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Visuo-Spatial Abilities Diagnosis - Test (VSAD): Evaluate the potential cognitive difficulties of children with vestibular impairment through a new tablet-based computerised test battery
Abstract
Background: Recent data collected on adult patients with vestibular loss (VL) tends to demonstrate possible cognitive impairments in visuospatial working memory, mental rotation, selective attention and space orientation. However, the neuropsychological profile of children with VL remains largely under investigated in the scientific literature. Although previous research has shown that children with VL may experience some degree of delayed motor development, it is not yet clear if VL could also lead to specific delayed cognitive development.
Objective: In this study, we will present the development and validation of a new tablet-based computerised test battery (VSAD) that evaluates visuospatial working memory, mental rotation, selective attention and space orientation abilities.
Methods: 13 children with VL and 54 average-age matched healthy children performed the VSAD and classical paper and pencil neuropsychological tasks twice within a one-month interval.
Results: Our results demonstrated a good concurrent validity with strong correlations between the visuospatial working memory, mental rotation and space orientation tests of the VSAD and classical tasks. Test-retest reliability was also supported through good intra-class coefficients. However, the test of selective attention showed no concurrent validity with the matched classical task. The discriminant validity of the VSAD was partially supported for visuospatial working memory and mental rotation performance accuracy.
Conclusion: The VSAD shows good concurrent validity and reliability for measuring visuospatial working memory, mental rotation and space orientation in children with VL. Future studies are needed to extend discriminant validity with other populations.
... Offline touchscreen experiments have already been administered across different species, such as rodents (Cook et al., 2004;Morton et al., 2006;Bussey et al., 1994Bussey et al., , 2008authorname, year;Dumont et al., 2021), monkeys (Hopper et al., 2021;Huskisson et al., 2020;Roy et al., 2000;Amiez et al., 2003), and humans (Robinson & Brewer, 2016;Atkinson, 2008;Clark et al., 2006) for decades. Moreover, behavioral data acquisition via touchscreens has gained popularity for studying human behavior (Bignardi et al., 2021;Pahor et al., 2022;Lacroix et al., 2021). For instance, Bignardi et al. (2021) administered app-based touchscreen experiments to 7 to 9-year-old children to examine cognitive abilities, such as visual search speed or arithmetic fluency. ...
... Nevertheless, in the context of computational modeling, Gomez et al. (2015) have demonstrated that behavioral model parameters obtained from assessments of human behavior via touchscreens experiments are aligned with model parameters obtained from keyboard experiments (Gomez et al., 2015), demonstrating the comparability of results between touchscreen and traditional keyboard devices. Finally, a study by Lacroix et al. (2021) focused on evaluating visuospatial abilities through touchscreen interfaces. The research established strong correlations between data gathered via touchscreens and traditional paper-pencil methods, thereby validating the efficacy of touchscreen-based measures for assessing visuospatial skills. ...
... Our results comport with these findings, showing that participants responded slower on the touchscreen versions compared to the desktop versions (see the discussion on limitations below). In another study, Lacroix et al. (2021) reported similar results on visuospatial abilities when comparing data collected via touchscreens with data collected with traditional paper-pencil methods and observed strong correlations between the touchscreen data and the paper-pencil data. Furthermore, Pronk et al. (2023) examined whether the test re-test reliability of interference effects observed from the flanker task differs between touchscreen and keyboard devices collected through a crowd-sourced research platform. ...
Online experiments are increasingly gaining traction in the behavioral sciences. Despite this, behavioral researchers have largely continued to use keyboards as the primary input devices for such online studies, overlooking the ubiquity of touchscreens in everyday use. This paper presents an open-source touchscreen extension for jsPsych, a JavaScript framework designed for conducting online experiments. We additionally evaluated the touchscreen extension assessing whether typical behavioral findings from two distinct perceptual decision-making tasks – the random-dot kinematogram and the Stroop task – can similarly be observed when administered via touchscreen devices compared to keyboard devices. Our findings indicate similar performance metrics for each paradigm between the touchscreen and keyboard versions of the experiments. Specifically, we observe similar psychometric curves in the random-dot kinematogram across the touchscreen and keyboard versions. Similarly, in the Stroop task, we detect significant task, congruency, and sequential congruency effects in both experiment versions. We conclude that our open-source touchscreen extension serves as a promising tool for data collection in online behavioral experiments on forced-choice tasks.
... We designed the "weeding test" inspired by the traditional Corsi Block Tapping paradigm and the work of Claessen et al. (31) and Lacroix et al. (32), which evaluates visuospatial attention and working memory processes. There are two subtests in the task: a forward and a backward condition. ...
... Inspired by Lacroix et al. (32), we designed the "maze test" to assess spatial navigation and executive function. The map was randomly generated through math algorithm, which can be divided into numerous small squares (map "8 × 8, " i.e., this map can be divided into 64 small squares). ...
... The "card rotation test" is inspired by traditional mental rotation paradigm and the work of Lacroix et al. (32) and Henn et al. (33). There are 8 questions in total. ...
Background
A convergence of research supports a key role of the vestibular system in visuospatial ability. However, visuospatial ability may decline with age. This work aims to elucidate the important contribution of vestibular function to visuospatial ability in old adults through a computerized test system.
Methods
Patients with a clinical history of recurrent vertigo and at least failed one vestibular test were included in this cross-sectional study. Healthy controls of three age groups: older, middle-aged, and young adults were also involved. Visuospatial cognitive outcomes including spatial memory, spatial navigation, and mental rotation of all the groups were recorded. Comparing the performance of the visuospatial abilities between patients and age-matched controls as well as within the controls.
Results
A total of 158 individuals were enrolled. Results showed that patients performed worse than the age-matched controls, with the differences in the forward span (p < 0.001), the time of the maze 8 × 8 (p = 0.009), and the time of the maze 12 × 12 (p = 0.032) being significant. For the differences in visuospatial cognitive outcomes within the controls, the younger group had a significantly better performance than the other groups. The older group and the middle-aged group had comparable performances during all the tests.
Conclusions
Older patients with vestibular dysfunction had more difficulties during visuospatial tasks than age-matched controls, especially in spatial memory and spatial navigation. Within the controls, younger adults did much better than other age groups, while older adults behaved similarly to middle-aged adults. It is a valuable attempt to computerize the administration of tests for visuospatial ability.
... The AISAT test [28] was developed for use with architect students and provides a sample drawing typical of what may be used in architecture and asks test takers to determine which of the given representations is a rotated version of the original drawing. Similarly, the VSAD test [29] was developed for children with vestibular impairment and requires subjects to view a drawing of a shield with certain marks and determine which of the given rotated shield drawings represents a rotated version of the original. The spatial ability test for middle school students presents similar figures with unique identifying marks in 2D with four possible answers. ...
... [32]" Results from this test may be biased due to the test takers' perceptions of their ability. The VSAD test [29] also contains a portion dedicated to spatial orientation where students are required to complete twelve different mazes and receive a score based on the how short of a line they are able to complete the maze with and how many errors they make. The orientation section of the spatial ability test for middle school students [22] requires students to mentally situate objects in a coordinate system and provide directions to other objects in reference to the original object. ...
... Furthermore, visuospatial cognition research in clinical and related fields is important because it can provide clinical tools for spatial cognitive ability testing with a high clinical diagnostic and early warning value. Lacroix et al. (2021) preliminarily explored spatial cognitive assessment for children with vestibular dysfunction. In contrast, this study investigated adult patients with vestibular dysfunction, emphasizing older adults. ...
... The maze test evaluated participants' spatial navigation abilities and used the A * algorithm combined with the prime tree algorithm and dynamic route rendering to randomly generate different mazes with the same difficulty level, avoiding learning effects and thereby improving test accuracy. The maze task developed by Lacroix et al. (2021) can only be completed using an electronic pen to draw lines. In contrast, the maze test of VCAS allows the simulated villain to move by manipulating the direction arrows. ...
Introduction
The vestibular system is anatomically connected to extensive regions of the cerebral cortex, hippocampus, and amygdala. However, studies focusing on the impact of vestibular impairment on visuospatial cognition ability are limited. This study aimed to develop a mobile tablet-based vestibular cognitive assessment system (VCAS), enhance the dynamic and three-dimensional (3D) nature of the test conditions, and comprehensively evaluate the visuospatial cognitive ability of patients with vestibular dysfunction.
Materials and methods
First, the VCAS assessment dimensions (spatial memory, spatial navigation, and mental rotation) and test content (weeding, maze, card rotation, and 3D driving tests) were determined based on expert interviews. Second, VCAS was developed based on Unity3D, using the C# language and ILruntime hot update framework development technology, combined with the A* algorithm, prime tree algorithm, and dynamic route rendering. Further, the online test was built using relevant game business logic. Finally, healthy controls (HC) and 78 patients with vertigo (VP) were recruited for the VCAS test. The validity of VCAS was verified using the test results of random controls.
Results
In the weeding test, the HC group had a significantly longer span and faster velocity backward than did the VP group. In the 12 × 12 maze, statistically significant differences in step and time were observed between the two groups, with VP taking longer time and more steps. In the mental rotation task, no significant difference was observed between the two groups. Similarly, no significant difference was found in the performance of the two groups on maps 2, 3, and 4 in the 3D driving task.
Discussion
Thus, impaired visuospatial cognition in patients with vestibular dysfunction is primarily related to spatial memory and navigation. VCAS is a clinically applicable visuospatial cognitive ability test for VP.
Answering important questions about child development often requires large samples of school- aged children, but data-collection using traditional one-on-one assessments can be expensive and time-consuming. One way a small team of researchers can quickly collect large datasets is to utilise group-testing. In this paper, we evaluate the results from a novel tablet application developed for the Resilience in Education and Development (RED) Study, an ongoing longitudinal developmental study. The RED-app includes 12 cognitive tasks designed for groups of children aged 7-13 to independently complete during a one-hour school lesson. Most outcomes from the tablet showed moderate or high reliability, estimated using internal consistency metrics. Tablet-measured cognitive abilities also explained up to 52% of variance in teacher-rated academic achievement. Overall, the results suggest that tablet-based, group cognitive assessments of children are an e cient, reliable and valid method of collecting the large datasets that modern developmental psychology requires.
A child’s socio-economic status has been independently associated with poorer educational outcomes, slower cognitive development, and mental ill-health. However, while these factors clearly do not operate in a vacuum, testing all within a single study is challenging, and their interrelations thus remain largely unclear. We aimed to close this knowledge gap by developing a comprehensive tablet-based assessment of developmental variables in a sample of 519 children aged 7-9 years. We employed clustering algorithms to show that children do not group into discrete phenotypes. We then cast the broad range of measured variables as a network to explore the psychological architecture of cognitive, educational, mental health, and several environmental factors. Educational outcomes (reading and maths fluency) were directly related to cognition (short-term memory, number sense, and processing speed). By contrast, mental health (anxiety and depression symptoms) and attitudes (conscientious, grit, and growth mindset) showed indirect relationships with school outcomes by moderating cognition. Finally, socio-economic factors (neighbourhood deprivation and family affluence) related directly to educational outcomes, cognition, mental health, and even grit. In sum, cognition is the central cog through which mental health and attitude relate to educational outcomes. However, socio-economic status acts as the great unequaliser through its direct relations with all developmental outcomes.
Behavioral studies in rodents and humans have demonstrated deficits of spatial memory and orientation in bilateral vestibular failure (BVF). Our aim was to explore the functional consequences of chronic vestibular failure on different cognitive domains including spatial as well as non-spatial cognitive abilities. Sixteen patients with a unilateral vestibular failure (UVF), 18 patients with a BVF, and 17 healthy controls (HC) participated in the study. To assess the cognitive domains of short-term memory, executive function, processing speed and visuospatial abilities the following tests were used: Theory of Visual Attention (TVA), TAP Alertness and Visual Scanning, the Stroop Color-Word, and the Corsi Block Tapping Test. The cognitive scores were correlated with the degree of vestibular dysfunction and the duration of the disease, respectively. Groups did not differ significantly in age, sex, or handedness. BVF patients were significantly impaired in all of the examined cognitive domains but not in all tests of the particular domain, whereas UVF patients exhibited significant impairments in their visuospatial abilities and in one of the two processing speed tasks when compared independently with HC. The degree of vestibular dysfunction significantly correlated with some of the cognitive scores. Neither the side of the lesion nor the duration of disease influenced cognitive performance. The results demonstrate that vestibular failure can lead to cognitive impairments beyond the spatial navigation deficits described earlier. These cognitive impairments are more significant in BVF patients, suggesting that the input from one labyrinth which is distributed into bilateral vestibular circuits is sufficient to maintain most of the cognitive functions. These results raise the question whether BVF patients may profit from specific cognitive training in addition to physiotherapy.
Assessment of cognitive and motor functions is fundamental for developmental and neuropsychological profiling. Assessments are usually conducted on an individual basis, with a trained examiner, using standardized paper and pencil tests, and can take up to an hour or more to complete, depending on the nature of the test. This makes traditional standardized assessments of child development largely unsuitable for use in low-income countries. Touch screen tablets afford the opportunity to assess cognitive functions in groups of participants, with untrained administrators, with precision recording of responses, thus automating the assessment process. In turn, this enables cognitive profiling to be conducted in contexts where access to qualified examiners and standardized assessments are rarely available. As such, touch screen assessments could provide a means of assessing child development in both low- and high-income countries, which would afford cross-cultural comparisons to be made with the same assessment tool. However, before touch screen tablet assessments can be used for cognitive profiling in low-to-high-income countries they need to be shown to provide reliable and valid measures of performance. We report the development of a new touch screen tablet assessment of basic cognitive and motor functions for use with early years primary school children in low- and high-income countries. Measures of spatial intelligence, visual attention, short-term memory, working memory, manual processing speed, and manual coordination are included as well as mathematical knowledge. To investigate if this new touch screen assessment tool can be used for cross-cultural comparisons we administered it to a sample of children (N = 283) spanning standards 1–3 in a low-income country, Malawi, and a smaller sample of children (N = 70) from first year of formal schooling from a high-income country, the UK. Split-half reliability, test-retest reliability, face validity, convergent construct validity, predictive criterion validity, and concurrent criterion validity were investigated. Results demonstrate “proof of concept” that touch screen tablet technology can provide reliable and valid psychometric measures of performance in the early years, highlighting its potential to be used in cross-cultural comparisons and research.
Despite its high sensitivity and validity in the context of sleep loss, the Psychomotor Vigilance Test (PVT) could be improved. The aim of the present study was to validate a new smartphone PVT-type application called sleep-2-Peak (s2P) by determining its ability to assess fatigue-related changes in alertness in a context of extended wakefulness. Short 3-min versions of s2P and of the classic PVT were administered at every even hour during a 35-h total sleep deprivation protocol. In addition, subjective measures of sleepiness were collected. The outcomes on these tests were then compared using Pearson product-moment correlations, t tests, and repeated measures within-groups analyses of variance. The results showed that both tests significantly correlated on all outcome variables, that both significantly distinguished between the alert and sleepy states in the same individual, and that both varied similarly through the sleep deprivation protocol as sleep loss accumulated. All outcome variables on both tests also correlated significantly with the subjective measures of sleepiness. These results suggest that a 3-min version of s2P is a valid tool for differentiating alert from sleepy states and is as sensitive as the PVT for tracking fatigue-related changes during extended wakefulness and sleep loss. Unlike the PVT, s2P does not provide feedback to subjects on each trial. We discuss how this feature of s2P raises the possibility that the performance results measured by s2P could be less impacted by motivational confounds, giving this tool added value in particular clinical and/or research settings.
Vertigo patients frequently complain of emotional and associated cognitive problems, yet currently, there is no satisfactory questionnaire to measure these associated problems. In the present paper, we propose a new internet-based Neuropsychological Vertigo Inventory (NVI; French) that evaluates attention, memory, emotion, space perception, time perception, vision, and motor abilities. The questionnaire was created using four steps: (1) open interviews with patients suffering from vertigo; (2) semi-structured interviews with an analysis grid to quantify and define the various cognitive and emotional problems reported by the patients; (3) a first version of an internet questionnaire tested on 108 vertigo participants; and (4) the selection of subscale items using principal component analyses (PCA). From the development phase, the revised NVI was composed of seven subscales, each with four items (28 items). In the validation phase, Cronbach’s alphas were performed on the revised NVI for total and each subscale score, and to test extreme groups validity, the analyses of covariance (ANCOVAs) taking into account age were performed between 108 vertigo and 104 non-vertigo participants. The Cronbach’s alphas showed good to satisfactory coefficients for the total and for all subscale scores, demonstrating acceptable reliability. The extreme groups validity analyses (ANCOVAs) were reliable for the total scale and for four subscales. Supplementary analyses showed no effect of hearing difficulties and an inverse age effect for attention and emotion subscales, with reduced problems with increased age in the vertigo participants. The NVI provides a useful new questionnaire to determine cognitive and emotional neuropsychological complaints that are associated with vertigo.
Computerized as well as paper-and-pencil tasks are applied in mapping visuospatial neglect in experimental research and clinical practice. This article presents a new kind of computer-based assessment method, using an electronic pen display and user-friendly software. The approach is tailored to specific spatial processes and highlights the usefulness of a pen display in neglect patients. The advantages of the introduced method are illustrated by a recently designed battery of classic, as well as new, types of tests. The development of the appropriate stimuli and the assorted scoring systems is addressed, as well as the resulting types of task implementation and data generation. The diagnostic value of the different visuospatial neglect tests is demonstrated by comparative analyses between a neglect group and a control group. Among the benefits of the proposed assessment method are (1) the opportunity to perform standardized repeated measurements to quantify recovery, (2) online performance monitoring, (3) flexible employment, (4) the collection of exact data over a short period, and (5) the easy availability of more refined quantitative as well as interesting qualitative information, especially as compared to classic or paper-and-pencil tasks. To indicate that this method also lends itself well to measures for treatment procedures, an illustration is given with respect to specific measurements during prism adaptation. The tasks of the Visuospatial Neglect Test Battery and the prism adaptation measures are illustrated by a case study. The outlined applications are discussed with respect to experimental as well as clinical purposes.
Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical–cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis – VN – and Benign Paroxysmal positional Vertigo – BPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations.
This manuscript is the first in a series on vestibular neuropharmacology, and serves to establish why it is important to develop pharmacologic interventions to treat disorders of the vestibular system. We will review the prevalence of vestibular disorders, present studies that describe the impact of vestibular disorders on quality of life and clinically significant outcomes such as falls, and discuss the need for rational, targeted treatment. We will advance a central hypothesis, that for vestibular disorders with a well-defined pathophysiology, targeted, effective treatments exist.
Vestibular inputs make a key contribution to the sense of one’s own spatial location. While the effects of vestibular stimulation on visuo-spatial processing in neurological patients have been extensively described, the normal contribution of vestibular inputs to spatial perception remains unclear. To address this issue, we used a line bisection task to investigate the effects of galvanic vestibular stimulation (GVS) on spatial perception, and on the transition between near and far space. Brief left-anodal and right-cathodal GVS or right-anodal and left-cathodal GVS were delivered. A sham stimulation condition was also included. Participants bisected lines of different lengths at six distances from the body using a laser pointer. Consistent with previous results, our data showed an overall shift in the bisection bias from left to right as viewing distance increased. This pattern suggests leftward bias in near space, and rightward bias in far space. GVS induced strong polarity dependent effects in spatial perception, broadly consistent with those previously reported in patients: left-anodal and right-cathodal GVS induced a leftward bisection bias, while right-anodal and left-cathodal GVS reversed this effect, and produced bisection bias toward the right side of the space. Interestingly, the effects of GVS were comparable in near and far space. We speculate that vestibular-induced biases in space perception may optimize gathering of information from different parts of the environment.
We have developed a new screening test for dementia that runs on an iPad and can be used for mass screening, known as the Cognitive Assessment for Dementia, iPad version (CADi). The CADi consists of items involving immediate recognition memory for three words, semantic memory, categorization of six objects, subtraction, backward repetition of digits, cube rotation, pyramid rotation, trail making A, trail making B, and delayed recognition memory for three words. The present study examined the reliability and validity of the CADi.
CADi evaluations were conducted for patients with dementia, healthy subjects selected from a brain checkup system, and community-dwelling elderly people participating in health checkups.
CADi scores were lower for dementia patients than for healthy elderly individuals and correlated significantly with Mini-Mental State Examination scores. Cronbach's alpha values for the CADi were acceptable (over 0.7), and test-retest reliability was confirmed via a significant correlation between scores separated by a one-year interval.
These results suggest that the CADi is a useful tool for mass screening of dementia in Japanese populations.
Reports of vestibular deficits and related impairments in children are increasing in number. However, vestibular dysfunction in childhood appears to be an under-reported and overlooked entity. This report provides an overview of current literature regarding the incidence of vestibular deficits in children, the related impairments of gaze stability and balance and intervention for vestibular related impairments in children.
The common approach to the multiplicity problem calls for controlling the familywise error rate (FWER). This approach, though, has faults, and we point out a few. A different approach to problems of multiple significance testing is presented. It calls for controlling the expected proportion of falsely rejected hypotheses – the false discovery rate. This error rate is equivalent to the FWER when all hypotheses are true but is smaller otherwise. Therefore, in problems where the control of the false discovery rate rather than that of the FWER is desired, there is potential for a gain in power. A simple sequential Bonferroni-type procedure is proved to control the false discovery rate for independent test statistics, and a simulation study shows that the gain in power is substantial. The use of the new procedure and the appropriateness of the criterion are illustrated with examples.
The vestibular system contributes to a wide range of functions, from postural and oculomotor reflexes to spatial representation and cognition. Vestibular signals are important to maintain an internal, updated representation of the body position and movement in space. However, it is not clear to what extent they are also necessary to mentally simulate movement in situations that do not involve displacements of the body, as in mental imagery. The present study assessed how vestibular loss can affect object-based mental transformations (OMTs), i.e., imagined rotations or translations of objects relative to the environment. Participants performed one task of mental rotation of 3D-objects and two mental scanning tasks dealing with the ability to build and manipulate mental images that have metric properties. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (1 week and 1 month). They were compared to healthy participants tested at similar time intervals and to bilateral vestibular-defective patients tested after the recovery period. Vestibular loss impaired all mental imagery tasks. Performance varied according to the extent of vestibular loss (bilateral patients were frequently the most impaired) and according to the time elapsed after unilateral vestibular neurotomy (deficits were stronger at the early stage after neurotomy and then gradually compensated). These findings indicate that vestibular signals are necessary to perform OMTs and provide the first demonstration of the critical role of vestibular signals in processing metric properties of mental representations. They suggest that vestibular loss disorganizes brain structures commonly involved in mental imagery, and more generally in mental representation.
Children aged 7-17 years and adults aged 18-22 years were tested on three aspects of visual attention: the ability to distribute visual attention across the field to search for a target, the time required for attention to recover from being directed towards a target, and the number of objects to which attention can be simultaneously allocated. The data suggested different developmental trajectories for these components of visual attention within the same set of participants. This suggests that, to some extent, spatial, temporal and object-based attentional processes are subserved by different neural resources which develop at different rate. In addition, participants who played action games showed enhanced performance on all aspects of attention tested as compared to non-gamers. These findings reveal a potential facilitation of development of attentional skills in children who are avid players of action video games. As these games are predominantly drawing a male audience, young girls are at risk of under-performing on such tests, calling for a careful control of video game usage when assessing gender differences in attentional tasks.
Early deafness leads to enhanced attention in the visual periphery. Yet, whether this enhancement confers advantages in everyday life remains unknown, as deaf individuals have been shown to be more distracted by irrelevant information in the periphery than their hearing peers. Here, we show that, in a complex attentional task, a performance advantage results for deaf individuals.
We employed the Useful Field of View (UFOV) which requires central target identification concurrent with peripheral target localization in the presence of distractors - a divided, selective attention task. First, the comparison of deaf and hearing adults with or without sign language skills establishes that deafness and not sign language use drives UFOV enhancement. Second, UFOV performance was enhanced in deaf children, but only after 11 years of age.
This work demonstrates that, following early auditory deprivation, visual attention resources toward the periphery slowly get augmented to eventually result in a clear behavioral advantage by pre-adolescence on a selective visual attention task.
Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
The Dizziness Handicap Inventory (DHI) is a condition-specific health status measure for persons with vestibular disease, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) is a generic health status assessment. The purposes of this study were (1) to describe the relationship between the DHI and the SF-36, (2) to examine the reliability and responsiveness of these measures for persons in a vestibular rehabilitation program, and (3) to compare health-related quality of life between individuals with vestibular disease and the general population.
Ninety-five patients, aged 25 to 88 years (mean = 57.0, SD = 14.9), were assessed.
To determine reliability, 20 subjects completed both questionnaires twice, 24 to 48 hours apart. Thirty-one subjects completed both questionnaires before and after 6 to 8 weeks of vestibular rehabilitation to establish responsiveness. To establish the relationship between the two assessment tools, 95 subjects completed both questionnaires.
Each test was moderately to highly reliable (intraclass correlation coefficients [2, 1] = .64-.95), but the tests were poorly to moderately correlated to each other (r = .11-.71). The DHI was more responsive to change than the SF-36. The SF-36 scores of individuals were lower than scores of the general population.
The DHI and the SF-36 provide reliable and responsive measurements, but they appear to provide different information about the health status of patients with vestibular disease. Compared with the general population, patients with vestibular disease had lower scores for health-related quality of life, but these scores improved after 6 to 8 weeks of treatment. Future studies should clarify whether this improved health status is due to vestibular rehabilitation.
We compared normally hearing individuals and congenitally deaf individuals as they monitored moving stimuli either in the periphery or in the center of the visual field. When participants monitored the peripheral visual field, greater recruitment (as measured by functional magnetic resonance imaging) of the motion-selective area MT/MST was observed in deaf than in hearing individuals, whereas the two groups were comparable when attending to the central visual field. This finding indicates an enhancement of visual attention to peripheral visual space in deaf individuals. Structural equation modeling was used to further characterize the nature of this plastic change in the deaf. The effective connectivity between MT/MST and the posterior parietal cortex was stronger in deaf than in hearing individuals during peripheral but not central attention. Thus, enhanced peripheral attention to moving stimuli in the deaf may be mediated by alterations of the connectivity between MT/MST and the parietal cortex, one of the primary centers for spatial representation and attention.
In order to investigate whether bilateral peripheral vestibular lesions cause long-term impairment of spatial learning, rats were tested in a reference memory radial arm maze learning task at least 5 weeks following a bilateral labyrinthectomy (BL) or sham control lesion. All control rats reached criterion (i.e., 1 error or less, averaged across 7 trials for 3 consecutive days of training) but only 4 of the 8 BL rats had reached criterion by day 21 of the training sessions. The control rats reached criterion more quickly than the lesioned rats (Control, 7.0 +/- 0.63 days, Lesioned, 15.8 +/- 1.4 days, t10= 5.84, p < 0.0001). This difference resulted from the greater number of errors made by the BL animals. However, the latency to respond was comparable as a result of the increased locomotor activity of the BL group (i.e., 'hyperkinesis), and the overall rate of acquisition of the task, as indicated by analysis of the exponential decrease in errors over the entire training period, was not significantly different between the 2 groups. The results of this study demonstrate that BL in rats produces long-term changes in performance in a spatial reference memory task, which are not simply due to the inability to move but may relate to the way that the brain uses vestibular information to create spatial representations and determines behavioural strategies on the basis of these representations.
The human hippocampal formation plays a crucial role in various aspects of memory processing. Most literature on the human hippocampus stresses its non-spatial memory functions, but older work in rodents and some other species emphasized the role of the hippocampus in spatial learning and memory as well. A few human studies also point to a direct relation between hippocampal size, navigation and spatial memory. Conversely, the importance of the vestibular system for navigation and spatial memory was until now convincingly demonstrated only in animals. Using magnetic resonance imaging volumetry, we found that patients (n = 10) with acquired chronic bilateral vestibular loss (BVL) develop a significant selective atrophy of the hippocampus (16.9% decrease relative to controls). When tested with a virtual variant (on a PC) of the Morris water task these patients exhibited significant spatial memory and navigation deficits that closely matched the pattern of hippocampal atrophy. These spatial memory deficits were not associated with general memory deficits. The current data on BVL patients and bilateral hippocampal atrophy revive the idea that a major--and probably phylogenetically ancient--function of the archicortical hippocampal tissue is still evident in spatial aspects of memory processing for navigation. Furthermore, these data demonstrate for the first time in humans that spatial navigation critically depends on preserved vestibular function, even when the subjects are stationary, e.g. without any actual vestibular or somatosensory stimulation.
The possibility that, following early auditory deprivation, the remaining senses such as vision are enhanced has been met with much excitement. However, deaf individuals exhibit both better and worse visual skills than hearing controls. We show that, when deafness is considered to the exclusion of other confounds, enhancements in visual cognition are noted. The changes are not, however, widespread but are selective, limited, as we propose, to those aspects of vision that are attentionally demanding and would normally benefit from auditory-visual convergence. The behavioral changes are accompanied by a reorganization of multisensory areas, ranging from higher-order cortex to early cortical areas, highlighting cross-modal interactions as a fundamental feature of brain organization and cognitive processing.
Statistical procedures underpin the process of scientific discovery. As researchers, one way we use these procedures is to test the validity of a null hypothesis. Often, we test the validity of more than one null hypothesis. If we fail to use an appropriate procedure to account for this multiplicity, then we are more likely to reach a wrong scientific conclusion-we are more likely to make a mistake. In physiology, experiments that involve multiple comparisons are common: of the original articles published in 1997 by the American Physiological Society, approximately 40% cite a multiple comparison procedure. In this review, I demonstrate the statistical issue embedded in multiple comparisons, and I summarize the philosophies of handling this issue. I also illustrate the three procedures-Newman-Keuls, Bonferroni, least significant difference-cited most often in my literature review; each of these procedures is of limited practical value. Last, I demonstrate the false discovery rate procedure, a promising development in multiple comparisons. The false discovery rate procedure may be the best practical solution to the problems of multiple comparisons that exist within physiology and other scientific disciplines.
Objective:
The objective of this study is to provide an overview of the prevalence of vestibular dysfunction in children with SNHL classified according to the applied test and its corresponding sensitivity and specificity.
Design:
Data were gathered using a systematic search query including reference screening.
Study sample:
Pubmed, Web of Science and Embase were searched. Strategy and reporting of this review was based on the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality was assessed with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.
Results:
All studies, regardless the applied vestibular test, showed that vestibular function differs significantly between children with hearing loss and normal hearing (p < 0.05). Compared with caloric testing, the sensitivity of the Rotational Chair Test (RCT) varies between 61 and 80% and specificity between 21 and 80%, whereas this was, respectively, 71-100% and 30-100% for collic Vestibular Evoked Myogenic Potentials (cVEMP). Compared with RCT, the sensitivity was 88-100% and the specificity was 69-100% for the Dynamic Visual Acuity test, respectively, 67-100% and 71-100% for the (video) Head Impulse Test and 83% and 86% for the ocular VEMP.
Conclusions:
Currently, due to methodological shortcoming, evidence on sensitivity and specificity of vestibular tests is unknown to moderate. Future research should focus on adequate sample sizes (subgroups >30).
Objective:
Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
Discussion for researchers:
There are 10 forms of ICCs. Because each form involves distinct assumptions in their calculation and will lead to different interpretations, researchers should explicitly specify the ICC form they used in their calculation. A thorough review of the research design is needed in selecting the appropriate form of ICC to evaluate reliability. The best practice of reporting ICC should include software information, "model," "type," and "definition" selections.
Discussion for readers:
When coming across an article that includes ICC, readers should first check whether information about the ICC form has been reported and if an appropriate ICC form was used. Based on the 95% confident interval of the ICC estimate, values less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9, and greater than 0.90 are indicative of poor, moderate, good, and excellent reliability, respectively.
Conclusion:
This article provides a practical guideline for clinical researchers to choose the correct form of ICC and suggests the best practice of reporting ICC parameters in scientific publications. This article also gives readers an appreciation for what to look for when coming across ICC while reading an article.
Neuroinformatics for Neuropsychology Vinoth Jagaroo Emerson College and Boston University School of Medicine, Boston, MA, USA Bioinformatics involves specialized application of computer technology to investigative and conceptual problems in biology and medicine; neuroinformatics (NI) is the practice of bioinformatics in the neurosciences. Over the past two decades the biomedical sciences have been revolutionized by databases, data mining and data modeling techniques. The Human Genome Project, which depended on informatics methods, has been the most well recognized bioinformatics undertaking. Bioinformatics has since been applied all across biology and medicine, and has also transformed almost every avenue in neuroscience. Yet in neuropsychology, NI perspectives remain largely unrealized. Ironically, NI offers enormous potential to the essential praxis of neuropsychology - assessing cognitive behavior and relating cognition to neural systems. Neuroinformatics can be applied to neuropsychology as richly as it has been applied across the neurosciences. Neuroinformatics for Neuropsychology is the first book to explain the relevance and value of NI to neuropsychology. It systematically describes NI tools, applications and models that can enhance the efforts of neuropsychologists. It also describes the implications of NI for neuropsychology in the 21st century - fundamental shifts away from the conventional modes of research, practice and communication that have thus far characterized the field. One of the foremost experts on the subject: Illustrates the vital role NI is playing throughout the neurosciences. Provides a sampling of NI tools and applications in neuroscience research, and lays out current organization structures that support NI. Describes the lack of NI in neuropsychology, differentiates between NI systems for neuropsychology and conventional computerized assessment methods, and proposes criteria for neuropsychology-specific NI systems. Describes NI applications and models currently in use in neuropsychology, and NI models for neuropsychology that are being pioneered in phenomics research. Discusses potential obstacles and aids to NI in neuropsychology, including issues such as data sharing, standardization of methods, and data ontology. Projects the future of neuropsychological research and practice in light of the new generation of the internet, Web 2.0, geared to collective knowledge building. A vital introduction to a profound technological practice, Neuroinformatics for Neuropsychology is important reading for clinical neuropsychologists, cognitive neuroscientists, behavioral neurologists, and speech-language pathologists. Researchers, clinicians, and graduate students interested in informatics for the brain-behavioral sciences will especially welcome this unique volume. © Springer Science+Business Media, LLC 2009. All rights reserved.
Working memory (WM) refers to the human capacity to encode, store, manipulate, and recall information. A proper understanding of WM therefore provides essential insights into human cognition. This chapter reviews available research concerning the impact of deafness and sign language use on WM, much of which comes from the study of a single subcomponent of WM termed short-term memory (STM). We argue that excessive focus on STM (the ability to encode, store, and retrieve a sequence of unrelated words in serial order) to the exclusion of other WM subprocesses has caused an extreme interest in phonological coding at the expense of other known codes used in WM, in particular visual but also episodic codes. Deafness and use of a sign language may result in greater reliance on not only visual but also episodic coding, as compared to what is typically observed in hearing nonsigners. This multiple coding hypothesis calls into question whether the robust phonological bias described in hearing individuals should be taken by researchers, clinicians, and educators as the gold standard for deaf populations.
The tablet computer initiates an important step toward computerized administration of
neuropsychological tests. Because of its lack of standardization, the Corsi Block-Tapping
Task could benefit from advantages inherent to computerization. This task, which
requires reproduction of a sequence of movements by tapping blocks as demonstrated
by an examiner, is widely used as a representative of visuospatial attention and working
memory. The aim was to validate a computerized version of the Corsi Task (e-Corsi) by
comparing recall accuracy to that on the standard task. Forty university students
(M age = 22.9 years, SD = 2.7 years; 20 female) performed the standard Corsi Task and
the e-Corsi on an iPad 3. Results showed higher accuracy in forward reproduction on
the standard Corsi compared with the e-Corsi, whereas backward performance was comparable.
These divergent performance patterns on the 2 versions (small-to-medium effect
sizes) are explained as a result of motor priming and interference effects. This finding
implies that computerization has serious consequences for the cognitive concepts that
the Corsi Task is assumed to assess. Hence, whereas the e-Corsi was shown to be useful
with respect to administration and registration, these findings also stress the need for
reconsideration of the underlying theoretical concepts of this task.
Objective: The clinical balance performance of normal-hearing (NH) children was compared with the balance performance of hearing-impaired (HI) children with and without vestibular dysfunction to identify an association between vestibular function and motor performance.
Study Design: Prospective study.
Setting: Tertiary referral center.
Patients: Thirty-six children (mean age, 7 yr 5 mo; range, 3 yr 8 mo-12 yr 11 mo) divided into three groups: NH children with normal vestibular responses, HI children with normal vestibular responses, and HI children with abnormal vestibular function.
Interventions: A vestibular test protocol (rotatory and collic vestibular evoked myogenic potential testing) in combination with three clinical balance tests (balance beam walking, one-leg hopping, one-leg stance).
Main Outcome Measures: Clinical balance performance.
Results: HI children with abnormal vestibular test results obtained the lowest quotients of motor performance, which were significantly lower compared with the NH group (p < 0.001 for balance beam walking and one-leg stance; p = 0.003 for one-leg hopping). The balance performance of the HI group with normal vestibular responses was better in comparison with the vestibular impaired group but still significantly lower compared with the NH group (p = 0.020 for balance beam walking; p = 0.001 for one-leg stance; not significant for one-leg hopping).
Conclusion: These results indicate an association between vestibular function and motor performance in HI children, with a more distinct motor deterioration if a vestibular impairment is superimposed to the auditory dysfunction.
This chapter presents analytic methods for matched studies with multiple risk factors of interest. We consider matched sample designs of two types, prospective (cohort or randomized) and retrospective (case-control) studies. We discuss direct and indirect parametric modeling of matched sample data and then focus on conditional logistic regression in matched case-control studies. Next, we describe the general case for matched samples including polytomous outcomes. An illustration of matched sample case-control analysis is presented. A problem solving section appears at the end of the chapter.
Objectives
To systematically review and discuss the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent advances in diagnosis and therapy.
Methods
One appropriate string was run on PubMed to retrieve articles dealing with the topics mentioned above. A cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. A non-comparative meta-analysis concerning the rate of singular vertiginous forms was performed.
Results
Ten articles were identified comprising a total of 724 subjects. Overall, the articles we analyzed indicated benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) as the two main entities connected with vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo. The mean (95% CI) rate of every vertiginous form was also calculated in relation to the nine studies analyzed with vestibular migraine (27.82%), benign paroxysmal vertigo (15.68%) and vestibular neuritis (9.81%) being the three most common forms. There appeared to be a paucity of recent literature concerning the development of new diagnostic methods and therapies.
Conclusions
On the basis of the literature study, when evaluating a young patient with vertigo and dizziness, the otolaryngologist should be aware that, in children, these symptoms are often connected to different pathologies in comparison to the entities observed in the adult population.
AimThis study sought to confirm the test-retest reliability and validity of the National Center for Geriatrics and Gerontology functional assessment tool (NCGG-FAT), a newly developed assessment of multidimensional neurocognitive function using a tablet personal computer (PC). Methods
This study included 20 community-dwelling older adults (9 females, aged 65-81 years). Participants were administered the NCGG-FAT twice, separated by approximately 30 days to determine test-retest reliability. To test the validity of the measure, participants underwent established neurocognitive measurements, including memory, attention, executive function, processing speed and visuospatial function within a week from the first administration of the NCGG-FAT. ResultsTest-retest reliability was in an acceptable range for each component of the NCGG-FAT, with intraclass correlation coefficients ranging from 0.764 to 0.942. Each task in the NCGG-FAT showed a moderate to high correlation with scores on widely-used conventional neurocognitive tests (r=0.496 to 0.842). Conclusion
We found that the NCGG-FAT using a tablet PC was reliable in a sample of community-dwelling older adults. The NCGG-FAT might be useful for cognitive screening in population-based samples and outcomes, enabling assessment of the effects of intervention on multidimensional cognitive function among older adults. Geriatr Gerontol Int 2013; 13: 860-866.
Objectives/Hypothesis: To identify the predictive ability of vestibular function test results on motor performance among hearing-impaired children.
Study Design: Cross-sectional study.
Methods: Fifty-one typically developing children and 48 children with a unilateral (n ¼ 9) or bilateral hearing impairment (n ¼ 39) of more than 40 dB HL between 3 and 12 years were tested by the Movement Assessment Battery for Children–Second Edition (M ABC-2), clinical balance tests, posturography, rotatory chair testing, and vestibular evoked myogenic potential (VEMP). From the group of hearing-impaired children, 23 had cochlear implants.
Results: Balance performance on M ABC-2, clinical balance tests, as well as the sway velocity assessed by posturography in bipedal stance on a cushion with eyes closed and in unilateral stance differed significantly between both groups. Presence of a VEMP response is an important clinical parameter because comparison of the motor performance among hearingimpaired children between those with present and absent VEMPs showed significant differences in balance performance. The three most important predictor variables on motor performance by bivariate regression analyses are the vestibular-ocular reflex (VOR) gain value of the rotatory chair test at 0.01 and 0.05 Hz frequency, as well as the VEMP asymmetry ratio. Multivariate regression analyses suggest that the VOR asymmetry value of the rotatory chair test at 0.05 Hz and the etiology of the hearing loss seem to have additional predictive value.
Conclusions: Hearing-impaired children are at risk for balance deficits. A combination of rotatory chair testing and VEMP testing can predict the balance performance.
Mental body representations are flexible and depend on sensory signals from the body and its surrounding. Clinical observations in amputees, paraplegics and brain-damaged patients suggest a vestibular contribution to the body schema, but studies using well-controlled psychophysical procedures are still lacking. In Experiment 1, we used a tactile distance comparison task between two body segments (hand and forehead). The results showed that objects contacting the hand were judged longer during caloric vestibular stimulation when compared to control thermal stimulation. In Experiment 2, participants located four anatomical landmarks on their left hand by pointing with their right hand. The perceived length and width of the left hand increased during caloric vestibular stimulation with respect to a control stimulation. The results show that the body schema temporarily adjusts as a function of vestibular signals, modifying the internal representation of the hand size. The data provide evidence that vestibular functions are not limited to postural and oculomotor control, and extend the contribution of the vestibular system to bodily cognition. The findings from this study suggest the inclusion of vestibular signals into current models of body representations and bodily self-consciousness.
The Bells Test, a cancellation task, permits a quantitative and qualitative evaluation of visual neglect. The construction of the test allows for rapid visualization of the spatial distribution of the omitted targets and their quantification. The examiner can also obtain a qualitative picture through an approximation of the visual scanning pattern used by the subject; this provides valuable information on 'how' the task is performed. In summary, the Bells Test is a more dynamic, and thus, more sensitive clinical examination for visual neglect.
It has recently been shown that a lack of vestibular sensory information decreases spatial memory performance and induces biochemical changes in the hippocampus in rodents. After vestibular neurectomy, patients display spatial memory deficit and hippocampal atrophy. Our objectives were to explore: (a) spatial (Y maze, radial-arm maze), and non-spatial (object recognition) memory performance, (b) modulation of NMDA receptors within the hippocampus using radioligand binding, and (c) hippocampal atrophy, using MRI, in a rat model of bilateral labyrinthectomy realized in two operations. Chemical vestibular lesions (VLs) were induced in 24 animals by transtympanic injections of sodium arsanilate (30 mg/0.1 ml/ear), one side being lesioned 3 weeks after the other. The control group received transtympanic saline solution (0.1 ml/ear) (n = 24). Spatial memory performance (Y maze and radial maze) decreased after VL. Conversely, non-spatial memory performance (object recognition) was not affected by VL. No hippocampal atrophy was observed with MRI, but density of NMDA receptors were increased in the hippocampus after VL. These findings show that the lack of vestibular information induced specific deficits in spatial memory. Additionally, quantitative autoradiographic data suggest the involvement of the glutamatergic system in spatial memory processes related to vestibular information. When studying spatial memory performances in the presence of vestibular syndrome, two-step labyrinthectomy is a suitable procedure for distinguishing between the roles of the specific components of vestibular input loss and those of impaired locomotor activity.
Previous studies of rats with bilateral vestibular deafferentation (BVD) have demonstrated spatial memory deficits, suggesting adverse effects on the hippocampus. However, the longest post-operative time interval that has been studied was approx. 5-7 months post-surgery. In this study, we investigated whether rats exhibited spatial memory deficits at 14 months following BVD and whether these deficits could be exacerbated by administration of cannabinoid (CB) drugs. Twenty-eight adult rats were divided into four groups: (1) sham surgery+vehicle; (2) sham surgery+the CB1/CB(2) receptor agonist WIN55,212-2 ('WIN'); (3) BVD+vehicle; and (4) BVD+WIN. WIN (1.0 or 2.0 mg/kg/day) or vehicle, was administered (s.c.) on days 1-10 and 11-20 (respectively), 30 min before the rats performed in a foraging task. On day 21, the CB receptor inverse agonist, AM251 (3.0 mg/kg, s.c.), was administered before WIN or vehicle. To our surprise, BVD animals were impaired in using the visual cues during the probe test in light. In the dark trials, when visual cues were unavailable, BVD animals were unable to use self-movement cues in homing. However, WIN at 2 mg/kg, significantly improved BVD animals' homing time and number of errors in the dark through strategies other than the improvement in using self-movement cues. Furthermore, AM251 significantly improved heading angle in vehicle-treated animals and the first home choice in WIN-treated animals. These results suggest that at 14 months post-BVD, the animals are not only impaired in path integration, but also piloting and that the spatial memory deficits may be permanent. The involvement of the cannabinoid system is more complicated than expected.
Short title on half-title page: Memory and the medial temporal region of the brain. Thesis (Ph. D.)--McGill University, 1972. Includes bibliographical references (leaves 69-78). Microfilm of typescript.
Previous work in deaf populations on phonological coding and working memory, two skills thought to play an important role in the acquisition of written language skills, have focused primarily on signers or did not clearly identify the subjects' native language and communication mode. In the present study, we examined the effect of sensory experience, early language experience, and communication mode on the phonological awareness skills and serial recall of linguistic items in deaf and hearing individuals of different communicative and linguistic backgrounds: hearing nonsigning controls, hearing users of ASL, deaf users of ASL, deaf oral users of English, and deaf users of cued speech. Since many current measures of phonological awareness skills are inappropriate for deaf populations on account of the verbal demands in the stimuli or response, we devised a nonverbal phonological measure that addresses this limitation. The Phoneme Detection Test revealed that deaf cuers and oral users, but not deaf signers, performed as well as their hearing peers when detecting phonemes not transparent in the orthography. The second focus of the study examined short-term memory skills and found that in response to the traditional digit span as well as an experimental visual version, digit-span performance was similar across the three deaf groups, yet deaf subjects' retrieval was lower than that of hearing subjects. Our results support the claim (Bavelier et al., 2006) that lexical items processed in the visual-spatial modality are not as well retained as information processed in the auditory channel. Together these findings show that the relationship between working memory, phonological coding, and reading may not be as tightly interwoven in deaf students as would have been predicted from work conducted in hearing students.
Similarities between the peripheral auditory and vestibular systems suggest that children with sensorineural hearing loss (SNHL) may demonstrate vestibular and balance impairments. This hypothesis was studied in 40 children with severe to profound SNHL and unilateral cochlear implants.
Prospective cross-sectional study with repeated measures.
Vestibular function was assessed with caloric, rotational, and vestibular evoked myogenic potential testing; balance was assessed using the balance subset of the Bruininks-Oseretsky Test of Motor Proficiency-II, a standardized test of static and dynamic balance.
Horizontal semicircular canal function was abnormal in response to a caloric stimulus in 50% (16/32), with a large proportion of those [6/16 (38%)] reflecting mild to moderate unilateral abnormalities. In comparison, horizontal semicircular canal function in response to rotation was abnormal in 38% (14/37). Saccular function was absent bilaterally in 5/26 (19%) and unilaterally in 5/26 (19%) with vestibular evoked myogenic potential. Age standardized balance abilities were significantly poorer in the study population [micro = 12.9 +/- 5(SD)] compared with normal hearing controls [micro = 17 +/- 5(SD); P = .0006] and correlated best with horizontal canal function in response to a rotational stimulus (P = .004; R = 0.24). SNHL from meningitis was associated with worse balance function than other etiologies.
Vestibular and balance dysfunction occurred in >1/3 of children with SNHL and cochlear implants, and is highly dependent on etiology. Although compliance with all tests was high, rotational chair testing, which assesses higher frequency motion (0.25-5 Hz) and thus more "real world" vestibular function, correlated best with dynamic balance. For this reason, rotational chair testing may represent the test of choice in this population, particularly given that it is amenable to testing children of all ages.
To recommend instrument assessment criteria, deriving from psychometric textbooks and articles and disability and research experts, for reviewing and assessing surveys and questionnaires for disability outcomes research. Traditional criteria are recommended, including psychometric properties of validity, reliability, and sensitivity to change, as are newer statistical methods for assessing scaling properties, such as Rasch analysis. Special consideration is needed for generic instruments that may be poorly scaled for disability research. Pragmatic aspects of data collection, including acceptability and disability accommodation, also are recommended.
Neuropsychological testing batteries are applied in neurobehavioral evaluations of brain disorders, including neuropsychiatric populations. They are lengthy, require expert administrators and professional scorers, and are prone to data handling errors. We describe a brief computerized neurocognitive "scan" that assesses similar domains with adequate reliability. The scan and a traditional battery were administered to a sample of 92 healthy individuals (44 men, 48 women) in a counterbalanced order. Both approaches showed a significant "sex-typical" gradient, with women outperforming men in verbal memory relative to spatial tasks. Both methods also yielded similar profiles of sex differences, with the additional computerized measure of face memory showing better performance in women. Age effects were evident for both methods, but the computerized scan isolated the effects to speed rather than accuracy. Therefore, the computerized scan has favorable reliability and construct validity and can be applied efficiently to study healthy variability related to age and gender.
Children with sensorineural hearing impairment (SNHI) and concomitant vestibular hypofunction demonstrate deficits in gaze stability that may affect reading. The objective of this study was to develop a reliable, valid clinical test of dynamic visual acuity (DVA) for children.
Seventy-six typically developing children, 26 adults and 11 children with sensorineural hearing impairment participated. Visual acuity was tested under three conditions: (1) head stable (static acuity), (2) head tipped forward 30 degrees and passively rotated 30 degrees in the yaw plane at 2 Hz (horizontal dynamic acuity) and (3) head passively moved in the pitch plane 30 degrees at 2 Hz (vertical dynamic acuity, vDVA). The difference, in number of chart lines, between static dynamic acuity was calculated (dynamic acuity score). Based on normative data collected, results were scored as: (1) pass < or =2S.D. from the normative mean and (2) fail > or =2S.D. from normative mean. Children were grouped by age to enable examination of the effect of age on scores.
We found excellent test-retest and inter-tester reliability (ICC(2,2)=0.94 and ICC(3,2)=0.84) for the horizontal dynamic acuity (hDVA) test. Sensitivity, specificity, positive and negative predictive values were 100% to identify children with bilateral vestibular hypofunction (BVH). Although a statistical difference was found, the difference was not clinically significant (all achieved DVA scores <2 lines). The vertical dynamic acuity test was not tolerated by most children, precluding its usefulness.
The clinical test of horizontal dynamic acuity is a reliable test for children as young as 3 years. It is simple and inexpensive, and will enable identification of those for whom more extensive testing is warranted.
The role of the vestibular system for navigation and spatial memory has been demonstrated in animals but not in humans. Vestibular signals are necessary for location-specific "place cell" activity in the hippocampus which provides a putative neural substrate for the spatial representation involved in navigation. To investigate the spatial memory in patients with bilateral vestibular failure due to NF2 with bilateral neurectomy, a virtual variant (on a PC) of the Morris water task adapted to humans was used. Significant spatial learning and memory deficits were shown in 12 patients as compared to 10 healthy controls. These data suggest that functional hippocampal deficits manifest due to a chronic lack of vestibular input in these patients. These deficits can even be demonstrated with the subjects stationary, i.e., without any actual vestibular or somatosensory stimulation.
Despite reported gaze stability deficits in children with hearing impairment and concurrent vestibular hypofunction, the reading difficulties reported in this population have not been linked to the gaze instability. The purpose of this study was to develop a modified version of the MNREAD chart that enabled responses orally or using sign language.
Seventy-two typically developing children and 14 children with sensorineural hearing loss with and without vestibular hypofunction participated. We examined: (1) reliability and age related changes in reading acuity scores, (2) the effect of vestibular hypofunction on reading acuity scores, and (3) the relationship between these scores and a test of dynamic visual acuity.
The test was reliable (ICC (3,2)>or=0.86). Reading acuity scores were significantly worse in children with vestibular hypofunction (p<or=0.002). Furthermore, reading acuity scores correlated with dynamic not static visual acuity scores (r=0.55, p<0.001).
These results imply that the gaze instability due to vestibular hypofunction affects reading ability in young children.
The aim of this study was to investigate the interference between postural control and cognitive processing in patients with surgically confirmed unilateral vestibular lesions. These patients were well-compensated for vestibular lesions with no symptoms of dizziness or definable postural deficit. We hypothesized that attentional processes would play a greater role in postural control of these patients compared to healthy age-matched controls suggesting that successful compensation for a vestibular impairment involves ongoing increased attentional resources, and is not an automatic process. To explore this hypothesis, we used a dual-task paradigm that combined postural challenges with concurrently performed cognitive tasks. The postural conditions were seated, standing on a fixed floor, standing on a sway-referenced floor, and standing on a translating floor. Cognitive tasks were simple, inhibitory, and forced choice reaction time (RT) tasks. Patients had slower RTs compared to the controls under all conditions, including the seated condition. This effect was particularly large for the choice and inhibitory tasks. Both groups had increased RTs as the postural task became more challenging. Postural sway increased similarly in the patients and controls when performing the RT tasks for all postural conditions. These results suggest that patients with vestibular lesions that are well-compensated require increased attention compared to healthy controls; however, this increased demand on attention extends beyond postural control. The site of action may be at the sensory integration level resolving multiple sensory signals for spatial orientation.