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Language emphasis should be placed on establishing joint attention, encouraging babbling, imitation, and turn-taking, stimulating independent vocalizations, increasing variety in phonetic repertoire, stimulating babbling and use of jargon, developing use of communicative gestures, developing receptive and expressive vocabulary, developing functional play with objects, fostering imitative and independent verbalizations, and developing response to cued directions. Oral-motor interventions should include direct oral-motor stimulation exercises to normalize sensitivity to tactile stimulation and to facilitate tooth brushing and oral swabbing. Patient should receive hearing screening and tympanogram to determine her present level of auditory function. 6 12 02 Splint Medical Plaza, Las Vegas, AR., Consultation referred by Dr. M.S. Instance to Dr. Adam C. Gold. Procedure: Two-view chest. Impression: Bilateral consolidation. Infiltrate seen anteriorly over heart. Possible left lower lobe pneumonia. A bubble of gas seen above diaphragm may represent a hiatal hernia. 7 02 Splint Medical Plaza, Forth Smith, AR., Consultation referred by Dr. M.S. Instance to Dr. David G. Albers. Procedure: AP and lateral radiographs of right lower extremity. Impression: Fracture of distal femur. This involves distal femoral metaphyseal region and its junction with femoral shaft. There is impaction at fracture site. No other fractures noted. 07 19 02 The Gregory Kistler Treatment Center for Children, Inc., Forth Smith, AR., Physical Therapy Re-Evaluation performed by Rose C. Stevens, P.T. Tests administered were Gross Motor Function Measure GMFM ; , the Pediatric Evaluation of Disability Inventory PEDI ; and clinical observations. Patient's abilities prior to her fracture were taken into consideration in regards to these tests. Patient scored as follows: GMFM ; - a ; lying and rolling 82% Dimension percent score, b ; sitting 57%, c ; crawling and kneeling 12%, d ; standing 0%, e ; walking, running, and jumping 0%. Total 30%, Goal Total Score: 17%. PEDI ; : Mobility Functional Skills Normative Std. Score: below 10, Mobility Caregiver Assistance Normative Std. Score: below 10. Normative standard scores below 10 indicate significant motor delays. Inspection Posture: Patient has lateral C curve convex ; to right of thoracic spine. Patient sits with posterior pelvic tilt, decreased spinal curves, and forward head. Patient can stand with forearms resting on stable object and knees hyperextended for three minutes. She cruises with her trunk leaning heaving against a support surface with maximal assistance. Muscle Tone: Patient presents with fluctuating muscle tone and underlying low muscle tone. Range of Motion Strength: Overall passive range of motion is within normal limits. Active range of motion is limited secondary to.
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Nificantly between derivations ipsilateral and contralateral to the lesion ipsilateral 0.150.03 V2 0.25 Hz, contralateral 0.170.03 V2 0.25 Hz ; . Peak heights in the acute phase 10 days post stroke ; did not differ significantly from peak heights in chronic phase 60 days post stroke ; recordings acute 0.160.03 V2 0.25 Hz, chronic 0.130.03 V2 0.25 Hz; F 1, 123 ; 1.276, p 0.261 ; . However, visual inspection of the power spectra suggested that some individual subjects showed progressive recovery of spindles over time. Conclusions: Previous studies of neurologic patients suggested that sleep spindle activity is depressed primarily in the pathologically affected hemisphere. In contrast, we did not observe significant differences between spindle peak heights measured from derivations ipsilateral and contralateral to the lesion. Compared to HCs, patients with unilateral hemispheric lesions exhibited a significant decrease in mean spindle peak height across all derivations. The results imply that each cerebral hemisphere is critically involved in generating spindle activity in both hemispheres. Research supported by the Swiss National Science Foundation, grant 32-49853.96 659.O Sleep EEG in De Novo Patients with Parkinson's Disease: Effects of Dopamine on the Spectral Profiles Friess E, Brunner H, Wetter T C, Yassouridis A, Hoegl B, Trenkwalder C Max Planck Institute of Psychiatry, 80804 Munich, Germany Introduction: The typical sleep abnormalities of patients with Parkinson's disease include a sleep fragmentation, loss of deep sleep, and in particular rapid eye movement REM ; sleep disorders. However, most of the previous studies have been conducted in patients receiving a dopaminergic treatment. Methods: Therefore we investigated the sleep EEG in a carefully selected group of de novo patients with Parkinson's disease n 14, 63.711.8 yr ; and compared it to a control group matched for age n 10, 65.46.9 yr ; . Some of the patients were reinvestigated under a dopaminergic medication n 7, 67.012.8 yr ; . Polysomnographic sleep recordings were visually analyzed according to standard criteria. In addition, we submitted the digitized EEG data to a serial spectral analysis EEG power spectrum from 0.39 - 19.1 Hz ; frequency resolution 0.39 Hz ; . The EEG power spectra were cumulated across the delta 0.8-4.3 Hz ; , theta 4.37.8 Hz ; , alpha 7.8-11.7 Hz ; , sigma 11.7-15.2 Hz ; and beta 15.2-19.1 Hz ; range. Statistical evaluations were made by MANOVAs for between subjects and repeated measures design. Results: The quantitative analysis of the sleep EEG in de novo patients with Parkinson's disease showed an enhanced sigma EEG activity during non-REM sleep. The REM sleep EEG was characterized by a significant increase in the higher theta lower alpha frequency range including a lack of the physiologic decline of these power densities throughout the night. The treatment effects of a dopaminergic medication appeared to be restricted to the non-REM sleep specific changes. The conventional parameters describing the sleep architecture and sleep continuity revealed no significant differences between the groups. Conclusions: In summary, the results of our study point to moderate, but distinct changes in the spectral profiles of the sleep EEG in patients with an early stage of Parkinson's disease that responded only in part to a dopaminergic treatment.
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