Determinants of on-the-job-barriers in employed persons with multiple sclerosis: the role of disability severity and cognitive indices.

BACKGROUND: Literature has shown that work maintenance is central in order to guarantee participation to persons with disability. Knowledge about potential sources of difficulties and obstacles is then crucial in order to prevent barriers and facilitate work maintenance and career development for persons with disabilities. OBJECTIVE: Studies analyzing on-the-job barriers among employed people with multiple sclerosis (MS) have found evidence for a role of clinical determinants. The aim of this study was to describe in more detail the role of disability severity and of cognitive indices on work barriers. PARTICIPANTS: Thirty-two employed adults with a diagnosis of MS with mild to moderate disability severity were included in the study. They were involved in the descriptive study while attending their planned care in the MS unit. METHODS: Subjects completed neurocognitive tasks, a self-report measure of executive functioning and a face-to-face semi-structured interview exploring their perception of barriers at work. RESULTS: Regression analyses showed a specific role of disability severity on perception of barriers due to physical, cognitive and interpersonal relationships; cognitive indices, on the other hand, predicted barriers ascribed to company policy (cognitive score), to accessibility (planning score) or difficulties in cognitive and task related abilities (self-rated executive functioning). CONCLUSION: These findings underline the relevance of objective tasks and self-report questionnaire, direct and indirect multi-dimensional assessment of functioning for an early intervention planning. An ecological model of career development in adults with disabilities is also supported.

Executive deficits appearing in the initial stage of Alzheimer's disease.

The presence of executive deficits has been sought at a stage of Alzheimer's disease where currently used neuropsychological batteries could not yet distinguish Alzheimer's patients from normal age- and education-matched controls. This study shows that, at this early stage, those patients that 6 months later are found to show clear signs of Alzheimer's had been significantly worse than normal controls in an executive function task adapted from the Brown-Peterson procedure.

A componential analysis of visual object recognition deficits in patients with herpes simplex virus encephalitis.

Five patients with a diagnosis of Herpes Simplex Virus Encephalitis (HSVE) underwent neuropsychological assessment to explore the integrity of their visual perceptual abilities. Selective deficits affecting different levels of the recognition processing were found; impaired recognition abilities were also influenced by selective task requirements, which resulted either in facilitatory or constraining effects on patients' performance. A theoretical model of object recognition (Humphreys & Riddoch, 1987) was taken into account to explain patients' performance. Further, the role of specific components of visual processing was evidenced in explaining the performance of patients affected by HSVE.

Memory for/and execution of future intentions: evidence from patients with Herpes Simplex Encephalitis.

Prospective remembering was studied in a group of patients who suffered from Herpes Simplex Encephalitis (HSE). All patients showed a marked deficit in executing intentions for future actions under all the given constraints. The deficit extended to both time- and event-based intentions. The analysis of errors showed somewhat different patterns and some dissociations with evidence for selective preservation or damage to specific components involved in prospective remembering. These patients, in fact, may fail because of a difficulty in taking into account all given constraints or in activating stored intentions and in forming intentions or in remembering the content of the actions. Time- and event-based tasks seem to show different sources of errors also in the same patient.

Production of proper names: a clinical case study of the effects of phonemic cueing.

The production of proper names is a task that in everyday life is particularly prone to temporary failures, especially in elderly subjects. The reason for this is still rather obscure but indications in recent literature suggest an independent status for proper names in comparison with common ones, which may entail differences in processing or in processing demands. The main sources of empirical evidence come, on the one hand, from studies of face and person identity recognition and, on the other, from neuropsychological observations. All the findings appear to concur in supporting theoretical distinctions that have been made for a long time in the field of philosophy of language. These distinctions have directed the endeavours of experimental research. The present study describes, for the first time, a neuropsychological patient who shows, in certain conditions, a sparing of proper names despite an otherwise deeply troubled linguistic production. This finding may appear to be counterintuitive, considering the fact that proper names are viewed, in general, as more difficult to produce than common ones. However, in consideration also of other emerging neuropsychological and experimental findings, it is proposed that possible differences in lexical access for the two categories of common and proper names may explain the phenomenon and still be consistent with mainstream philosophical theories.

Analysis of the spontaneous writing errors of normal and aphasic writers.

Samples of spontaneous writing were collected from 150 normal subjects, 13 Broca's aphasics, 23 Wernicke's aphasics and 14 conduction aphasics. The errors obtained were classified using a system derived from investigations of slips of the pen in normal subjects. All three aphasic groups made a higher proportion of word-level errors than did the normal writers. Word-level errors tended to be selection errors (substitutions, blends, neologisms, and omissions) rather than movement errors (anticipations, perseverations and reversals). Conduction aphasics showed proportionately more letter movement and fewer letter selection errors than normal writers while Wernicke's and Broca's aphasics showed similar proportions. Graphic and phonetic similarity was no more important a determinant of letter errors in aphasics than in normals. The span of movement errors was particularly restricted in the Broca's and conduction aphasics. Asking patients to write connected text yields insight into the nature of the underlying disorder that could not be obtained from studying the writing of single words.