We report a case of a 39-yr-old man with a bilateral occipito-parietal contusion. After conservative treatment at an emergency hospital, he was transferred to our hospital for rehabilitative ...intervention. On admission, he presented with mild cortical blindness and visual agnosia. As his visual acuity gradually improved, Bálint's syndrome became apparent. This syndrome is characterized by difficulties with visual scanning, dysmetria secondary to visual perceptual deficits, and an inability to perceive more than one object at a time. After rehabilitative intervention, consisting of both visuo-perceptual retraining and a functional adaptation program, he was able to bathe and toilet independently. However, neuropsychological findings over 3 years remain consistent with Bálint's syndrome.
Intraindividual comparisons of sensory-perceptual and motor functions frequently provide one of the bases for inferring brain damage and/or dysfunction in cases involved in litigation. Valid ...determination of whether the lateralized deficit is due to brain damage or peripheral nerve injury is imperative in many such cases. This report presents a longitudinal study of a case of peripheral nerve injury, together with guidelines for differentiating central and peripheral injuries. Measurements of grip strength were made twice daily on a single subject for 89 days following a mild right ulnar nerve injury. The results revealed mild residual impairment long after the subjective symptoms of pain and numbness had resolved. The valid differentiation of central versus peripheral bases for lateralized sensory-perceptual and motor deficits is especially important in cases of traumatic head injury, because either basis (central and/or peripheral) is often implicated (especially with multiple injuries), and head injuries represent a type of personal injury that is frequently involved in litigation.
To assure high-quality, cost-effective rehabilitation programs for this population, occupational therapists need to do more research to define perceptual interventions, and determine the efficacy of ...different approaches to perceptual problems. Offers guidance on the design of studies to achieve the latter goal. (Abstract amended)
Sixteen post-stroke, hemiplegic patients, who requested that they be allowed to return to driving, were extensively evaluated by a physiatrist, psychologist, occupational therapist, and driver ...training specialist. After they completed a driver training program, the patients were divided into three groups based on their driving program success and follow-ups. Significant differences in the psychological test results were found between Group I (those who drove without any difficulty) and Groups II and III (those who drove limited distance or who failed driver training). Results suggest that patients with significant cognitive and perceptual problems who take training and limit their driving can be safe drivers when they return to driving.
Tested therapeutic implications of the learned helplessness model of depression in 2 experiments with a total of 128 undergraduates. Depression was assessed with the Beck Depression Inventory. ...Nondepressed Ss receiving inescapable noise and depressed/no-noise Ss later showed noise escape deficits in a shuttlebox and perceptions of response-reinforcement independence when compared with nondepressed/no-noise Ss. Experience with solvable discrimination problems reversed the escape deficits and perceptions of response-reinforcement independence associated with both inescapability and depression. Results support the learned helplessness model of depression, which claims (a) that uncontrollable events induce distorted perceptions of response-reinforcement independence in nondepressed people which cause performance deficits parallel to those found in naturally occurring depression, and (b) that experience with controllable events reverses the perceptions of response-reinforcement independence and the performance deficits associated with both helplessness and depression. (25 ref)
Perceptual problems such as tactile neglect are important features of stroke and strong predictors of a poor outcome. Although new methods of treatment have been described, documentation of the ...effects of such treatment is inadequate, mainly because satisfactory methods of quantifying tactile neglect are unavailable. We describe a device for quantifying neglect based upon the principle of the Bender test which uses double or simultaneous bilateral stimulation to determine neglect. The device, which is computer driven to ensure uniformity of test protocols, determines the cutaneous perceptual threshold to controlled-current electrical stimulation using surface electrodes. The effect of rival contralateral stimulation on the perceptual thresholds on the affected side of the patient's body is a quantitative measure of tactile neglect. The device was evaluated in normal young and neurologically normal elderly subjects and in stroke patients with clinical evidence of tactile neglect. It was shown to distinguish reliably between normal subjects and those who had tactile neglect. The device will be suitable for use in trials of treatments for tactile neglect and in tracking the natural history of this symptom.
Reports results of a neuropsychiatric study focusing on psychiatric disorders in minimal brain disorder (MBD) syndromes. Prevalence figures for marked psychiatric abnormality in MBD were shown to be ...greater than those for psychiatric abnormality in children with neuroepileptic disorders in the Isle of Wight study. Psychotic behavior was found to be specifically associated with MBD. (RH)
Mirror writing is often produced by healthy children during early acquisition of literacy, and has been observed in adults following neurological disorders or insults. The neural mechanisms ...responsible for involuntary mirror writing remain debated, but in healthy children, it is typically attributed to the delayed development of a process of overcoming mirror invariance while learning to read and write. We present an unusual case of sudden-onset, persistent mirror writing in a previously typical seven-year-old girl. Using her dominant right hand only, she copied and spontaneously produced all letters, words and sentences, as well as some numbers and objects, in mirror image. Additionally, she frequently misidentified letter orientations in perceptual assessments. Clinical, neuropsychological, and functional neuroimaging studies were carried out over sixteen months. Neurologic and ophthalmologic examinations and a standard clinical MRI scan of the head were normal. Neuropsychological testing revealed average scores on most tests of intellectual function, language function, verbal learning and memory. Visual perception and visual reasoning were average, with the exception of below average form constancy, and mild difficulties on some visual memory tests. Activation and functional connectivity of the reading and writing network was assessed with fMRI. During a reading task, the VWFA showed a strong response to words in mirror but not in normal letter orientation – similar to what has been observed in typically developing children previously – but activation was atypically reduced in right primary visual cortex and Exner's Area. Resting-state connectivity within the reading and writing network was similar to that of age-matched controls, but hemispheric asymmetry between the balance of motor-to-visual input was found for Exner's Area. In summary, this unusual case suggests that a disruption to visual-motor integration rather than to the VWFA can contribute to sudden-onset, persistent mirror writing in the absence of clinically detectable neurological insult.
•Presentation of a unique case of persistent mirror writing in a previously typically developing 7-year-old girl.•Sudden onset of mirror reversal with the dominant right hand only in the absence of a neurologic insult or disorder.•Atypical activation and connectivity of visual, motor and language regions, with asymmetry between hemispheres.
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