compounds through neuropsychological methods. The lexical retrieval of compound nouns is tested in 30 aphasic patients using a visual confrontation naming task. The target names are VN compounds, Noun-Noun (NN) compounds, and long morphologically simple nouns (LSN). In order to check the ability to produce simple nouns and verbs in the same participants, a further visual confrontation naming task of objects and actions is used. Results of the study confirm that several patients with disproportionate verb deficit are also impaired in naming VN compounds. Data are in favor of a (de)compositional processing of compound words. A further group of patients is selectively more impaired with compound nouns than with comparably long simple nouns, irrespective of their VN or NN morphological structure. It is suggested that this impairment is to be ascribed to a specific disorder in retrieving two different lexemes with a single lexical entry.

Reduced plasma levels of tyrosine, precursor of brain catecholamines, and of essential amino acids in patients with severe traumatic brain injury after rehabilitation

OBJECTIVEnTo investigate whether levels of plasma tyrosine and tryptophan, precursors of brain catecholamine and serotonin neurotransmitters, respectively, and other essential amino acids (EAA) may return to normal in patients with severe traumatic brain injury (TBI) after 2 months in a hospital rehabilitation center.nnnDESIGNnPeripheral plasma concentrations of tyrosine, tryptophan, and other EAAs in subjects with severe TBI, both at admission (44+/-11d postinjury) and at discharge from the center (110+/-15d after acute event) were compared with concentrations in control subjects.nnnSETTINGnTertiary care rehabilitation setting in Italy.nnnPARTICIPANTSnTen men (26.6+/-12.6y) with TBI and 6 healthy subjects (controls) matched for age, sex, voluntary loss of body weight, and sedentary lifestyle.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnConcentrations of brain neurotransmitter precursor amino acids and of EAA.nnnRESULTSnOn admission, patients had lower plasma tyrosine, leucine, valine, methionine, and phenylalanine concentrations than did control subjects. The plasma concentrations of tryptophan were similar in the 2 groups. These amino acid abnormalities were still present at discharge.nnnCONCLUSIONnThe levels of plasma tyrosine and many EAA in patients with TBI did not recover by discharge (110+/-15d) from rehabilitation. Plasma tryptophan concentrations were similar in patients and controls.

Functioning and disability in traumatic brain injury: the Italian patient perspective in developing ICF Core Sets

Objective.u2003The purpose of the study was to explore the aspects of functioning and health relevant to patients with traumatic brain injury (TBI) and to the caregivers of TBI patients explicitly involved in the preliminary study for the Development of the ICF Core Set for TBI using a qualitative research method. Method.u2003The sampling of patients followed the maximum variation strategy. To respect this strategy, we involved patients with different degrees of impairment and so, for some people it was not possible to join the group because of their severe cognitive impairment, in this case we interviewed their caregivers. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analyses, the resulting concepts were linked to ICF categories according to established linking rules. Results.u2003Eighteen focus groups and five single interviews were performed. Forty-one patients participated in 10 focus groups. Thirty-three caregivers participated in eight focus group and six caregivers underwent a single interview. Saturation at 10%% cutoff was reached. Based on 10 patient focus groups, we linked the concepts to 144 2nd level ICF different categories. In the eight focus group with caregiver we linked the concepts to129 2nd level categories. In the single interviews, we could link the concepts only to Environmental factors and we linked to 25 ICF different categories. Conclusion.u2003A broad range of aspects of functioning and health as well as several Environmental factors important to patients with TBI were explored and included in the preparatory phase of the development of ICF Core Sets for TBI. Whereas patients focused on problems in mobility, employment and recreation and leisure the caregivers highlighted several issues related to self-care as being important for the patients.

On the nature of the selective impairment of verb and noun retrieval.

Several neurolinguistic studies have shown that the retrieval of verbs and nouns can be damaged selectively in aphasic patients. It has been claimed that the retrieval of nouns may be more impaired in anomic patients, while agrammatic patients have more difficulty in retrieving verbs (e.g. Goodglass, 1993; Zingeser and Berndt, 1988, 1990). Non-agrammatic patients were found by some authors (e.g. Berndt et al., 1997) to show noun superiority as well. In this regard, Jonkers and Bastiaanse (1998) suggested that verbs and nouns dissociate in one direction only, as all aphasic patients have more difficulty retrieving verbs than nouns. As is true for the class of nouns, there is little justification for considering verbs as a unitary lexical class. Thompson et al. (1997) found that verbs taking fewer arguments are easier for agrammatic patients to produce, and a study done by Jonkers (1999) indicated that Broca’s aphasic patients name transitive verbs better than intransitive verbs. However, De Bleser’s (2000) work shows the opposite pattern of impairment (intransitive verbs less impaired than transitive ones). The objectives of the present study were: (i) to assess the prevalence of selective impairment of verbs and nouns; (ii) to ascertain whether verbor nounsuperiority is associated with a particular type of aphasia; (iii) to ascertain whether there are differences among verb types; (iv) to elucidate the mechanisms underlying verb-noun dissociation.

Functioning and disability in the vegetative state: Results from a pilot study in Italy

Purpose.u2003To describe functioning and disability of patients in vegetative state (VS) according to the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). Method.u2003Patients in VS admitted to long-stay hospitals were consecutively enrolled, and the ICF checklist was completed by trained professionals. ICF categories utilisation is described. Results.u2003Twenty-one patients (15 males) were enrolled, mean age was 51.9 and mean duration of VS was 22 months. The majority of body functions and structures categories are reported as problems in less than 20% of patients. In the activity and participation domain, majority of ICF categories were not applicable and, among opened categories, performance was usually better than capacity. Among environmental factors, categories are mostly described as facilitators. Conclusions.u2003This is the first pilot study in which the applicability of the ICF checklist to patients in VS was tested, showing the applicability of ICF categories within A&P domain, and the presence of few but very strong facilitating environmental factors. This study also sets the premises for a study on people in VS and in minimal conscious state both at a national and international level.

Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation: A case report

Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself (offline condition) and after having performed a series of verbally cued finger opposition movements (online condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patients awareness does not improve in both the offline condition (in which the patient does not attempt to perform the movement) and in the online condition, when vision is precluded (online condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.

Traumatic and nontraumatic brain injury

The neurological consequences of an acquired brain injury (ABI), of traumatic or nontraumatic origin, are caused by an alteration of neuronal activity that compromises physical integrity or function of one or more areas of the brain. Impairments resulting from an ABI often affect cognitive function, as well as language, memory, attention, and information processing faculties, leading to partial or total disability that is likely to prevent peoples functional and psychosocial recovery even in the long term. This situation has harmful clinical, social, and economic effects. Social costs caused by a patients death or acquired disability are extremely high, and costs to healthcare systems rank among the top three in Europe. One of the main considerations when dealing with traumatic or nontraumatic brain injury is the complexity of the rehabilitation process. Many variables must be taken into account because of the great variety of clinical features that may occur, involving damage etiology, severity level, and health complications. Great advancements have been achieved over the past 10-15 years in the treatment of ABI, but new basic and clinical research must be encouraged and financially supported. Many challenging issues still occur when evaluating patients with ABI due to the lack of appropriate assessment measures and reliable prognostic indexes that could support clinical observation. Furthermore, researcher authors need to create a network of rehabilitation services that responds to the needs - medical, emotional, and social - of all brain-injured patients and their families, from initial hospitalization to reintegration into the community.

Motivation to change and posttreatment temptation to drink: a multicenter study among alcohol-dependent patients

Background An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink. Methods We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change – alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment – outcome evaluation). Results Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation to drink. Multivariate linear regression analysis revealed that significant predictors of posttreatment temptation to drink were polysubstance dependence (p<0.001), readiness to change (p=0.01), and self-efficacy (p=0.05). Conclusion Inpatients’ rehabilitation for alcohol dependence is associated with an overall improvement in motivation to change and a significant reduction of psychological distress. Treatments for alcohol-dependent patients should focus on motivation to change, negative moods, and relapse prevention strategies for the management of craving.

Validation of the ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury using focus groups

Abstract Introduction: The International Classification of Functioning, Disability and Health (ICF) Core Set for Vocational Rehabilitation is an application of the ICF of the World Health Organization with the purpose of identifying problems and resources relevant for people in a vocational rehabilitation given a health condition. Objective: The objective of the study was to validate the Comprehensive ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury (SCI). The specific aims were to explore the aspects of functioning and health important to patients with SCI regarding return to work and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for Vocational Rehabilitation. Methods: Focus group interviews were conducted. The sampling of patients followed the maximum variation strategy. Sample size satisfied saturation criterion. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Results: Twenty-four SCI patients participated in seven focus groups. Sixty-three ICF categories out of 90 ICF categories contained in the Comprehensive ICF Core Set for Vocational Rehabilitation were reported by the patients. Forty-two additional categories that are not covered in the Comprehensive ICF Core Set for Vocational Rehabilitation were found but adding the health condition-specific ICF Core Set for SCI in long-term context, only 11 categories were not covered. Conclusions: The existing version of the Comprehensive ICF Core Set for Vocational Rehabilitation was confirmed almost entirely by the focus groups to explore the vocational situation of patients with SCI. Implications for Rehabilitation Validation of the ICF Core Set for Vocational Rehabilitation as a useful tool to facilitate social reintegration and rehabilitation of patients with SCI. Return to work is a key outcome in vocational rehabilitation of patients with SCI including those who are young with long-term employment prospects. The results of this study could provide a foundation in utilizing the ICF Core Set for Vocational Rehabilitation to guide rehabilitation goals, service planning and evaluation, and fostering an engaging relationship with employers in the context of SCI rehabilitation. SCI patients have specific needs, not entirely covered by the both ICF Core Set for SCI long-term context and for Vocational Rehabilitation. Our results underline some of the second level categories, probably related to specific SCI impairment, which can be useful to plan specific rehabilitation programs to improve the return to work after SCI.