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Performance of kindergarten to second grade children on the fuld object memory evaluation (OME)
Abstracts of 16th Annual Meeting
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provided by their significant others. Both patients and significant others rated the patients' cognitive problems as more severe than either affective/behavioral or physical/dependency problems. On the SF-36, both the physical and mental composite mean scores of the patients were significantly worse than normative data means. Patients' CIQ mean total score did not differ significantly from CIQ normative data; this is consistent with the fact that 73% of patients had returned to work. Results suggest that the PCL and SF-36 are sensitive enough to detect problems soon after MTBI, but that most patients nevertheless return to work and other activities soon after injury. These findings are consistent with what has been found in previous prospective research, that has used many different measures. The recent and well-developed measures used in this study should be considered as standard outcome measures after MTBI, facilitating more consistency across researchers.
Paniak, C., Murphy, D., Lee, M., & Miller, H. Sensitivity of the WMS-R Logical Memory and Visual Reproduction Subtests to Traumatic Brain Injury in Children. We have previously presented WMS-R Logical Memory (LM) and Visual Reproduction (VR) norms on 716 children ages 9 to 15. The purpose of the present study was to assess the sensitivity of these WMS-R subtests to the effects of traumatic brain injury (TBI) in children. In the first study, a group of 26 children with moderate to severe traumatic brain injury (TBI: M age = 12.5 years, SD = 2.2; 14 males, 12 females) were compared to a group of normal control children individually matched on age and sex. The TBI children performed significantly worse than controls on LM I, LM II, VR II, LM II/LM I percent recall (i.e., savings), and VR II/VR I percent recall score. The groups did not differ on the VR I variable. In the second study, the TBI children were compared to different normal control children individually matched to the TBI children on age, sex, and WISC-III Vocabulary score (overall standard score M = 7.5, SD = 2.4). Results showed that the TBI children performed significantly worse on VR II, LM IULM I and VR II/VR I percent recall. The groups did not differ on LM I, LM II, or VR I. The LM and VR percent recall scores and the VR II score thus differed between controls and TBI children even when subjects were individually matched on WISC-III Vocabulary score. The particular utility of LM and VR percent recall scores has also been shown previously with adult amnesic, head-injured and Alzheimer disease patients. The relative insensitivity of the immediate recall LM I and VR I scores attests to the need for delay trials to properly assess memory deficits in TBI children. In summary, the WMS-R LM and VR subtests are brief, easy to administer measures that show sensitivity to memory deficits associated with moderate to severe TBI in children ages 9 to 15.
Papero, P. H., Cunningham, M. V., & Margolis, L. J. Performance of Kindergarten to Second Grade Children on the Fuld Object Memory Evaluation ( OME). Purpose. The Fuld Object-Memory Evaluation (OME) is a simplified measure of learning and memory based on Buschke's method of selective reminding which utilizes a set of 10 familiar objects "hidden" in a cloth bag. No pediatric normative data have been published to date despite the immediate appeal of the OME's novel, multimodal presentation of hidden objects, and its potential for reducing learning interference stemming from attentional fluctuations and/or receptive language confusion. The purpose of the current study was to gather preliminary norms for children of school entry age (K-Gr. 2). Method. Seventy-six children were recruited by grade from a local parochial elementary school: 29 K (mean 73 + 4 months), 20 Gr. 1 (mean 84 + 4 months), and 27 Gr.2 (mean 95 + 5 months). The sample represented middle class (two-factor Hollingshead Index mean 55 + 6), predominantly white
382
Abstracts of 16th Annual Meeting
children of above average estimated intelligence (mean IQ 116 + 14). Developmental and medical history was obtained by structured parent telephone interview. In the OME, objects are first identified by touch, followed by visual confirmation, and then placed back in the bag, which remains in view but closed. The initial free recall trial is followed by four more 60-second trials, each preceded by selective reminding for omitted items. A 5-minute delayed recall is followed by 3-item forced-choice recognition. Results. Age showed low-moderate correlations to learning scores. Neither IQ nor SES was related to OME scores. Grade by gender univariate ANOVAs for key demographic variables revealed no IQ or SES confounds. There was a grade main effect on learning efficiency (F = 7.114, df= 2, 70, p < .01), but this was modified by a grade by gender interaction (F = 3.993, df = 2, 70, p < .05). Post hoc one-way analyses found the grade main effect limited to girls (girls, F = 8.536, df = 2, 32, p = .001; boys, F = 1.041, df= 2, 38, p > .05). Delayed recall showed no grade or gender effects; however, adequacy of retrieval skills during acquisition was related to delayed recall [Kruskal-Wallis H (corrected for ties) = 16.24, df = 2, p <-- .001]: Poor retrievers differed significantly from both adequate and good retrievers, who also differed significantly from each other. Age was related to retrieval adequacy only for girls [rho (corrected for ties) = .46, p < .01]. Behavior ratings were related to retrieval adequacy only for boys [rho (corrected for ties) = -.40, p < .01].
Parker, K. A., Helgason, C. M., & Laatsch, L. K. Dramatic Neuropsychological Improvement in a Young Stroke Patient Following Cognitive Rehabilitation Therapy. Frequently, cortical strokes are treated with cognitive rehabilitation therapy (CRT). This study is unique in that a patient was treated with CRT following bilateral infarcts in the pica region (superior cerebellar artery). Presenting symptoms included sudden onset of ataxia, aphasia, dizziness, and incontinence. Pre and post-neuropsychological testing was conducted to assess cognitive change in a 19-year-old African American female college student following CRT. Medical history was positive only for spontaneous abortion 1 month prior to the CVA. Pre-treatment neuropsychological evaluation using the WAIS-R, WMS-R, WRAT-R, Wisconsin Card Sort and Stroop revealed low-average intellectual ability; lowaverage verbal and general memory; impaired concentration, problem-solving, and speed of processing; and reduction in academic ability. Eleven weekly sessions of CRT were conducted over a 3-month period, consisting of both computerized CRT (using a developmental format) as well as daily systematic interventions at home. Three months later, post-treatment neuropsyehological evaluation revealed average intellectual ability, average and high average memory skills, exceptional speed of processing, adequate problem-solving, and restoration of previously-expected academic ability. Functional improvement was noted as well, including a successful return to college, part-time employment, and independent travel via public transportation, Although this is not a controlled study, it is believed that, due to the specific stimuli provided by CRT and home exercises, there was a change in mid-brain processing that resulted in the improvement of all higher cortical functioning. The patients' unusually quick and dramatic progress suggests that CRT is appropriate in treating non-cortical lesions such as those located in the bilateral cerebellar area. This study suggests that broad range of CVA patients can benefit from CRT. Patterson, C. M. Pediatric Neuropsychological Profile after Left Putamen Punctate Hemorrhage. Focal brain insults in children are relatively rare. This is a case report of neuropsychological profile after an isolated left basal ganglia infarct in an 11-year-old male. Initial MRI with MRA showed left basal ganglia infarct with a punctate area of acute hemorrhage in the left
381
provided by their significant others. Both patients and significant others rated the patients' cognitive problems as more severe than either affective/behavioral or physical/dependency problems. On the SF-36, both the physical and mental composite mean scores of the patients were significantly worse than normative data means. Patients' CIQ mean total score did not differ significantly from CIQ normative data; this is consistent with the fact that 73% of patients had returned to work. Results suggest that the PCL and SF-36 are sensitive enough to detect problems soon after MTBI, but that most patients nevertheless return to work and other activities soon after injury. These findings are consistent with what has been found in previous prospective research, that has used many different measures. The recent and well-developed measures used in this study should be considered as standard outcome measures after MTBI, facilitating more consistency across researchers.
Paniak, C., Murphy, D., Lee, M., & Miller, H. Sensitivity of the WMS-R Logical Memory and Visual Reproduction Subtests to Traumatic Brain Injury in Children. We have previously presented WMS-R Logical Memory (LM) and Visual Reproduction (VR) norms on 716 children ages 9 to 15. The purpose of the present study was to assess the sensitivity of these WMS-R subtests to the effects of traumatic brain injury (TBI) in children. In the first study, a group of 26 children with moderate to severe traumatic brain injury (TBI: M age = 12.5 years, SD = 2.2; 14 males, 12 females) were compared to a group of normal control children individually matched on age and sex. The TBI children performed significantly worse than controls on LM I, LM II, VR II, LM II/LM I percent recall (i.e., savings), and VR II/VR I percent recall score. The groups did not differ on the VR I variable. In the second study, the TBI children were compared to different normal control children individually matched to the TBI children on age, sex, and WISC-III Vocabulary score (overall standard score M = 7.5, SD = 2.4). Results showed that the TBI children performed significantly worse on VR II, LM IULM I and VR II/VR I percent recall. The groups did not differ on LM I, LM II, or VR I. The LM and VR percent recall scores and the VR II score thus differed between controls and TBI children even when subjects were individually matched on WISC-III Vocabulary score. The particular utility of LM and VR percent recall scores has also been shown previously with adult amnesic, head-injured and Alzheimer disease patients. The relative insensitivity of the immediate recall LM I and VR I scores attests to the need for delay trials to properly assess memory deficits in TBI children. In summary, the WMS-R LM and VR subtests are brief, easy to administer measures that show sensitivity to memory deficits associated with moderate to severe TBI in children ages 9 to 15.
Papero, P. H., Cunningham, M. V., & Margolis, L. J. Performance of Kindergarten to Second Grade Children on the Fuld Object Memory Evaluation ( OME). Purpose. The Fuld Object-Memory Evaluation (OME) is a simplified measure of learning and memory based on Buschke's method of selective reminding which utilizes a set of 10 familiar objects "hidden" in a cloth bag. No pediatric normative data have been published to date despite the immediate appeal of the OME's novel, multimodal presentation of hidden objects, and its potential for reducing learning interference stemming from attentional fluctuations and/or receptive language confusion. The purpose of the current study was to gather preliminary norms for children of school entry age (K-Gr. 2). Method. Seventy-six children were recruited by grade from a local parochial elementary school: 29 K (mean 73 + 4 months), 20 Gr. 1 (mean 84 + 4 months), and 27 Gr.2 (mean 95 + 5 months). The sample represented middle class (two-factor Hollingshead Index mean 55 + 6), predominantly white
382
Abstracts of 16th Annual Meeting
children of above average estimated intelligence (mean IQ 116 + 14). Developmental and medical history was obtained by structured parent telephone interview. In the OME, objects are first identified by touch, followed by visual confirmation, and then placed back in the bag, which remains in view but closed. The initial free recall trial is followed by four more 60-second trials, each preceded by selective reminding for omitted items. A 5-minute delayed recall is followed by 3-item forced-choice recognition. Results. Age showed low-moderate correlations to learning scores. Neither IQ nor SES was related to OME scores. Grade by gender univariate ANOVAs for key demographic variables revealed no IQ or SES confounds. There was a grade main effect on learning efficiency (F = 7.114, df= 2, 70, p < .01), but this was modified by a grade by gender interaction (F = 3.993, df = 2, 70, p < .05). Post hoc one-way analyses found the grade main effect limited to girls (girls, F = 8.536, df = 2, 32, p = .001; boys, F = 1.041, df= 2, 38, p > .05). Delayed recall showed no grade or gender effects; however, adequacy of retrieval skills during acquisition was related to delayed recall [Kruskal-Wallis H (corrected for ties) = 16.24, df = 2, p <-- .001]: Poor retrievers differed significantly from both adequate and good retrievers, who also differed significantly from each other. Age was related to retrieval adequacy only for girls [rho (corrected for ties) = .46, p < .01]. Behavior ratings were related to retrieval adequacy only for boys [rho (corrected for ties) = -.40, p < .01].
Parker, K. A., Helgason, C. M., & Laatsch, L. K. Dramatic Neuropsychological Improvement in a Young Stroke Patient Following Cognitive Rehabilitation Therapy. Frequently, cortical strokes are treated with cognitive rehabilitation therapy (CRT). This study is unique in that a patient was treated with CRT following bilateral infarcts in the pica region (superior cerebellar artery). Presenting symptoms included sudden onset of ataxia, aphasia, dizziness, and incontinence. Pre and post-neuropsychological testing was conducted to assess cognitive change in a 19-year-old African American female college student following CRT. Medical history was positive only for spontaneous abortion 1 month prior to the CVA. Pre-treatment neuropsychological evaluation using the WAIS-R, WMS-R, WRAT-R, Wisconsin Card Sort and Stroop revealed low-average intellectual ability; lowaverage verbal and general memory; impaired concentration, problem-solving, and speed of processing; and reduction in academic ability. Eleven weekly sessions of CRT were conducted over a 3-month period, consisting of both computerized CRT (using a developmental format) as well as daily systematic interventions at home. Three months later, post-treatment neuropsyehological evaluation revealed average intellectual ability, average and high average memory skills, exceptional speed of processing, adequate problem-solving, and restoration of previously-expected academic ability. Functional improvement was noted as well, including a successful return to college, part-time employment, and independent travel via public transportation, Although this is not a controlled study, it is believed that, due to the specific stimuli provided by CRT and home exercises, there was a change in mid-brain processing that resulted in the improvement of all higher cortical functioning. The patients' unusually quick and dramatic progress suggests that CRT is appropriate in treating non-cortical lesions such as those located in the bilateral cerebellar area. This study suggests that broad range of CVA patients can benefit from CRT. Patterson, C. M. Pediatric Neuropsychological Profile after Left Putamen Punctate Hemorrhage. Focal brain insults in children are relatively rare. This is a case report of neuropsychological profile after an isolated left basal ganglia infarct in an 11-year-old male. Initial MRI with MRA showed left basal ganglia infarct with a punctate area of acute hemorrhage in the left