Incidental Verbal Semantic Processing Recruits the Fronto-temporal Semantic Control Network.

The frontoparietal semantic network, encompassing the inferior frontal gyrus and the posterior middle temporal cortex, is considered to be involved in semantic control processes. The explicit versus implicit nature of these control processes remains however poorly understood. The present study examined this question by assessing regional brain responses to the semantic attributes of an unattended stream of auditory words while participants' top-down attentional control processes were absorbed by a demanding visual search task. Response selectivity to semantic aspects of verbal stimuli was assessed via a functional magnetic resonance imaging response adaptation paradigm. We observed that implicit semantic processing of an unattended verbal stream recruited not only unimodal and amodal cortices in posterior supporting semantic knowledge areas, but also inferior frontal and posterior middle temporal areas considered to be part of the semantic control network. These results indicate that frontotemporal semantic networks support incidental semantic (control) processes.

VASCULAR STENOSIS DETECTION USING TEMPORAL-SPECTRAL DIFFERENCES IN CORRELATED ACOUSTIC MEASUREMENTS.

Central venous stenosis is often undiagnosed in patients with hemodialysis vascular access, partly due to imaging difficulties. Noninvasive, point-of-care detection could rely on detecting regions of turbulent blood flow caused by blood velocity changes. Here we present flexible microphone arrays for time-correlated measures of blood flow sounds and a new signal processing approach to calculate time correlation between spectral features. Continuous wavelet transform was used to produce an auditory spectral flux analytic signal, which was thresholded to identify systolic start and end phases. Microphone arrays were tested on pulsatile flow phantoms with blood flow rates of 850-1,200 mL/min and simulated stenosis from 10-85%. Measured results showed an inversion in the time onset of systolic spectral content for sites proximal and distal to stenosis for hemodynamically significant stenoses (+22 ms for stenosis<50% and -20 to -38 ms for stenosis>50%). Equivalent blood velocity increases were calculated as 142-155 cm/s in stenotic phantoms, which are within the physiologic range as measured by ultrasound.

SKIN-COUPLED PVDF MICROPHONES FOR NONINVASIVE VASCULAR BLOOD SOUND MONITORING.

Vascular access is the "Achilles Heel" of hemodialysis, as maintaining high flow characteristics (access patency) is critical to achieving efficient dialysis treatment. Thus, monitoring of vascular access is essential for maintaining long-term dialysis success. Blood sounds change in the presence of stenosis and can be analyzed digitally as phonoangiograms (PAGs) to determine changes in hemodynamic flow. We propose a multi-channel PAG recording sensor suitable for rapid, non-invasive vascular access monitoring. Here we present the initial design and characterization of sensors appropriate for recording PAGs from the skin surface. An optimized sensor size and backing material was selected to improve sensitivity and to provide a neutral frequency response. The sensor performance was finally compared with a conventional stethoscope on a controlled blood flow stenosis benchtop phantom.

Stenosis Characterization and Identification for Dialysis Vascular Access.

Vascular access dysfunction is the leading cause of hospitalization for hemodialysis patients and accounts for the most medical costs in this patient population. Vascular access flow is commonly hindered by blood vessel narrowing (stenosis). Current screening methods involving imaging to detect stenosis are too costly for routine use at the point of care. Noninvasive, real-time screening of patients at risk of vascular access dysfunction could potentially identify high-risk patients and reduce the likelihood of emergency surgical interventions. Bruits (sounds produced by turbulent blood flow near stenoses) can be interpreted by skilled clinical staff using conventional stethoscopes. To improve the sensitivity of detection, digital analysis of blood flow sounds (phonoangiograms or PAGs) is a promising approach for classifying vascular access stenosis using non-invasive auditory recordings. Here, we demonstrate auditory and spectral features of PAGs which estimate both the location and degree of stenosis (DOS). Auditory recordings from nine stenosis phantoms with variable DOS and hemodynamic flow rate were obtained using a digital recording stethoscope and analyzed to extract classification features. Autoregressive modeling and discrete wavelet transforms were used for multiresolution signal decomposition to produce 14 distinct features, most of which were linearly correlated with DOS. Our initial results suggest that the widely-used auditory spectral centroid is a simple way to calculate features which can estimate both the location and severity of vascular access stenosis.

Verbal short-term memory shows a specific association with receptive but not productive vocabulary measures in Down syndrome.

BACKGROUND: Verbal short-term memory (STM) capacity has been considered to support vocabulary learning in typical children and adults, but evidence for this link is inconsistent for studies in individuals with Down syndrome (DS). The aim of this study was explore the role of processing demands on the association between verbal STM and vocabulary measures in DS, by comparing receptive vocabulary measures with high STM processing demands to productive vocabulary measures with low STM processing demands. METHOD: Forty-seven adults with Down syndrome were administered receptive vocabulary and productive vocabulary tasks, as well as measures of verbal STM abilities and intellectual efficiency. RESULTS: Bayesian regression analyses showed that verbal STM abilities were strongly and specifically associated with receptive vocabulary measures but not productive lexical abilities after controlling for intellectual efficiency, and this is despite the fact that vocabulary abilities as measured by receptive and productive vocabulary tasks were closely associated. CONCLUSIONS: In Down syndrome, verbal STM abilities may be predictive of specific task demands associated with receptive vocabulary tasks rather than of vocabulary development per se.

How Flexible is the Use of Egocentric Versus Allocentric Frame of Reference in the Williams Syndrome Population?

OBJECTIVE: This study examined the spontaneous use of allocentric and egocentric frames of reference and their flexible use as a function of instructions. METHOD: The computerized spatial reference task created by Heiz and Barisnikov (2015) was used. Participants had to choose a frame of reference according to three types of instructions: spontaneous, allocentric and egocentric. The performances of 16 Williams Syndrome participants between 10 and 41 years were compared to those of two control groups (chronological age and non-verbal intellectual ability). RESULTS: The majority of Williams Syndrome participants did not show a preference for a particular frame of reference. When explicitly inviting participants to use an allocentric frame of reference, all three groups showed an increased use of the allocentric frame of reference. At the same time, an important heterogeneity of type of frame of reference used by Williams Syndrome participants was observed. CONCLUSION: Results demonstrate that despite difficulties in the spontaneous use of allocentric and egocentric frames of reference, some Williams Syndrome participants show flexibility in the use of an allocentric frame of reference when an explicit instruction is provided.

LONG-TERM EVALUATION OF A NON-HERMETIC MICROPACKAGE TECHNOLOGY FOR MEMS-BASED, IMPLANTABLE PRESSURE SENSORS.

This paper reports long-term evaluation of a micropackage technology for an implantable MEMS pressure sensor. The all-polymer micropackage survived 160 days when subjected to accelerated lifetime testing at 85 °C in a 1% wt. saline solution. The package shows minimum effect on sensors' sensitivity and nonlinearity, which deviated by less than 5% and 0.3%, respectively. A 6-month in vivo evaluation of 16 MEMS-based pressure sensors demonstrated that the proposed micropackage has good biocompatibility and can protect the MEMS pressure sensor. To the best of our knowledge, these results establish new lifetime records for devices packaged using an all-polymer micropackaging approach.

What about pain in disorders of consciousness?

The management and treatment of acute pain is very difficult in non-communicative patients with disorders of consciousness (i.e., vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state), creating an ethical dilemma for caregivers and an emotional burden among both relatives and caregivers. In this review, we summarize recent findings about the neural substrates of nociception and pain in VS/UWS patients as well as recent behavioral assessment methods of nociception specifically designed for patients in altered states of consciousness. We will finally discuss implications for pain treatment in these patients.

Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders.

PRIMARY OBJECTIVE: This study investigates (1) the utility of the bispectral index (BIS) to distinguish levels of consciousness in severely brain damaged patients and, particularly, disentangle vegetative state (VS) from minimally conscious state (MCS), as compared to other EEG parameters; (2) the prognostic value of BIS with regards to recovery after 1 year. RESEARCH DESIGN: Multi-centric prospective study. METHOD AND PROCEDURES: Unsedated patients recovering from coma were followed until death or transferal. Automated electrophysiological and standardized behavioural assessments were carried out twice a week. EEG recordings were categorized according to level of consciousness (coma, VS, MCS and Exit MCS). Outcome was assessed at 1 year post-insult. MAIN OUTCOMES AND RESULTS: One hundred and fifty-six EEG epochs obtained in 43 patients were included in the analyses. BIS showed a higher correlation with behavioural scales as compared to other EEG parameters. Moreover, BIS values differentiated levels of consciousness and distinguished VS from MCS while other EEG parameters did not. Finally, higher BIS values were found in patients who recovered at 1 year post-insult as compared to patients who did not recover. CONCLUSION: EEG-BIS recording is an interesting additional method to help in the diagnosis as well as in the prognosis of severely brain injured patients recovering from coma.

Voluntary brain processing in disorders of consciousness.

BACKGROUND: Disentangling the vegetative state from the minimally conscious state is often difficult when relying only on behavioral observation. In this study, we explored a new active evoked-related potentials paradigm as an alternative method for the detection of voluntary brain activity. METHODS: The participants were 22 right-handed patients (10 traumatic) diagnosed as being in a vegetative state (VS) (n = 8) or in a minimally conscious state (MCS) (n = 14). They were presented sequences of names containing the patient's own name or other names, in both passive and active conditions. In the active condition, the patients were instructed to count her or his own name or to count another target name. RESULTS: Like controls, MCS patients presented a larger P3 to the patient's own name, in the passive and in the active conditions. Moreover, the P3 to target stimuli was higher in the active than in the passive condition, suggesting voluntary compliance to task instructions like controls. These responses were even observed in patients with low behavioral responses (e.g., visual fixation and pursuit). In contrast, no P3 differences between passive and active conditions were observed for VS patients. CONCLUSIONS: The present results suggest that active evoked-related potentials paradigms may permit detection of voluntary brain function in patients with severe brain damage who present with a disorder of consciousness, even when the patient may present with very limited to questionably any signs of awareness.

[Pain assessment in non-communicative patients]. / Mesurer la douleur chez le patient non communicant.

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this context, indirect measurements such as behavioral observations or physiological measurements are needed. To facilitate the assessment of pain in non-communicative patients, numerous standardized behavioral scales have been developed. The aim of this review is to discuss the main validated pain scales employed in end-stage dementia, newborn and preverbal children, and severely brain damaged patients with a disorder of consciousness such as coma, the vegetative state or the minimally conscious state.

[Life with Locked-In syndrome]. / Quelle vie après le Locked-In syndrome?

The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here review the definition, etiologies, diagnosis and prognosis of LIS patients and briefly discuss the few studies on their quality of life and the challenging end-of-life decisions that can be encountered. Some clinicians may consider that LIS is worse than being in a vegetative or in a minimally conscious state. However, preliminary data from chronic LIS survivors show a surprisingly preserved self-scored quality of life and requests of treatment withdrawal or euthanasia, though not absent, are infrequent.

Neural networks for short-term memory for order differentiate high and low proficiency bilinguals.

Short-term memory (STM) for order information, as compared to STM for item information, has been shown to be a critical determinant of language learning capacity. The present fMRI study asked whether the neural substrates of order STM can serve as markers for bilingual language achievement. Two groups of German-French bilinguals differing in second language proficiency were presented STM tasks probing serial order or item information. During order STM but not item STM tasks, the high proficiency group showed increased activation in the lateral orbito-frontal and the superior frontal gyri associated with updating and grouped rehearsal of serial order information. Functional connectivity analyses for order encoding showed a functional network involving the left IPS, the right IPS and the right superior cerebellum in the high proficiency group while the low proficiency group showed enhanced connectivity between the left IPS and bilateral superior temporal and temporo-parietal areas involved in item processing. The present data suggest that low proficiency bilinguals activate STM networks for order in a less efficient and differentiated way, and this may explain their poorer storage and learning capacity for verbal sequences.

Short-term memory and the left intraparietal sulcus: focus of attention? Further evidence from a face short-term memory paradigm.

This study explored the validity of an attentional account for the involvement of the left intraparietal sulcus (IPS) in visual STM tasks. This account considers that during STM tasks, the IPS acts as an attentional modulator, maintaining activation in long-term memory networks that underlie the initial perception and processing of the specific information to be retained. In a recognition STM paradigm, we presented sequences of unfamiliar faces and instructed the participants to remember different types of information: either the identity of the faces or their order of presentation. We hypothesized that, if the left IPS acts as an attentional modulator, it should be active in both conditions, but connected to different neural networks specialized in serial order or face identity processing. Our results showed that the left IPS was activated during both order and identity encoding conditions, but for different reasons. During order encoding, the left IPS showed functional connectivity with order processing areas in the right IPS, bilateral premotor and cerebellar cortices, reproducing earlier results obtained in a verbal STM experiment. During identity encoding, the left IPS showed preferential functional connectivity with right temporal, inferior parietal and medial frontal areas involved in detailed face processing. These results not only support an attentional account of left IPS involvement in visual STM, but given their similarity with previous results obtained for a verbal STM task, they further highlight the importance of the left IPS as an attentional modulator in a variety of STM tasks.

A multiple case study of verbal short-term memory in velo-cardio-facial syndrome.

BACKGROUND: Velo-cardio-facial syndrome (VCFS, 22q11.2 deletion) is characterized by severely delayed language development. The current study explored the integrity of verbal short-term memory (STM), a cognitive function critically involved in language development, in eight children with VCFS. METHODS: Using a multiple case study design, we presented a series of STM tasks exploring immediate serial recall for word and non-word lists to eight children with VCFS (aged 8-12 years) and to chronological-age-matched control groups. A first task assessed the integrity of phonological coding in verbal STM by comparing recall for phonologically similar and dissimilar words. Subsequently, the interaction between verbal knowledge and STM capacity was investigated by comparing recall for high- and low-imageability words, for high- and low-frequency words, and for words and non-words. A final task assessed short-term serial order recognition for digit sequences. RESULTS: When computing the number of items recalled in the word recall tasks, independently of their serial position, only one child presented consistent difficulties. Short-term recall of non-words was normal in each child. Phonological similarity and verbal knowledge influenced STM performance to a similar extent in children with VCFS and controls. On the other hand, when applying a strict serial recall criterion, difficulties with the word and non-word recall tasks were observed in most children. Half of the patients were also impaired in the serial order recognition task. CONCLUSIONS: Despite mild intellectual disability, it is possible for short-term retention capacities for verbal item information to be at an age-appropriate level in VCFS. However, STM for serial order information could be impaired more specifically.

The left intraparietal sulcus and verbal short-term memory: focus of attention or serial order?

One of the most consistently activated regions during verbal short-term memory (STM) tasks is the left intraparietal sulcus (IPS). However, its precise role remains a matter of debate. While some authors consider the IPS to be a specific store for serial order information, other data suggest that it serves a more general function of attentional focalization. In the current fMRI experiment, we investigated these two hypotheses by presenting different verbal STM conditions that probed recognition for word identity or word order and by assessing functional connectivity of the left IPS with distant brain areas. If the IPS has a role of attentional focalization, then it should be involved in both order and item conditions, but it should be connected to different brain regions, depending on the neural substrates involved in processing the different types of information (order versus phonological/orthographic) to be remembered in the item and order STM conditions. We observed that the left IPS was activated in both order and item STM conditions but for different reasons: during order STM, the left IPS was functionally connected to serial/temporal order processing areas in the right IPS, premotor and cerebellar cortices, while during item STM, the left IPS was connected to phonological and orthographic processing areas in the superior temporal and fusiform gyri. Our data support a position considering that the left IPS acts as an attentional modulator of distant neural networks which themselves are specialized in processing order or language representations. More generally, they strengthen attention-based accounts of verbal STM.

Cerebral processing in the minimally conscious state.

We studied a patient in a minimally conscious state using PET and cognitive evoked potentials. Cerebral metabolism was below half of normal values. Auditory stimuli with emotional valence (infant cries and the patient's own name) induced a much more widespread activation than did meaningless noise; the activation pattern was comparable with that previously obtained in controls. Cognitive potentials showed preserved P300 responses to the patient's own name.

Can phonological and semantic short-term memory be dissociated? Further evidence from landau-kleffner syndrome.

Recent studies have made a distinction between short-term storage capacities for phonological information and short-term storage capacities for lexico-semantic information (R. Martin, Lesch, & Bartha, 1999). In this multiple case study, we tried to provide further evidence for the dissociability of phonological and lexico-semantic short-term memory (STM) components, by studying verbal STM in three patients who had recovered from Landau-Kleffner syndrome. Furthermore, we explored to what extent apparent dissociations between phonological and lexico-semantic STM could be related to underlying phonological and lexico-semantic processing impairments. We found clear dissociations between phonological and lexico-semantic STM measures in patients TG, JPH, and DC, whose performance was impaired in nonword immediate serial recall and in a rhyme probe task, while performance was normal for a category probe task. These patients also presented reduced phonological effects (word length, phonological similarity, phonotactic frequency) but normal lexico-semantic effects (lexicality, word imageability, word frequency) in STM. Moreover, there were no systematic correspondencies between phonological and lexico-semantic STM and phonological and lexico-semantic processing impairments. Implications for current models of STM and language processing are discussed.