Cognitive profile of mild traumatic brain injury patients requiring acute hospitalization - A UC davis cognitive screener (UCD-Cog) study.

OBJECTIVE: Identification of patients with mTBI at risk for developing persistent-post concussive syndromes should begin during the ED/inpatient evaluation due to frequent lack of post-discharge follow-up. The best method for evaluating cognitive deficits in these acute settings and how to utilize this information to optimize follow-up care is a matter of ongoing research. In this descriptive study, we present the cognitive profile of 214 hospitalized patients with mTBI using a novel cognitive and behavioral screener, the UCD-Cog. METHOD: A retrospective review of patients with mTBI requiring hospitalization who were enrolled in the UC Davis TBI Registry over the course of 1 year. RESULTS: Reasoning, executive function, and delayed recall were the most frequently impaired cognitive domains. GCS 13-14 was associated with higher numbers of impaired cognitive domains and frequencies of impairments in domains traditionally associated with post-concussive symptoms. Patients with abnormal UCD-Cog results, regardless of GCS, were recommended higher levels of post-discharge care and supervision. CONCLUSION: Inpatient cognitive profiles using the UCD-Cog were consistent with evaluations during the subacute/chronic phase of mTBI and supports the clinical utility of acute cognitive screeners for mTBI management. Future studies will determine how the acute cognitive assessments correlate with long-term mTBI outcomes.

Treating apraxia of speech with an implicit protocol that activates speech motor areas via inner speech.

BACKGROUND: Treatments of apraxia of speech (AOS) have traditionally relied on overt practice. One alternative to this method is implicit phoneme manipulation which was derived from early models on inner speech. Implicit phoneme manipulation requires the participant to covertly move and combine phonemes to form a new word. This process engages a system of self-monitoring which is referred to as fully conscious inner speech. AIMS: The present study aims to advance the understanding and validity of a new treatment for AOS, implicit phoneme manipulation. Tasks were designed to answer the following questions. 1. Would the practice of implicit phoneme manipulation improve the overt production of complex consonant blends in words? 2. Would this improvement generalize to untrained complex and simpler consonant blends in words? 3. Would these treatment tasks activate regions known to support motor planning and programming as verified by fMRI? METHOD & PROCEDURES: The participant was asked to covertly manipulate phonemes to create a new word and to associate this newly formed word to a target picture among 4 phonologically-related choices. To avoid overt practice, probes were collected only after each block of training was completed. Probe sessions assessed the effects of implicit practice on the overt production of simple and complex consonant blends in words. An imaging protocol compared semantic baseline tasks to treatment tasks to verify that implicit phoneme manipulation activated brain regions of interest. OUTCOMES & RESULTS: Behavioral: Response to implicit training of complex consonant blends resulted in improvements which were maintained 6 weeks after treatment. Further, this treatment generalized to simpler consonant blends in words. Imaging: Functional imaging during implicit phoneme manipulation showed significant activation in brain regions responsible for phonological processing when compared to the baseline semantic task. CONCLUSIONS: Implicit phoneme manipulation offers an alternative to traditional methods that require overt production for treatment of AOS. Additionally, this implicit treatment method was shown to activate neural areas known to be involved in phonological processing, motor planning and programming.

The neural basis for simulated drawing and the semantic implications.

This functional magnetic resonance imaging (fMRI) study of the mental simulation of drawing (1) investigated the neural substrates of drawing and (2) delineated the semantic aspects of drawing. The goal was to advance our understanding of how drawing a familiar object is linked to lexical semantics and therefore a viable method to use to rehabilitate aphasia. We hypothesized that the semantic aspects of drawing familiar objects compared to drawing non-objects would yield greater activation in the inferior temporal cortex and the inferior frontal cortex of the left hemisphere. To test this hypothesis, eight right-handed subjects performed an fMRI experiment that directly contrasted drawing familiar objects to non-objects using mental imagery. Simulated drawing recruited a large, distributed network of frontal, parietal, and temporal structures. In the contrast comparing drawing familiar objects to non-objects there was stronger activation in the left hemisphere within the inferior temporal, anterior inferior frontal, inferior parietal and superior frontal cortices. The activation within the inferior temporal cortex was associated with visual semantic processing and semantic mediated naming. We suggest that the anterior inferior frontal activation is linked to the inferior temporal cortex and is involved in the selection of specific semantic features of the object as well as retrieval of information regarding the perceptual aspects of the object.

Comparison of the neural basis for imagined writing and drawing.

Drawing and writing are complex processes that require the synchronization of cognition, language, and perceptual-motor skills. Drawing and writing have both been utilized in the treatment of aphasia to improve communication. Recent research suggests that the act of drawing an object facilitated naming, whereas writing the word diminished accurate naming in individuals with aphasia. However, the relationship between object drawing and subsequent phonological output is unclear. Although the right hemisphere is characteristically mute, there is evidence from split-brain research that the right hemisphere can integrate pictures and words, likely via a semantic network. We hypothesized that drawing activates right hemispheric and left perilesional regions that are spared in aphasic individuals and may contribute to semantic activation that supports naming. Eleven right-handed subjects participated in a functional MRI (fMRI) experiment involving imagined drawing and writing and 6 of the 11 subjects participated in a second fMRI experiment involving actual writing and drawing. Drawing and writing produced very similar group activation maps including activation bilaterally in the premotor, inferior frontal, posterior inferior temporal, and parietal areas. The comparison of drawing vs. writing revealed significant differences between the conditions in areas of the brain known for language processing. The direct comparison between drawing and writing revealed greater right hemisphere activation for drawing in language areas such as Brodmann area (BA) 46 and BA 37.

Drawing: its contribution to naming in aphasia.

Drawing in aphasia therapy has been used predominately as a substitution for speech or to augment communication when other modalities are non-functional. The value of drawing as a route for facilitating verbal expression has not been a focus of prior research. We compared the usefulness of drawing and writing as compensatory strategies for improving naming in individuals with aphasia. Activation patterns of writing and drawing in healthy adults were examined using fMRI. Clinical results suggest that drawing facilitated naming whereas writing diminished accurate naming responses, and that drawing quality is not relevant to this facilitatory effect. Functional MRI findings revealed strong bi-hemispheric activation of semantic and phonological networks while drawing that may support our clinical findings.