Thesis (D.C.P./Ph. D.)--University of Sydney, 2008. / Title from title screen (viewed February 4, 2009). Includes graphs, tables and questionnaries. Includes list of publications co-authored with others: leaves 21-22. Submitted in fulfilment of the requirements for the degree of Doctor of Clinical Psychology / Doctor of Philosophy to the Department of Psychology, Faculty of Science. Includes bibliographical references. Also available in print form.

nÃo hà / O trabalho avalia em duas fases as alteraÃÃes clÃnicas, alteraÃÃes do sono, a alteraÃÃo cognitiva e as alteraÃÃes de estruturas cerebrais atravÃs de RessonÃncia MagnÃtica (RM) e morfologia baseada em voxel (VBM) em pacientes com DoenÃa de Parkinson. Foram estudados 100 pacientes (71% masculino), com idade entre 40 e 80 anos (66,1+9,5), recrutados do AmbulatÃrio de DistÃrbios do Movimento do Hospital UniversitÃrio Walter CantÃdio. A amostra faz parte de uma coorte longitudinal (Sleep-For-PD study). Foram estudadas as alteraÃÃes do sono e seus fatores associados e preditivos. A escala de sono da DoenÃa de Parkinson (PDSS) que avalia alteraÃÃes de sono na DP, a escala Pittsburgh Sleep Quality Index (PSQI) que avalia a qualidade do sono, a escala Epworth Sleepiness Scale (ESS) que avalia o grau subjetivo de sonolÃncia e a escala Unified Parkinsonâs Disease Scale (UPDRS partes I, II, III e IV) que avalia a gravidade da doenÃa foram estudados. Os sintomas depressivos foram avaliados atravÃs das escalas Beck Depression Inventory (BDI-II) e Hospital Anxiety Depression (HAD). Os pacientes foram submetidos ao Mini Exame do Estado Mental (MEEM) que avaliou o grau de alteraÃÃo cognitiva e a escala de distÃrbio comportamental do sono REM (RBD). A dose de levodopa (DEL) foi avaliada. Pacientes com alteraÃÃes do sono (PDSS) apresentaram mais alucinaÃÃes diurnas, mais alteraÃÃo cognitiva, mais ansiedade, depressÃo e maior gravidade dos sintomas parkinsonianos (p<0,05). Pacientes com mà qualidade de sono (PSQI) tiveram mais sintomas depressivos. Os escores PDSS correlacionaram-se ainda com a funÃÃo cognitiva (MEEM), os sintomas depressivos (BDI e HAD), a qualidade do sono (PSQI), a gravidade da doenÃa e com a escala de RBD. Os escores PSQI correlacionaram-se com o MEEM, atividades de vida diÃria (UPDRS II) e sintomas de depressÃo/ansiedade (BDI e HAD). Gravidade de sintomas relacionados a atividades da vida diÃria (p=0,002), sintomas depressivos (p=0,01) e ansiedade (p=0,01) foram fatores independentes preditivos das alteraÃÃes do sono (PDSS). A DEL e o MEEM foram preditores da mà qualidade do sono (p=0,02). A escala RBD (p=0,002) e a UPDRS I (p=0,02) foram preditores do grau de sonolÃncia. ConcluÃmos que alteraÃÃes de sono, mà qualidade de sono e sonolÃncia diurna excessiva sÃo comuns na DP. As escalas PDSS, PSQI e ESS tÃm fatores associados e preditivos distintos. A escala PDSS apresenta maior abrangÃncia na avaliaÃÃo do sono na DP. Na segunda fase, foram avaliadas as estruturas cerebrais por RM, a presenÃa de alteraÃÃes cognitivas e fatores associados em 39 pacientes com DP e em 10 indivÃduos controles pareados por idade. As imagens de RM foram processadas de acordo com o protocolo para processamento de VBM. A variÃvel de desfecho usada foi o volume de substÃncia cinzenta. Nossos dados evidenciaram que pacientes com DP apresentaram maior comprometimento cognitivo e maior ansiedade. Pacientes com DP e alteraÃÃes cognitivas apresentaram maior gravidade da doenÃa. NÃo houve diferenÃa no volume de substÃncia cinzenta entre os pacientes com DP com e sem alteraÃÃes cognitivas. Estes achados provavelmente deveram-se a atrofia cerebral precoce nos pacientes cognitivamente intactos. Pacientes com DP, quando comparados aos controles, revelaram reduÃÃes de volume de substÃncia cinzenta na Ãnsula esquerda e cÃrtex prÃ-frontal esquerdo, demonstrando envolvimento assimÃtrico do cÃrebro na DP. / The present study evaluates clinical abnormalities, sleep disturbances, cognitive alterations and structural brain changes using Magnetic Resonance Imaging (MRI) with Voxel Based Morphometry (VBM) in patients with Parkinson`s Disease (PD). In the first phase of the study one hundred patients (71% male), aged between 40 and 80 years (66,1+9,5) were studied. Patients were recruited from a movement disorders clinics at Walter CantÃdio University Hospital. The study is part of a larger longitudinal cohort study (Sleep-For-PD study). Sleep abnormalities and their associated and predictive factors were scrutinized. Many clinical questionnaires were used, including the Parkinson`s Disease Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and the Unified Parkinsonâs Disease Rating Scale (UPDRS part I, II, III e IV). Depressive symptoms were evaluated with Beck Depression Inventory (IDB-II) and Hospital Anxiety Depression scale (HAD). The Minimental state examination (Folstein) (MMSE) evaluated the extent of cognitive dysfunction. REM sleep symptoms were evaluated by the REM Sleep Behavior Disorder (RBD) Scale. The levodopa equivalent dose was evaluated (DEL). Patients with sleep abnormalities (PDSS) had more diurnal visual hallucinations, cognitive dysfunction, anxiety, depression and worse parkinsonian symptoms (p<0.05). Patients with worse sleep quality (PSQI) had more depressive symptoms. PDSS scores were correlated with cognitive function (MEEM), depressive symptoms (BDI and HAD), sleep quality (PSQI), severity of PD and the RBD scale. PSQI scores were correlated with MMSE scores, activity of daily living symptoms (UPDRS II) and depression / anxiety (BDI e HAD). Activities of daily living (p=0.002), depressive symptoms (p=0.01) and anxiety (p=0.01) were independent predictors of sleep abnormalities (PDSS). The levodopa equivalent dose and MMSE scores were independent predictors of worse sleep quality (p=0.02). The RBD scale (p=0.002) and UPDRS I (p=0.02) were independent predictors of somnolence. We conclude that sleep disorders, disturbed sleep quality and excessive diurnal somnolence are common in PD. The PDSS, PSQI and ESS scales have distinct associated and predictive factors. PDSS scale is associated with a greater number of factors in PD patients. In the second phase of the study thirty-nine PD patients and ten control subjects were evaluated with regard to the presence of cognitive alterations. Structural brain abnormalities were also evaluated with MRI and VBM technique. The Gray matter volume was used as the ending variable. PD patients had more cognitive impairment and more anxiety. Patients with PD and cognitive alterations had worse disease severity. We found no difference in the volume of gray matter between the subgroups of PD patients with and without cognitive alterations, probably due to early brain atrophy in the patients without cognitive abnormalities. A significant reduction in gray matter volume in the left insula and left prefrontal cortex was observed when comparing PD patients in relation to controls. These findings indicate an asymmetrical brain involvement in PD, the left hemisphere being more affected.

Abstract Depression is a common consequence of stroke and it is known to be associated with deterioration of quality of life. However, only limited information is available on the relationships between depression and communicative and cognitive disorders. Moreover, the present knowledge of the determinants of the domains of quality of life is limited, and little is known of e.g. the changes in sexual behaviour of stroke patients and their spouses. This prospective study was carried out to evaluate the prevalence of post-stroke depression and aphasia and to study their interrelationships and neuropsychological and functional correlates. The particular aim of the study was to investigate the domain-specific quality of life, and to assess its clinical and sociodemographic correlates, and to study the impact of stroke on the sexual functions of stroke patients and their spouses. The study consisted of 156 first-ever stroke patients. Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months post-stroke according to DSM-III-R-criteria. One third of the patients were aphasic, 70% of them at 3 months and 62% at 12 months after stroke suffering from depression. Among the aphasic patients the prevalence of major depression increased from 11% to 33% during the 12 months follow-up. There was an association between post-stroke depression and cognitive impairment, the domains most likely to be defective being memory, non-verbal problem solving, and attention and psychomotor speed. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. The quality of life of the patients was low at 3 months after the stroke, and it did not improve during the follow-up of a year. The test domains most often impaired were Physical functioning, Physical role limitations, Vitality and General health. Depression, although mostly minor, and being married emerged as significant independent contributors to low score value of Vitality and Physical role limitations. All the analyzed aspects of sexuality were commonly decreased as a consequence of stroke both in the patients and their spouses. Nocturnal erections were impaired in 21 (55%) of the male patients. The present results demonstrate that more than half of the patients after stroke suffer from depression and the frequency of major depression seems to increase over time, especially among the aphasic patients. Both depression and aphasia increase the liability of cognitive deficits. Stroke affects various dimensions of quality of life extensively, and the most important determinants entailing low quality of life seem to be depression, and, interestingly, being married. As a part of quality of life, sexual function and satisfaction with sexual life are impaired both in stroke patients and spouses. These findings call for multidimensional evaluation of stroke patients and provide new challenges for stroke rehabilitation.

This study investigates the performance of two hemispherec-tomized subjects and ten normal subjects on a dichotic binaural frequency fusion (DBFF) test and on a competing dichotic message test. The DBFF test was designed to examine whether binaural integration of two complementary frequency segments of the same word, dichotically presented, necessitates the presence of two intact hemispheres. The competing dichotic message test was presented to provide a measure of the extent of strengthening of ipsilateral pathways in the hemispherectomized subjects. The DBFF test consisted of three fifty-word CNC lists which were processed through two band-pass filters and recorded on a two--channel magnetic tape. The test consisted of two binaural conditions. In the Dichotic A condition, the high band was delivered to the left ear and the low band to the right. The Dichotic B condition was the reverse of the first. For each condition 50 phonetically balanced (PB) words were presented and the subject was required to repeat the word in a 4 second interval between words. The competing dichotic message test consisted of 15 sets of three pairs of words, one of each pair being presented simultaneously to either ear, using stereophonic head-phones. The subject was required to repeat as many words from each set as possible. The Z scores, measuring the deviation in standard deviation units of the raw scores of the operated subjects from the mean scores of the normals indicated that the removal of a hemisphere did not significantly decrease the scores of two hemispherectomized subjects on a DBFF test. Removal of a hemisphere, however, decreased the scores of the hemispherectomees on the competing dichotic message test in one of the ears -- specifically the ear contralateral to the removed hemisphere. A comparative analysis of how the central auditory nervous system (CANS) of a hemispherectomized subject might process a complementary dichotic message (exemplified by the DBFF test), as opposed to a competing dichotic message, provides an interesting basis for a discussion on the nature of the "biological detector" of speech elements in the CANS. / Medicine, Faculty of / Audiology and Speech Sciences, School of / Graduate

M.Tech. / Voice disorders are defined as any deviation in quality, pitch or other basic vocal attributes, which consistently interfere with vocal ability (Kaufman and Johnson, 1991). Voice disorders are medical conditions or problems that affect a patient’s ability to use their voice efficiently. Voice disorders in any professional vocalist may have emotional, social, economical and financial implications. There is limited research on the effect of homoeopathic treatment of voice disorders. The aim of this study was to determine by means of case studies, the effect of homoeopathic simillimum treatment on professional vocalists suffering from voice disorders. The vocal and laryngeal symptoms were monitored by means of laryngoscopy and the modified Singing Voice Handicap Index. This was a descriptive study, using ten case studies. The study was conducted over a period of 12 weeks. Participants were recruited from the music-recording studio in Gauteng. All participants completed a selection questionnaire and had undergone laryngoscopy to rule out pathology. All participants underwent a complete Homoeopathic case taking, physical examination and completed the Singing Voice Handicap Index questionnaire. The researcher, to determine the similimum remedy for each participant’s case holistically used each participant’s unique physical, mental and emotional symptoms. All cases were repertorised, and the simillimum remedy found. All remedies were given in the 200cH potency based on the similarity of the remedy to the participant’s disease. Each participant attended six consultations, which took place at two-week intervals. At each follow up consultation, the participants completed the Singing Voice Handicap Index questionnaires and a case history was reviewed. Participants went for the final laryngoscopy screening during the last consultation. Treatment focused on the constitutional and emotional aspects of the individual. The physical manifestations of each participant were considered. This complies with the principles of classical homoeopathy, which states that the individual is a holistic entity, and should be treated as such. The voice disorder symptoms as measured by the Singing Voice Handicap Index improved in terms of severity and frequency for all ten participants. The results show a general improvement in the frequency, duration and intensity of discomfort and pain in the larynx associated with voice disorders. The results show an improvement in the emotional and general wellbeing of all participants over the study period.

Context: Human Immunodeficiency Virus (HIV) has both direct and indirect effect on the growing immature brain that could lead to impaired neurodevelopmental outcome in children. The extent of the motor dysfunctions becomes a matter of concern as the children grow up to school age. Objective: Our objective was to determine the extent and severity of motor dysfunctions in HIV infected school-age children at a referral centre in Namibia. Methodology: A cross sectional prospective study of 60 HIV-infected children aged 6-12 years attending the paediatric HIV clinic in Windhoek was conducted. Severity of motor dysfunction was assessed using the Gross Motor Functional Classification System (GMFCS) and the Manual Ability Classification System (MACS), and clinical data were collected from medical records and from a care-taker questionnaire. Result: Of the 60 children enrolled in the study, 28(46.67%) were males. The mean age of the children was 9.73 years (S.D = 2.024). The median age at the time of diagnosis was 12 months, with a range of 1 to 73 and a SD of 16.11months. The median age at the time of commencement of treatment was 20.5 months (males) and 35 months (female) with a P-value of 0.0039. Over five percent (5.1%) of HIV-infected school age children had motor dysfunction scored at Level II of the GMFCS while 7% had a score of Level II on the MACS. A positive correlation existed between time of start of intervention with antiretroviral therapy (ART) and motor function outcomes (p<0.0001), the serum viral RNA load and the presence of seizures in the children (correlation coefficient = 0.31; P = 0.00327); serum viral load and developmental delays among the children (correlation coefficient= 0.4; p-value = 0.00159). The CD4 cell count and motor dysfunctions were correlated (correlation coefficient: 0.37; p-value <0.0001).The CD4 cell count at diagnosis had a significant inverse correlation to the outcome of behavioural problems in the children as well (coefficient = - 0.22; P-value = 0.004912). Conclusion: A significant proportion of school-age HIV-infected children have neurodevelopmental challenges and gross motor dysfunction in particular. A study with standardized tools to ascertain the extent of impairment in the other domains of development is needed for a more comprehensive understanding of the effects of HIV infection on school-age children. / GR2018

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Previous data suggest the metrical properties of a word may influence the time course of phonological encoding, particularly in adults who stutter.  The purpose of the present study is to examine phonological and metrical encoding skills in fluent and non-fluent adults, in particular the medial stress-bearing vowel.  Investigators used a silent phoneme monitoring paradigm to assess reaction times for all phonemes within nonword CVCCVC stimuli.  This paradigm required participants to manually identify target phonemes within a nonword to further isolate the level of phonological encoding from other processes.  Eight participants were exposed to stimuli with initial-stress, and eight participants were exposed to stimuli with non-initial stress. Both groups demonstrated increased monitoring latencies for the initial vowel, regardless of initial or non-initial stress.  However, results did not yield any significant between-group latencies or false negative errors.  Participants from both groups demonstrated increased post-trial error rates compared with those from previous studies with similar methodology, suggesting the task of auditory identification of consonants and vowels in isolation may have been more challenging for both talker groups than identification of consonants alone. Together, these preliminary data suggest that AWS and AWNS demonstrate similar efficiency when encoding the medial, stress-bearing vowel.