Functional Object Use Research Articles

Reciprocal interactions among parietal and occipito-temporal representations support everyday object-directed actions

Everyday interactions with common manipulable objects require the integration of conceptual knowledge about objects and actions with real-time sensory information about the position, orientation and volumetric structure of the grasp target. The ability to successfully interact with everyday objects involves analysis of visual form and shape, surface texture, material properties, conceptual attributes such as identity, function and typical context, and visuomotor processing supporting hand transport, grasp form, and object manipulation. Functionally separable brain regions across the dorsal and ventral visual pathways support the processing of these different object properties and, in cohort, are necessary for functional object use. Object-directed grasps display end-state-comfort: they anticipate in form and force the shape and material properties of the grasp target, and how the object will be manipulated after it is grasped. End-state-comfort is the default for everyday interactions with manipulable objects and implies integration of information across the ventral and dorsal visual pathways. We propose a model of how visuomotor and action representations in parietal cortex interact with object representations in ventral and lateral occipito-temporal cortex. One pathway, from the supramarginal gyrus to the middle and inferior temporal gyrus, supports the integration of action-related information, including hand and limb position (supramarginal gyrus) with conceptual attributes and an appreciation of the action goal (middle temporal gyrus). A second pathway, from posterior IPS to the fusiform gyrus and collateral sulcus supports the integration of grasp parameters (IPS) with the surface texture and material properties (e.g., weight distribution) of the grasp target. Reciprocal interactions among these regions are part of a broader network of regions that support everyday functional object interactions.

542: AWAKENING AFTER EXTRACORPOREAL LIFE SUPPORT: ASSESSING AWARENESS IN UNRESPONSIVE WAKEFULNESS

Introduction: Emergence from coma have many stages. Patients enter unresponsive wakefulness (UW) from coma when they open eyes with only reflexive motor responses. The development of voluntary responses to stimuli indicates a minimally conscious state (MCS). The addition of functional communication or object use signifies emergence from MCS. Cognitive motor dissociation has been reported in unresponsive patients with evidence of appropriate brain activation. We present a pediatric case where we detected awareness with bedside electroencephalogram (EEG) and the patient showed eventual emergence from UW. Description: A depressed teenage girl was admitted after suicidal attempt with fluoxetine and lamotrigine ingestion with subsequent cardiopulmonary arrest. After prolonged cardiopulmonary resuscitation, she was cannulated on veno-arterial extracorporeal membrane oxygenation. Initial head computed tomography showed preserved gray-white differentiation. On post-arrest day 5, she was successfully decannulated but remained in an unresponsive wakefulness state. Brain magnetic resonance imaging showed diffuse cerebral microhemorrhages. To assess preserved awareness, we performed protocolized stimulation with EEG. Consistent reactivity with increased frequency and amplitude were observed after both nociceptive and auditory stimulation, with greater response to stimuli from her parent. After slow improvement she emerged from UW on post-arrest day 35 and showed consistent appropriate responses. She was discharged to inpatient rehabilitation on post-arrest day 50. Discussion: Analysis of quantitative EEG data often requires advanced machine learning algorithms that were not readily available to bedside providers. Assessing EEG reactivity with protocolized stimulation is an effective alternative to assess preserved awareness. Our case adds to limited pediatric literature on emergence from coma and detection of preserved awareness early after brain injury. Clinically she was unresponsive to external stimuli but demonstrated signs of arousal to nociceptive and auditory stimuli on EEG, especially when from her parents. Our case demonstrates the feasibility of assessing preserved awareness at bedside via protocolized stimulation with EEG, which may assist in prognosis.

Determining the Hierarchy of Coma Recovery Scale-Revised Rating Scale Categories and Alignment with Aspen Consensus Criteria for Patients with Brain Injury: A Rasch Analysis.

This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Revised (CRS-R) rating scale categories and their alignment with the Aspen consensus criteria for determining disorders of consciousness (DoC) following a severe brain injury. CRS-R data from 262 patients with DoC following a severe brain injury were analyzed applying the partial credit Rasch Measurement Model. Rasch Analysis produced logit calibrations for each rating scale category. Twenty-eight of the 29 CRS-R rating scale categories were operationalized to the Aspen consensus criteria. We expected the hierarchical order of the calibrations to reflect Aspen consensus criteria. We also examined the association between the CRS-R Rasch person measures (indicative of performance ability) and states of consciousness as determined by the Aspen consensus criteria. Overall, the order of the 29 rating scale category calibrations reflected current literature regarding the continuum of neurobehavioral function: category 6 "Functional Object Use" of the Motor item was hardest for patients to achieve; category 0 "None" of the Oromotor/Verbal item was easiest to achieve. Of the 29 rating scale categories, six were not ordered as expected. Four rating scale categories reflecting the Vegetative State (VS)/Unresponsive Wakefulness Syndrome (UWS) had higher calibrations (reflecting greater neurobehavioral function) than the easiest Minimally Conscious State (MCS) item (category 2 "Fixation" of the Visual item). Two rating scale categories, one reflecting MCS and one not operationalized to the Aspen consensus criteria, had higher calibrations than the easiest eMCS item (category 2 "Functional: Accurate" of the Communication item). CRS-R person measures (indicating amount of neurobehavioral function) and states of consciousness, based on Aspen consensus criteria, showed a strong correlation (rs = 0.86; p < 0.01). Our study provides empirical evidence for revising the diagnostic criteria for MCS to also include category 2 "Localization to Sound" of the Auditory item and for Emerged from Minimally Conscious State (eMCS) to include category 4 "Consistent Movement to Command" of the Auditory item.

Should Consistent Command-Following Be Added to the Criteria for Emergence From the Minimally Conscious State?

ObjectiveTo determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (eMCS). DesignRetrospective cohort study. SettingInpatient rehabilitation hospital. ParticipantsPatients (N=214) with acquired brain injury resulting in disorders of consciousness (DoC) admitted to a specialized rehabilitation program. Main Outcome MeasuresDifference between time to recovery of CCF and time to recovery of functional object use (FOU) or functional communication (FC), the 2 existing criteria for eMCS as measured by the Coma Recovery Scale–Revised (CRS-R). ResultsOf 214 patients (median age, 53 years [interquartile range {IQR}, 34-66 years], male: 134 [62.6%], traumatic etiology: 115 [53.7%], admission CRS-R total score: 10 [IQR, 7-13]) admitted to rehabilitation without CCF, FOU, or FC, 162 (75.7%) recovered CCF and FOU or FC during the 8-week observation period. On average, recovery of CCF, FOU, and FC was observed within 1 day of one another, approximately 46 days (IQR, 38.25-58 days) post injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF. ConclusionsIn patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding may reflect the shared dependency of these behaviors on cognitive processes (eg, language comprehension, attention, motor control) that are essential for effective interpersonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for eMCS, but further validation in an independent sample should be conducted.

Revisiting Criteria for Emergence From The Minimally Conscious State

<h3>Research Objectives</h3> To determine whether consistent command following (CCF) may be a sign of emergence from the minimally conscious state (MCS). <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Specialized disorders of consciousness (DoC) program in an inpatient rehabilitation hospital. <h3>Participants</h3> Patients with severe acquired brain injury and DoC. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Time from injury to recovery of CCF and time from injury to emergence from MCS (defined as functional object use [FO] or functional communication [FC] on the Coma Recovery Scale – Revised [CRS-R]) across the first eight weeks of rehabilitation. <h3>Results</h3> Of 214 patients admitted to rehabilitation without CCF, FO, or FC (median [interquartile range, IQR] age: 53 [34, 66] years, male: 134 (62.6%), traumatic etiology: 115 (53.7%), admission CRS-R total score: 10 [7, 13]), 162 (75.7%) recovered CCF and emerged from MCS during the eight-week observation period. Of these, 116 patients (71.6%) recovered CCF either at the same time or after emerging from MCS. Both CCF and emergence from MCS occurred approximately 46 days post-injury. FO and FC were equally likely to be the first observed behavior consistent with emergence from MCS (p <.001). <h3>Conclusions</h3> Most patients admitted to rehabilitation following severe brain injury recovered CCF and emerged from MCS during the first eight weeks of rehabilitation. CCF and emergence from MCS occur at approximately the same time during the recovery course, suggesting that CCF should be included as a criterion signaling emergence from MCS. Including CCF as a criterion for emergence from MCS may improve access to clinical services for patients with DoC, as this suggests capacity for active participation in rehabilitation. <h3>Author(s) Disclosures</h3> The authors declare no relevant conflict of interest.

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress.

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

The clinical effect of vagus nerve stimulation in the treatment of patients with a minimally conscious state

Objective:Vagus nerve stimulation (VNS) has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity. The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state (MCS).Methods:All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019. Ten patients diagnosed with MCS by Coma Recovery Scale-Revised (CRS-R) test who underwent VNS surgery were enrolled. The scores on CRS-R evaluation at baseline (before VNS implantation) and 1, 3, and 6 months after VNS treatment were recorded. The stimulation parameters were chosen according to a previous study. All clinical rehabilitation protocols remained unchanged during the study. Furthermore, safety was assessed by analyzing treatment-emergent adverse events (TEAEs).Results:No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed (p &gt; 0.05). After 3 months of stimulation, a significant difference (p = 0.0078) was observed in the total CRS-R scores compared with the baseline. After 6 months of VNS treatment, CRS-R assessments showed a continuous significant improvement (p = 0.0039); one patient emerged from the MCS and recovered functional communication and object use. Interestingly, one item of CRS-R scores on visual domain was sensitive to VNS treatment (p = 0.0039). Furthermore, no serious adverse event occurred throughout the study.Conclusion:This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.

Assessing emergence from a prolonged disorder of consciousness: Current opinion and practice in the UK

ABSTRACT Background: A patient in PDOC must demonstrate functional object use or functional communication to confirm they have emerged from this state. A range of tasks and stimuli are used and patients must achieve 100% accuracy. As consciousness occurs along a continuum, determining emergence is not straightforward. Objective: To establish the opinions of expert clinicians on how emergence is determined in practice. Methods: An online survey was completed by clinicians working in specialist rehabilitation settings across the UK. Questions were asked about diagnosis and confidence, informal assessment, formal assessment, and family involvement. Descriptive statistics were used to analyse responses to closed questions. Responses to open questions were analysed using thematic analysis. Results: Seventy-five surveys were analysed. Approximately a third (30.4 %) used tasks other than those recommended to determine emergence. A lack of confidence in tasks to detect the return of functional communication was reported by 46.4%. The majority (78.6%) reported they worked with patients who they felt had emerged, but could not demonstrate it based on the current criteria. A range of stimuli were employed, but 30.6% of respondents were not confident they could choose stimuli appropriately. Respondents reported a range of benefits and challenges when involving family in assessment.

Amantadin İnfüzyonunun Travmatik Beyin Hasarında Etkisi

Objective: Traumatic brain injury (TBI) is a significant socioeconomic and public health problem. Amantadine sulfate has been used as a neuroprotective drug. In this study, We aim that amantadine infusion treatment effects positively in patients with a severe head injury on conscious recovery. Materials and Methods: Patients with TBI were classified into two groups: Patients that used amantadine infusion group was Group I (n=40) and patients that not used amantadine infusion group was Group group II (n=40). Age, gender, Glasgow Coma Scale (GCS), education level, intubated or non-intubated when he/she come to Intensive Care Unit (ICU), the recovery time of conscious, discharge time, recovery of CT or MR scan and Coma Recovery Scale-Revised (CRS-R) were retrospectively recorded. Results: Time to recovery in consciousness was statistically significant shorter in group I. There were no statistically significant differences between the educational status of patients. The GCS of patients, when admitted to ICU, was lower in group I. Functional object use and long-term attention were have higher scores in group I when compared to CRS-R.Conclusion: Amantadine infusion affects positively neurological recovery and neurocognitive function for TBI in this study.

Preliminary validation of the coma recovery scale for pediatrics in typically developing young children

ABSTRACTObjective: To examine the basic psychometric features of a modified version of the Coma Recovery Scale-Revised (CRS-R) for use in young children with disorders of consciousness (DoC).Method: The CRS-R was modified to create the Coma Recovery Scale for Pediatrics (CRS-P) and administered to 33 typically developing children (8–59 months). Total scores, subtest scores, and inter-rater reliability were evaluated. Performance on the two items representing emergence to conscious state (CS) – functional object use (FOU) and functional communication (FC) was examined across the age range.Results: Inter-rater reliability of CRS-P subscale scores was adequate (Kw = .87–1.00). All 4-year-olds, 75% of 3-year-olds, 10% of 2-year-olds, and 0% <2 years scored at the CRS-P ceiling. Total and subtest scores were strongly correlated with age as were the two behaviors representing emergence to CS (FOU, FC) – all children >12 months and none <12 months of age met criteria for FOU; all children ≥3 years, 20% between 2 and <3 years, and none <2 years met criteria for FC.Conclusions: The CRS-P is appropriate for use in children as young as 12 months of age, with a strong association between performance and age at administration. The CRS-P also captures emergence to CS, a key clinical milestone.

Clinical Features of Disorders of Consciousness in Young Children

ObjectivesTo investigate behavioral and demographic features of levels of consciousness in young children with brain injury, including the classifications of consciousness: conscious state (CS), minimally conscious state (MCS), and vegetative state (VS), and to investigate the course of recovery in children with disorders of consciousness (DOC). DesignRetrospective chart review and post hoc analysis. SettingPediatric inpatient rehabilitation unit. ParticipantsChildren aged 6 months to 5 years (N=54) admitted for inpatient rehabilitation directly from an acute care hospital following new neurologic injury from 2011 to 2016. InterventionsNot applicable. Main Outcome MeasuresClinically abstracted behavioral features of DOC and levels of consciousness at admission and discharge, based on established guidelines from the Aspen Neurobehavioral Conference Workgroup. ResultsChildren in MCS were younger than children in CS. Commonly observed behaviors in children in VS were mouth movements or vocalizations, flexion withdrawal or motor posturing, visual or auditory startle, and localization to sound. Common features of MCS were contingent affect, visual fixation or pursuit, automatic motor behavior, and contingent communicative intent. No children in MCS showed command following or intelligible verbalizations. All children in CS showed functional object use, while functional communication was observed in a subset. By discharge, more than half of children in VS emerged to MCS, and a third emerged from MCS to CS. No child emerged from VS to CS. ConclusionsVisual and motor skills may be most applicable, and language-based skills may be least applicable for the assessment of DOC in very young children. Accurate classifications of consciousness may have important prognostic implications, and additional research is needed to develop clear guidelines for assessment of DOC in this population.

Personalized objects can optimize the diagnosis of EMCS in the assessment of functional object use in the CRS-R: a double blind, randomized clinical trial

BackgroundBehavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item “Functional Object Use” in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients’ scores of behavioral assessment scale. So, we attempted to find out if personalized objects can improve the diagnosis of EMCS in the assessment of Functional Object Use by comparing the use of patients’ favorite objects and other common objects in MCS patients.MethodsTwenty-one post-comatose patients diagnosed as MCS were prospectively included. The item “Functional Object Use” was assessed by using personalized objects (e.g., cigarette, paper) and non-personalized objects, which were presented in a random order. The rest assessments were performed following the standard protocol of the CRS-R. The differences between functional uses of the two types of objects were analyzed by the McNemar test.ResultsThe incidence of Functional Object Use was significantly higher using personalized objects than non-personalized objects in the CRS-R. Five out of the 21 MCS studied patients, who were assessed with non-personalized objects, were re-diagnosed as EMCS with personalized objects (χ2 = 5, df = 1, p < 0.05).ConclusionsPersonalized objects employed here seem to be more effective to elicit patients’ responses as compared to non-personalized objects during the assessment of Functional Object Use in DOC patients.Trial registrationClinical Trials.gov: NCT02988206; Date of registration: 2016/12/12.

The assessment of language and the emergence from disorders of consciousness

ABSTRACTIn order to demonstrate emergence from a disorder of consciousness (DoC) an individual is currently required to demonstrate functional object use of two objects, or functional communication defined as accurately answering six yes/no questions on two consecutive occasions (Giacino et al., 2002). In practice, experienced speech and language therapists (SLTs) working with this group often focus on facilitating object use or employ other language tasks, since achieving a 100% accurate yes/no response can be difficult for patients following an extensive brain injury due to language and/or cognitive impairments. There is an increasing awareness of this issue in the literature and in practice and there is discussion about reviewing the current definition of emergence. This paper outlines the traditional definition of emergence and recent updates, discusses some of the problems and implications associated with current assessment, highlights the importance of getting it right, explores potential other ways to determine emergence, and suggests further areas for research.

Poster 44 An Empirical Classification Scheme for Detection of Impossible and Improbable CRS-R Subscore Combinations

Objective(s): The Coma Recovery Scale-Revised (CRS-R) is a standardized neurobehavioral measure designed for use in diagnostic and prognostic assessment in patients with disorders of consciousness (DOC). The aims of this study are to determine the probability with which specific CRS-R subscale score combinations occur and to provide clinicians and researchers with a method of determining impossible or improbable scores. Design: Retrospective data analysis from three databases including patients admitted to hospitals in the United States and Belgium. Setting: Specialized inpatient DOC Program and university hospitals. Participants: 869 patients diagnosed with DOC (569 male, mean age Z 47y, standard deviationZ20y, time since insultZ 240 815 days). Interventions: N/A. Main Outcome Measure(s): Impossible score combinations were defined as two scores that cannot co-occur based on standard scoring guidelines. To determine improbable score combinations, we calculated the Mahalanobis distance for each pair of subscores (e.g., visual subscore of 1 and motor subscore of 2) and conducted a chi square analysis to determine the p value associated with the distance of each pair from the centroid. We then classified score combinations as “improbable” (p<0.05) and “very improbable” (p<0.02). Results: Of the 869 CRS-R profiles analyzed, 8.5% were excluded because they met impossible scoring criteria. Among the 796 remaining profiles, 7% (24/330) of subscale score pairs were classified as improbable and 18% (60/330) very improbable (e.g., functional object use co-occurring with auditory startle). Conclusions: An empirically-derived classification scheme can be used to determine the validity and probability of CRS-R subscore combinations. This methodology can be applied in data quality analysis and may have diagnostic utility in clinical practice.

Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem

Background: Zolpidem, a short-acting non-benzodiazepine GABA agonist hypnotic, has been shown to induce paradoxical responses in some patients with disorders of consciousness (DOC), leading to recovery of arousal and cognitive abilities. We here assessed zolpidem-induced changes in regional brain metabolism in three patients with known zolpidem response in chronic post-anoxic minimally conscious state (MCS).Methods: [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and standardized clinical assessments using the Coma Recovery Scale-Revised were performed after administration of 10 mg zolpidem or placebo in a randomized double blind 2-day protocol. PET data preprocessing and comparison with a healthy age-matched control group were performed using statistical parametric mapping (SPM8).Results: Behaviorally, all patients recovered functional communication after administration of zolpidem (i.e., emergence from the MCS). FDG-PET showed increased metabolism in dorsolateral prefrontal and mesiofrontal cortices after zolpidem but not after placebo administration.Conclusion: Our data show a metabolic activation of prefrontal areas, corroborating the proposed mesocircuit hypothesis to explain the paradoxical effect of zolpidem observed in some patients with DOC. It also suggests the key role of the prefrontal cortices in the recovery of functional communication and object use in hypoxic patients with chronic MCS.

Zolpidem and Restoration of Consciousness

Zolpidem has been reported to cause temporary recovery of consciousness in vegetative and minimally conscious patients, but how often and why this occurs are unknown. The authors aimed to determine the frequency of this phenomenon and whether it can be predicted from demographic and clinical variables. This is a placebo-controlled, double-blind, single-dose, crossover study performed by caregivers and replicated by trained professionals, for naive participants. Four previously identified responders were also studied to further characterize the clinical drug response. Eighty-four participants with traumatic and nontraumatic disorders of consciousness of at least 4 mos' duration were studied. Four "definite responders" were identified, but no demographic or clinical features were predictive of the response. Indicators of a drug response included increased movement, social interaction, command following, attempts at communication, and functional object use; typically lasted 1-2 hrs; and sometimes ended with increased somnolence. Adverse events were more common on zolpidem than placebo, but most were rated as mild. Approximately 5% (4.8%) of the participants responded to zolpidem, but the responders could not be distinguished in advance from the nonresponders. Future research is needed to understand the mechanism of zolpidem in enhancing consciousness and its potential role in treatment and research.

Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study

Zolpidem has been reported as an "awakening drug" in some patients with disorders of consciousness (DOC). We here present the results of a prospective openlabel study in chronic DOC patients. Sixty patients (35±15 years; 18 females; mean time since insult ± SD: 4±5.5 years; 31 with traumatic etiology) with a diagnosis of vegetative state/unresponsive wakefulness syndrome (n=28) or minimally conscious state (n=32) were behaviorally assessed using the Coma Recovery Scale-Revised (CRS-R) before and one hour after administration of 10 mg of zolpidem. At the group level, the diagnosis did not change after intake of zolpidem (p=0.10) and CRS-R total scores decreased (p=0.01). Twelve patients (20%) showed improved behaviors and/or CRS-R total scores after zolpidem administration but in only one patient was the diagnosis after zolpidem intake found to show a significant improvement (functional object use), which suggested a change of diagnosis. However, in this patient, a double-blind placebo-controlled trial was performed in order to better specify the effects of zolpidem, but the patient, on this trial, failed to show any clinical improvements. The present open-label study therefore failed to show any clinically significant improvement (i.e., change of Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study diagnosis) in any of the 60 studied chronic DOC patients.

Effects of Object Use on Reaching and Postural Balance

To evaluate whether the functional use of certain task objects while standing influences reaching performance and postural balance in persons with left or right cerebral vascular accidents, and also in healthy individuals. Thirty-five stroke patients (20 patients with left and 15 patients with right cerebral vascular accidents) and 31 healthy controls (15 using the left and 16 the right arm) performed two experimental reaching tasks (task object present vs. absent) using the less affected arm while standing. For the object-present task, subjects held a glass and moved it forward as far as possible. For the object-absent task, subjects simply reached forward as far as possible. We measured reaching performance using kinematic analysis and assessed postural control using derivatives of the center of pressure, including forward displacement, mediolateral shift, and average velocity. Object presence did not significantly improve overall reaching performance in any group. However, for patients with left cerebral vascular accidents and controls (using either the left or the right arm), there were significant effects of object presence on the average velocity of the center of pressure. For patients with right cerebral vascular accidents, there were significant effects of task object on the forward distance and average velocity of the center of pressure. The positive findings regarding center-of-pressure derivatives suggest that a functional use of objects during a standing reaching task can decrease postural sway, as represented by the average velocity of the center of pressure, in individuals with and without stroke. Patients with right cerebral vascular accidents may benefit considerably more from functional object use during a standing reaching task, apparently because such tasks can facilitate greater forward displacement of the center of pressure.

Characterizing communicative development in children referred for Autism Spectrum Disorders using the MacArthur-Bates Communicative Development Inventory (CDI)

Characterizing early communicative development in children with Autism Spectrum Disorders (ASD) is valuable for understanding profiles of ability in this population. The current investigation was modeled on Charman, Drew, Baird & Baird (2003b). Analyses explored parent report of early vocabulary, non-verbal communication, functional object use and play skills on the MacArthur-Bates Communicative Development Inventory (CDI) in 93 children with ASD, 31 children with developmental delay (DD) and 29 typically developing children. Results were generally consistent with those of Charman and colleagues (2003b), suggesting that skills improve with increasing non-verbal mental age and chronological age but that most children with ASD are delayed in receptive and expressive vocabulary and non-verbal communication, functional object use and play skills. Vocabulary profiles in the ASD sample were similar to those in the comparison samples, as was the developmental pattern of gesture and vocabulary mastery. However, when compared to published norms, children with ASD may show less of a discrepancy between their receptive and expressive vocabulary.

Neural substrates of knowledge of hand postures for object grasping and functional object use: Evidence from fMRI

A number of lines of evidence suggest that computation of hand posture differs for object grasping as compared to functional object use. Hand shaping for grasping appears to rely strongly upon calculations of current object location and volume, whereas hand shaping for object use additionally requires access to stored knowledge about the skilled manipulation specific to a given object. In addition, the particular hand postures employed for functional object use may be either prehensile (clenching, pinching) or non-prehensile (e.g., palming, poking), in contrast to the prehensile postures that are obligatory for grasping. In this fMRI study, we assessed the hypothesis that a left-hemisphere-lateralized system including the inferior parietal lobe is specifically recruited for the computation and recognition of hand postures for functional object use. Fifteen subjects viewed pictures of manipulable objects and determined whether they would be grasped with a pinch or clench (Grasp condition), functionally used with a pinch or clench (Prehensile Use condition), or functionally used with a palm or poke hand posture (Non-prehensile Use condition). Despite the fact that the conditions were equated for behavioral difficulty, significantly greater activations were observed in the left inferior frontal gyrus (IFG), posterior superior temporal gyrus (STG), and inferior parietal lobule (IPL) in Non-prehensile Use trials as compared to Grasp trials. Comparison of Non-prehensile Use and Prehensile Use activations revealed significant differences only in the left IPL. These data confirm the importance of the left IPL in storing knowledge of hand postures for functional object use, and have implications for understanding the interaction of dorsal and ventral visual processing systems.