A validation and acceptability study of cognitive testing using switch and eye-gaze control technologies for children with motor and speech impairments: A protocol paper.

Despite the importance of knowing the cognitive capabilities of children with neurodevelopmental conditions, less than one-third of children with cerebral palsy participate in standardized assessments. Globally, approximately 50% of people with cerebral palsy have an intellectual disability and there is significant risk for domain-specific cognitive impairments for the majority of people with cerebral palsy. However, standardized cognitive assessment tools are not accessible to many children with cerebral palsy, as they require manual manipulation of objects, verbal response and/or speeded response. As such, standardised assessment may result in an underestimation of abilities for children with significant motor and/or speech impairment. The overall aim of the project is to examine and compare the psychometric properties of standardised cognitive assessment tools that have been accommodated for use with either a switch device or eye-gaze control technologies, with the specific aims to: (1) Examine the psychometric properties (measurement agreement and validity) of accommodated assessment tools by comparing the performance of typically developing children on six cognitive assessment tools administered via standardised versus accommodated (switch or eye-gaze control) administration; (2) Describe and compare the performance and user experience of children with cerebral palsy on six accommodated cognitive assessments administered via switch or eye-gaze control technologies. Secondary aims are to: (1) Describe the completion rates and time to complete assessments of participants in each group; (2) Within the group with cerebral palsy, examine the effects of condition-specific characteristics (type of cerebral palsy, functional levels, and pain) and demographics (age, socio-demographic) on participation. This protocol paper describes a two-phase validation and acceptability study that utilizes a mixed-model design. This study will collect concurrent data from 80 typically developing children and 40 children with cerebral palsy, who use switch or eye-gaze control technology as alternate access communication methods. The set of instruments will measure receptive vocabulary, fluid reasoning, sustained attention, vision perception, visuospatial working memory and executive functions. Data analyses will be conducted using SPSS v. 25 and R v 4.1.0. SPSS Sample Power 3 was used for power computation and allows for a 10% drop out rate. Quantitative descriptive statistics, measurement agreement data plotting, bivariate and multiple regressions analysis will be conducted using appropriate methods.

Postinfectious SARS-CoV-2 Opsoclonus-Myoclonus-Ataxia Syndrome.

BACKGROUND: The opsoclonus-myoclonus-ataxia syndrome (OMAS) represents a pathophysiology and diagnostic challenge. Although the diverse etiologies likely share a common mechanism to generate ocular, trunk, and limb movements, the underlying cause may be a paraneoplastic syndrome, as the first sign of cancer, or may be a postinfectious complication, and thus, the outcome depends on identifying the trigger mechanism. A recent hypothesis suggests increased GABAA receptor sensitivity in the olivary-oculomotor vermis-fastigial nucleus-premotor saccade burst neuron circuit in the brainstem. Therefore, OMAS management will focus on immunosuppression and modulation of GABAA hypersensitivity with benzodiazepines. METHODS: We serially video recorded the eye movements at the bedside of 1 patient with SARS-CoV-2-specific Immunoglobulin G (IgG) serum antibodies, but twice-negative nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR). We tested cerebrospinal fluid (CSF), serum, and nasopharyngeal samples. After brain MRI and chest, abdomen, and pelvis CT scans, we treated our patient with clonazepam and high-dose Solu-MEDROL, followed by a rituximab infusion after her formal eye movement analysis 10 days later. RESULTS: The recordings throughout her acute illness demonstrated different eye movement abnormalities. While on high-dose steroids and clonazepam, she initially had macrosaccadic oscillations, followed by brief ocular flutter during convergence the next day; after 10 days, she had bursts of opsoclonus during scotopic conditions with fixation block but otherwise normal eye movements. Concern for a suboptimal response to high-dose Solu-MEDROL motivated an infusion of rituximab, which induced remission. An investigation for a paraneoplastic etiology was negative. CSF testing showed elevated neuron-specific enolase. Serum IgG to Serum SARS-CoV2 IgG was elevated with negative RT-PCR nasopharyngeal testing. CONCLUSION: A recent simulation model of macrosaccadic oscillations and OMAS proposes a combined pathology of brainstem and cerebellar because of increased GABAA receptor sensitivity. In this case report, we report 1 patient with elevated CSF neuronal specific enolase, macrosaccadic oscillations, ocular flutter, and OMAS as a SARS-CoV-2 postinfectious complication. Opsoclonus emerged predominantly with fixation block and suppressed with fixation, providing support to modern theories on the mechanism responsible for these ocular oscillations involving cerebellar-brainstem pathogenesis.

Syphilis at age 15 years.

We present a case of a 15-year-old girl who presented with 1 month of worsening nonpruritic rash limited to her palms and soles. She had been treated twice for sexually transmitted infections. With her presentation of a nonpruritic rash on the palms and soles, a diagnosis of syphilis must be considered.

Pediatric rehabilitation psychology: Rehabilitating a moving target.

The current special section includes manuscripts focusing on four aspects of pediatric rehabilitation psychology that are unique to this practice area. The first domain addressed is natural developmental progression in the context of a disability (i.e., habilitation). The next domain addressed in this special section is pediatric rehabilitation; pediatric rehabilitation psychology addresses the reacquisition of previously attained skills and abilities within the context of the natural developmental milieu. This special section also highlights the inherently interdisciplinary and transdisciplinary nature of pediatric rehabilitation psychology given the complex environment in which children exist. Finally, the special section includes illustrations of the crucial role pediatric rehabilitation psychologists play in facilitating transitions through major milestones, particularly from pediatrics to adulthood when living with a disability. (PsycINFO Database Record

Health self-management, transition readiness and adaptive behavior in persons with cerebral palsy or myelomeningocele.

PURPOSE/OBJECTIVE: This study was conducted to examine the associations between generic and condition-specific health self-management and levels of adaptive behavior in 2 groups of transition-age youth with congenital neurodevelopmental conditions. METHOD: The sample included 43 adolescents/young adults diagnosed with cerebral palsy (CP) and 36 with spina bifida/myelomeningocele (SBM), ages 13-29, mean age 18.96 (4.77), 51.9% female. Health self-management was assessed with the Transition Readiness Assessment Questionnaire (TRAQ) completed by the child, and the Kennedy Krieger Independence Scales-Spina Bifida (KKIS-SB) completed by the parent/guardian. The Adaptive Behavior Assessment System (ABAS-II) completed by the parent/guardian was used to assess levels of adaptive behavior. RESULTS: There were significant group differences in condition-specific health self-management, including lower KKIS-SB Initiation of Routines and KKIS-SB Prospective Memory scores in the group with SBM. Those differences were no longer significant when scoring was modified to account for item applicability. Group differences in generic health self-management and adaptive behavior were not significant. There were significant differences in the correlations between health self-management instruments and ABAS-II composite scores. CONCLUSIONS: For youth with congenital neurodevelopmental conditions who are in the transition to adulthood, there are important condition-specific self-management needs that are not captured by measuring generic transition readiness or adaptive behavior. Findings highlight the need for clinicians to assess health self-management needs from multiple perspectives, utilizing generic and condition-specific measures that can inform targeted interventions and supports for optimal independence. (PsycINFO Database Record

Mastery motivation and executive functions as predictors of adaptive behavior in adolescents and young adults with cerebral palsy or myelomeningocele.

PURPOSE/OBJECTIVE: To examine mastery motivation and executive functions or behaviors as predictors of adaptive behavior in adolescents and young adults with congenital neurodevelopmental conditions. METHOD: Participants were 2 groups of adolescents and young adults, ages 13-29, including 43 with cerebral palsy and 36 with myelomeningocele living with a parent or caregiver. Participants completed measures of mastery motivation, executive functions or behaviors, and a measure of adaptive behavior. RESULTS: Group differences in mastery motivation, executive functions and executive behaviors, and adaptive behavior profiles were not significant. Mastery motivation, executive functions, and executive behaviors explained a significant portion of variance in adaptive behavior. CONCLUSIONS: Findings highlight the importance of assessing and addressing motivational and executive needs in developing interventions to promote independence. Findings also suggest the need for more comprehensive assessment of adaptive behaviors that include the ability to self-direct others in the completion of tasks necessary for successful daily functioning. (PsycINFO Database Record

A comparison of visual inspection time measures in children with cerebral palsy.

PURPOSE/OBJECTIVE: This study examined the performance of children with and without cerebral palsy on two inspection time (IT) tests, as accessible nonspeeded response measures of cognitive processing speed. RESEARCH METHOD/DESIGN: Participants, ages 8 to 16, included 66 children with congenital CP and 119 typically developing peers. Measures were two visual IT tasks with identical target stimuli but differential response strategies either via a traditional dual-key method or with an assistive technology pressure switch interface and response option scanning. RESULTS: The CP group had slower IT than the control group independent of test version. Log transformations were used to address skew, and transformed mean intraclass correlations showed moderate agreement between test versions for both participant groups. Bland-Altman plots showed that at higher mean IT thresholds, greater discrepancies between test version scores were observed. CONCLUSIONS/IMPLICATIONS: Findings support the feasibility of developing tests that reduce speeded motor response demands. Future test development should incorporate increased gradations of difficulty at the extremes of neuropsychological functioning to more accurately assess the performance of individuals whose conditions are associated with atypical performance levels.

The influence of spatial working memory on ipsilateral remembered proprioceptive matching in adults with cerebral palsy.

Somatosensation is frequently impaired in individuals with Cerebral Palsy (CP). This includes the sense of proprioception, which is an important contributor to activities of daily living. One means of determining proprioceptive deficits in CP has been use of an Ipsilateral Remembered (IR) position matching test. The IR test requires participants to replicate, without vision, memorized joint/limb positions previously experienced by the same (i.e. ipsilateral) effector. Given the memory component inherent to this task, the present study sought to determine the extent to which IR proprioceptive matching might be influenced by known spatial working memory deficits. Eleven adults with CP underwent IR elbow position matching, where blindfolded individuals were given either a short (2 s) or long (15 s) duration to memorize the target elbow angle. A standard clinical measure of spatial working memory (i.e. Corsi block-tapping task) was also administered. The results showed that the directional (i.e. constant) error produced across trials did not differ between the short and long target duration conditions. However, it was found that participants were significantly more consistent in their matches (i.e. had smaller variable errors) when given more time to encode proprioceptive targets in the long duration condition. The benefit of having more time was greatest for those individuals with the highest variable errors in the short target condition, and a significant association was seen between improvements in variable error and greater performance on 4/5 spatial working memory measures. These findings provide the best evidence to date that IR position matching tests are influenced by spatial working memory.

Modified test administration using assistive technology: preliminary psychometric findings.

This study examined the psychometric properties of test presentation and response formats that were modified to be accessible with the use of assistive technology (AT). First, the stability of psychometric properties was examined in 60 children, ages 6 to 12, with no significant physical or communicative impairments. Population-specific differences were then examined with samples that included 24 children with cerebral palsy and matched control peers. Children were administered standard and modified versions of tests. The type of AT access did not have a statistically significant effect on modified test scores. Measurement stability between the standard and modified versions of quadrant forced-choice format tests was sufficient. The findings support the potential use of AT and accessible procedures for some test instruments in the assessment of children with cerebral palsy.

Inspection time and attention-deficit/hyperactivity disorder symptoms in children with cerebral palsy.

OBJECTIVE: To examine between-groups differences in the associations between aspects of processing speed assessed with an inspection time task and attention-deficit/hyperactivity disorder (ADHD) symptoms. RESEARCH DESIGN: Two groups comprising 34 children with cerebral palsy (CP) and 70 nonaffected peers (control), ages 8-16 years, participated in a prospective correlational study. Measures included a visual inspection time task and the Conners' Parent Rating Scale-Revised: Long Version. RESULTS: Children with CP exhibited significantly slower processing speed and more symptoms of inattention and hyperactivity than controls. Significant associations between inspection time and ADHD symptoms were found only in the control group. CONCLUSIONS: Findings have implications for clinical assessment and understanding of attentional risks associated with CP.

Acute effects of cocaine on the neurobiology of cognitive control.

Compromised ability to exert control over drug urges and drug-seeking behaviour is a characteristic of addiction. One specific cognitive control function, impulse control, has been shown to be a risk factor for the development of substance problems and has been linked in animal models to increased drug administration and relapse. We present evidence of a direct effect of cocaine on the neurobiology underlying impulse control. In a laboratory test of motor response inhibition, an intravenous cocaine administration improved task performance in 13 cocaine users. This improvement was accompanied by increased activation in right dorsolateral and inferior frontal cortex, regions considered critical for this cognitive function. Similarly, for both inhibitory control and action monitoring processes, cocaine normalized activation levels in lateral and medial prefrontal regions previously reported to be hypoactive in users relative to drug-naive controls. The acute amelioration of neurocognitive dysfunction may reflect a chronic dysregulation of those brain regions and the cognitive processes they subserve. Furthermore, the effects of cocaine on midline function suggest a dopaminergically mediated intersection between cocaine's acute reinforcing effects and its effects on cognitive control.

Training requirements and scope of practice in rehabilitation psychology and neuropsychology.

The purpose of this article is to educate the reader regarding the training requirements and scope of practice for rehabilitation psychology and neuropsychology. As discussed below, subspeciality training in pediatric rehabilitation psychology and pediatric neuropsychology is not yet formalized. While the clinical services of rehabilitation psychologists largely involve providing treatment, most clinical neuropsychologists primarily are involved in diagnostic assessment [19,20]. In rehabilitation settings, it is not unusual for psychologists to draw upon both rehabilitation psychology and neuropsychology expertise.

Cognition in neuromuscular disease.

Although neuromuscular diseases primarily affect an individual's physical functioning, the cognitive and psychosocial effects of these conditions can be quite significant. This paper provides an overview of a subset of neuromuscular diseases and their associated neurocognitive risks. It provides a heuristic for thinking about the associated neuropsychological differences in children and adolescents with neuromuscular disorder. Areas for further research are identified and practical guidelines for optimizing functioning within the school setting are provided.

A validation of event-related FMRI comparisons between users of cocaine, nicotine, or cannabis and control subjects.

OBJECTIVE: Noninvasive brain imaging techniques are a powerful tool for researching the effects of drug abuse on brain activation measures. However, because many drugs have direct vascular effects, the validity of techniques that depend on blood flow measures as a reflection of neuronal activity may be called into question. This may be of particular concern in event-related functional magnetic resonance imaging (fMRI), where current analytic techniques search for a specific shape in the hemodynamic response to neuronal activity. METHOD: To investigate possible alterations in task-related activation as a result of drug abuse, fMRI scans were conducted on subjects in four groups as they performed a simple event-related finger-tapping task: users of cocaine, nicotine, or cannabis and control subjects. RESULTS: Activation measures, as determined by two different analytic methods, did not differ between the groups. A comparison between an intravenous saline and an intravenous cocaine condition in cocaine users found a similar null result. Further in-depth analyses of the shape of the hemodynamic responses in each group also showed no differences. CONCLUSIONS: This study demonstrates that drug groups may be compared with control subjects using event-related fMRI without the need for any post hoc procedures to correct for possible drug-induced cardiovascular alterations. Thus, fMRI activation differences reported between these drug groups can be more confidently interpreted as reflecting neuronal differences.

Interrupting the "stream of consciousness": an fMRI investigation.

In functional neuroimaging, a local decrease in blood flow during an active task, relative to a "resting" baseline, is referred to as task-induced deactivation (TID). TID may occur when resources shift from ongoing, internally generated processing typical of "resting" states to processing required by an exogenous task. We previously found specific brain regions in which TID increased as task processing demands increased. When engaged in an exogenous cognitive task, reallocation of resources from areas involved in internal processing should result in suspension of that processing. Self-reported thought content has been used as an indicator of the extent of internal processing activity. We investigated the relationship between TID and task-unrelated thought (TUT) frequency using an auditory target detection task with seven levels of task difficulty. At varied intervals during task performance, subjects indicated whether they were experiencing a TUT. We expected TUT frequency to decrease as task demands increased and for this pattern to correlate with TID magnitude across conditions. Generally, fewer TUTs were reported during difficult task conditions than during easier conditions. As TID magnitude increased across task conditions, the frequency of TUTs declined (r = 0.90, P = 0.005). Four left hemisphere regions (posterior parieto-occipital cortex, anterior cingulate gyrus, fusiform gyrus, and middle frontal gyrus) showed strong relationships between TUTs and TID (r > 0.79, P < 0.05 corrected). As these regions have been implicated in semantic processing and self-referential thought, the findings support the suspension of internal cognitive processing as one mechanism for TID.

Policy for therapeutic acupuncture in an academic health center: a model for standard policy development.

Acupuncture as a therapeutic modality offers multiple applications. Its effectiveness coupled with its general acceptance by conventional health care professionals makes it one of the first complementary and alternative medicine (CAM) modalities to be incorporated in an integrative approach to care. However, few centers that offer acupuncture have written standard policies to regulate its use. This lack of standard policies may impede provision of quality care, serve as a barrier to cross-institutional data collection and clinical application of that data, and may put health care professionals and institutions at risk when credentialing or malpractice liability has not been clearly addressed. Here we present a policy for acupuncture, created by a diverse group of health care professionals at the University of Michigan Health System. It may function as a generalizable template for standard policy development by institutions incorporating acupuncture.

Cingulate hypoactivity in cocaine users during a GO-NOGO task as revealed by event-related functional magnetic resonance imaging.

Although extensive evidence exists for the reinforcing properties of drugs of abuse such as cocaine, relatively less research has addressed the functional neuroanatomical correlates of the cognitive sequelae of these drugs. We present a functional magnetic resonance imaging study of a GO-NOGO task in which successful performance required prepotent behaviors to be inhibited. Significant cingulate, pre-supplementary motor and insula hypoactivity was observed for both successful NOGOs and errors of commission in chronic cocaine users relative to cocaine-naive controls. This attenuated response, in the presence of comparable activation levels in other task-related cortical areas, suggests cortical and psychological specificity in the locus of drug abuse-related cognitive dysfunction. The results suggest that addiction may be accompanied by a disruption of brain structures critical for the higher-order, cognitive control of behavior.

A parametric manipulation of factors affecting task-induced deactivation in functional neuroimaging.

Task-induced deactivation (TID) refers to a regional decrease in blood flow during an active task relative to a "resting" or "passive" baseline. We tested the hypothesis that TID results from a reallocation of processing resources by parametrically manipulating task difficulty within three factors: target discriminability, stimulus presentation rate, and short-term memory load. Subjects performed an auditory target detection task during functional magnetic resonance imaging (fMRI), responding to a single target tone or, in the short-term memory load conditions, to target sequences. Seven task conditions (a common version and two additional levels for each of the three factors) were each alternated with "rest" in a block design. Analysis of covariance identified brain regions in which TID occurred. Analyses of variance identified seven regions (left anterior cingulate/superior frontal gyrus, left middle frontal gyrus, right anterior cingulate gyrus, left and right posterior cingulate gyrus, left posterior parieto-occipital cortex, and right precuneus) in which TID magnitude varied across task levels within a factor. Follow-up tests indicated that for each of the three factors, TID magnitude increased with task difficulty. These results suggest that TID represents reallocation of processing resources from areas in which TID occurs to areas involved in task performance. Short-term memory load and stimulus rate also predict suppression of spontaneous thought, and many of the brain areas showing TID have been linked with semantic processing, supporting claims that TID may be due in part to suspension of spontaneous semantic processes that occur during "rest" (Binder et al., 1999). The concept that the typical "resting state" is actually a condition characterized by rich cognitive activity has important implications for the design and analysis of neuroimaging studies.