Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2016-12-07T14:41:15Z No. of bitstreams: 1 Dissertação - Julyanne G. Ferreira.pdf: 1304061 bytes, checksum: e0aae9f1e8040af47a7a917419933147 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2016-12-07T14:41:29Z (GMT) No. of bitstreams: 1 Dissertação - Julyanne G. Ferreira.pdf: 1304061 bytes, checksum: e0aae9f1e8040af47a7a917419933147 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2016-12-07T14:41:44Z (GMT) No. of bitstreams: 1 Dissertação - Julyanne G. Ferreira.pdf: 1304061 bytes, checksum: e0aae9f1e8040af47a7a917419933147 (MD5) / Made available in DSpace on 2016-12-07T14:41:44Z (GMT). No. of bitstreams: 1 Dissertação - Julyanne G. Ferreira.pdf: 1304061 bytes, checksum: e0aae9f1e8040af47a7a917419933147 (MD5) Previous issue date: 2016-06-15 / FAPEAM - Fundação de Amparo à Pesquisa do Estado do Amazonas / Up to the year 2025, there will be a decrease in the Brazilian population growth rate, with the consequent increase of elderly population. Memory impair is some of the most common complaints among elderly, and the use of tests are necessary to assess the memory performance and assess to verify the evolution of dementia. However, neuropsychological tasks adapted to Brazilian population are still recent and scarce. At the end of 20th century, adaptation and normatization studies to Brazilian context opened doors to the creation of other neuropsychological tests, increasing the interest of researchers and clinicians on the field, what motivated the creation of the “Test of Short Term Memory”, developed to assess short term memory and be used as a tool for differential diagnosis of dementia. The purpose of this work was to study the validity of the Test of Short Term Memory, in order to demonstrate its potential to inform about the short term storage process, in an elderly population. The research was conducted with 187 elderly of Manaus. Among them, 63,1% were female and 36,9% were male. Ages varied between 60 to 85 years-old, and education varied between 1 to 23 years of study. In the test activities, elderly with more than 8 years of education had a greater performance than those with none or low education. In relation to age, the bigger the age, the worse the performance of the elderly. Normative data were developed to the test and, due to the homogeneity of the group, they were classified by age and education level to an adequate measure of the results. The study showed low internal consistency between the items of the test and low correlation between activities. Therefore, using validity studies (criteria and construct validity), we recognize the need for new studies to verify the validity of this instrument. / Estudos têm revelado uma diminuição no ritmo de crescimento geral da população brasileira, com consequente aumento da população idosa. As dificuldades de memória estão entre as queixas mais comuns no envelhecimento, sendo necessários testes para avaliar o desempenho de memória em pacientes idosos e verificar a evolução para demências. No entanto, as tarefas adaptadas para avaliação neuropsicológica no Brasil são recentes e ainda escassas. No final do século XX, os estudos de adaptação e normas para o contexto brasileiro abriram as portas para que outros testes neuropsicológicos fossem criados, despertando o interesse de pesquisadores e clínicos da área, o que motivou a criação do “Teste de Memória de Curto Prazo”, desenvolvido para avaliar memória de curto prazo e servir como ferramenta para diagnóstico diferencial de demências. O objetivo desse trabalho foi estudar a validade de critério e construto do Teste de Memória de Curto Prazo (TMCP), a fim de demonstrar seu potencial informativo acerca do processo de armazenamento de curto prazo, em uma população de idosos. A pesquisa foi realizada com 187 idosos da cidade de Manaus. Desses, 63,1% do sexo feminino e 36,9% do sexo masculino. As idades variaram entre 60 e 85 anos, e a escolaridade entre 1 e 23 anos. Com relação aos resultados da pesquisa, observou-se que quanto menor a escolaridade e idade, pior o desempenho dos idosos. Foram desenvolvidos também padrões normativos do teste e, devido à heterogeneidade do grupo, dividiu-se em idade e escolaridade para uma adequada aferição de resultados. O estudo demonstrou fraca consistência interna entre os itens do TMCP e baixa correlação entre as atividades propostas. Então, a partir dos estudos de validade (critério e construto), percebeu-se a necessidade de outros estudos para comprovar a validade desse instrumento.

Made available in DSpace on 2016-03-15T19:40:49Z (GMT). No. of bitstreams: 1 Natalia Martins Dias.pdf: 1935013 bytes, checksum: d73cb90443ea926ba2dd01d20bafd766 (MD5) Previous issue date: 2009-12-11 / Fundo Mackenzie de Pesquisa / Executive functions (EF) are an abilities set, including selective attention, cognitive flexibility, inhibitory control, planning, monitoring and working memory, among others, whose function is to regulate and control goals oriented behaviors. There are evidences that these abilities follow distinct developmental paths, and some of them still are in full development until the initial adulthood. In this way, this study aimed to investigate the development tends of different abilities of the EF in children and adolescents, searching for validity evidences of neuropsychological assessment instruments of these abilities. The participants were 572 children and adolescents with ages between 6 and 14 years, students of 1st to 8th grades of two public schools of a city of the SP interior. The instruments utilized were Auditive Work Memory Test, Visual Work Memory Test, Cancel Attentional Test, Trail Making Test parts A and B, Semantic Generation Test, Computerized Stroop Test, the Tower of London and the FAS Verbal Fluency Test. The Cancel Attentional Test and Trail Making Test parts A and B were applied collectively; the others, individually. Variance analysis and Kruskal-Wallis analysis revealed age effect in the performances in all instruments. The data suggested that the abilities evaluated follow developmental courses lightly distinct, the most initiating a more abrupt development between the 9 and 10 years. Mann-Whitney analysis showed that the girls were better that the boys in the auditive working memory, alternated attention and verbal fluency measures. Diverse significant correlations were find between the performances, the most of them were of low to moderate, corroborating the literature that defends the notion of the EF unit and diversity. Exploratory Factorial Analysis returned a two factors solution and regression analysis enabled the verification that the executive abilities can contribute of differential ways to the complex task performance, like as the FAS Verbal Fluency Test and the Tower of London Test. In this way, the study provided his contributions to the knowledge about EF and its development, as well derived validity evidences to the diverse instruments and, it‟s a hope, can expand its contribution to the future availability of adequate instruments for the construct assessment. / Funções executivas (FE) designam um conjunto de habilidades, incluindo atenção seletiva, flexibilidade cognitiva, controle inibitório, planejamento, monitoramento e memória de trabalho, dentre outros, cuja função é regular e controlar comportamentos orientados a metas. Há evidências de que estas habilidades seguem distintas trajetórias desenvolvimentais, sendo que algumas ainda estão em pleno desenvolvimento até a idade adulta inicial. Destarte, este estudo tem por objetivo investigar tendências de desenvolvimento dos diferentes processos que integram as FE em crianças e adolescentes, buscando evidências de validade de instrumentos de avaliação neuropsicológica de tais habilidades. Participaram 572 crianças e adolescentes com idades entre 6 e 14 anos, estudantes de 1ª a 8ª série de duas escolas públicas de uma cidade do interior de SP. Foram utilizados os instrumentos: Teste de Memória de Trabalho Auditiva, Teste de Memória de Trabalho Visual, Teste de Atenção por Cancelamento, Teste de Trilhas partes A e B, Teste de Geração Semântica, Teste de Stroop Computadorizado, Torre de Londres e Teste de Fluência Verbal FAS. Os instrumentos Teste de Atenção por Cancelamento, Teste de Trilhas partes A e B foram aplicados coletivamente; os demais, individualmente. Análises de Variância e de Kruskal-Wallis revelaram efeito da idade sobre os desempenhos em todos os instrumentos. Verificou-se que as habilidades avaliadas seguem cursos desenvolvimentais levemente distintos, a maioria iniciando um desenvolvimento mais abrupto entre os 9 e 10 anos. Análise de Mann-Whitney evidenciou que as meninas foram melhores que os meninos nas medidas de memória de trabalho auditiva, atenção alternada e fluência verbal. Diversas correlações significativas foram evidenciadas entre os desempenhos, a maioria delas de baixas a moderadas, corroborando a literatura no que tange à noção de unidade e diversidade das FE. Análise Fatorial exploratória retornou uma solução de dois fatores e análises de regressão possibilitaram a constatação de que as habilidades executivas podem contribuir de modo diferencial ao desempenho em tarefas complexas, como o Teste de Fluência Verbal FAS e Teste da Torre de Londres. Deste modo, o estudo proveu contribuições ao conhecimento sobre FE e seu desenvolvimento, bem como derivou evidências de validade aos diversos instrumentos e, espera-se, possa expandir sua contribuição à futura disponibilização de instrumentos adequados à avaliação do construto.

O objetivo desta pesquisa foi estabelecer os parâmetros psicométricos dos Cubos de Kohs para crianças e adolescentes do município de Curitiba, e obter normas do instrumento para esta população, para avaliação do funcionamento executivo relacionado às áreas pré-frontais do cérebro. Assim, foi realizada a adaptação dos sistemas de pontuação e aplicação do teste e obtidos os parâmetros de validade, precisão e discriminação dos itens. A amostra foi composta por 543 participantes de 7 a 14 anos, sendo 49,7% do gênero masculino, matriculados em escolas municipais (21,2%), estaduais (39%) e particulares (39,8%) de Curitiba-PR. Os instrumentos foram os Cubos de Kohs, a cópia da Figura Complexa de Rey e o subteste Labirintos do WISC-III. Os resultados para o sistema de pontuação indicaram que o total de acertos na realização dos itens foi a variável que melhor representou o funcionamento executivo, mas o mesmo não ocorreu com os movimentos extras. Por isso, optou-se por dicotomizar os escores dos itens considerando a presença de acertos. A análise do tempo de execução dos itens mostrou a necessidade de aumentar o limite de tempo de execução dos itens. Foi o estabelecido o critério de suspensão do teste após quatro erros consecutivos. Para a discriminação dos itens, obtiveram-se índices D entre 11,1 e 90,7, bem como correlações ponto-bisseriais entre 0,30 e 0,75, indicando que são suficientemente discriminativos. A validade de constructo foi investigada pela análise fatorial (método de componentes principais, rotação promax). Os resultados indicaram uma estrutura unidimensional para os Cubos de Kohs. O fator encontrado apresentou autovalor de 7,42 e explicou 44% da variância total dos itens, com alfa de Cronbach de 0,92. As cargas fatoriais oscilaram de 0,35 a 0,78 (70% acima de 0,60), indicando que os itens são bons representantes comportamentais do constructo medido pelo instrumento. A validade de critério para a função executiva de planejamento foi investigada utilizando-se dois instrumentos. Assim, uma comparação entre participantes com magnitudes diferentes de planejamento (analisado pela cópia da Figura de Rey) indicou uma diferença significativa nos escores dos Cubos (t=3,9; gl=165; p< 0,001). Além disso, observouse uma correlação entre a pontuação nos Cubos e na Figura de Rey (r=0,50; p<0,001). De forma semelhante, foi encontrada correlação entre os Cubos de Kohs e os Labirintos do WISC-III (r=0,48; p=0,004). Os resultados mostraram validade concorrente satisfatória para o instrumento. O coeficiente de precisão do teste pelo método das metades (correlação de Pearson com correção de Spearman-Brown), foi r=0,88 (p<0,001). Não foram observadas diferenças entre os gêneros (t=1,22; p=0,22). No entanto, uma diferença significativa foi verificada entre crianças de escolas públicas municipais e as demais escolas (F=24,75; p<0,001), bem como entre destros e canhotos (t=2,03; p=0,04). Por fim, foram construídas tabelas normativas considerando as diferenças encontradas entre as idades (F=23,26; p<0,001). / The purpose of this research was to analyze the psychometric parameters of Kohs Block Test for children and adolescents from Curitiba, to establish norms for this population and to assess the executive function connected to the prefrontal areas of the brain. Thereby, an adaptation of the administration and scoring test systems were developed, and were obtained parameters of validity, reliability and discrimination of the items. The sample was composed by 543 participants ranging from 7 to 14 years old, being 49.7% male, enrolled in municipal (21.2%), state (39%) and private schools (39.8%) of Curitiba-Pr. The instruments were the Kohs Block Test, the copy of the Rey Complexe Figure and the Maze WISC-III subtest. The results for the scoring system pointed out a relationship between the total score of the test and the executive functions, which was not observed in relation to the extra movements. For this reason, was chosen the scores of the items considering the presence of correct responses were dichotomized. The analysis of time execution of the items indicated the need to increase their time limits. It was established that the best criteria for interruption of the test was after four consecutive errors. For the items discrimination, it was obtained D index between 11.1 and 90.7, and point bisserial correlations ranging between 0.30 and 0.75, indicating that items were sufficiently discriminative. The construct validity was investigated by factor analysis (main components method, promax rotation). The results indicated a unidimensional structure for the Kohs Cubes. The factor found presented eigenvalue of 7.42 and explained 44% of the total variance of the items, with Cronbach\'s Alpha of 0.92. The load factors ranged from 0.35 to 0.78 (70% over 0.60), indicating that the items are good behavioral representatives of the construct assessed by the test. The criterion validity for the executive function of the planning was investigated using two instruments. Thereby, a comparison among participants with different magnitudes of planning (analyzed by the copy of the Rey Figure) indicated a significant difference in the scores of the Cubes (t=3.9; gl=165; p<0.001). Moreover, it was observed a correlation between the punctuation in the Cubes and in the Rey Figure (r=0.50; p<0.001). Similarly, it was found a correlation between the Kohs Block Test and the Mazes WISC-III subtest (r=0.48; p=0.004). Both findings suggested adequate simultaneous validity coefficients to the instrument. The reliability coefficient obtained split half method (Pearson correlation with Spearman-Brown correction), was 0.88 (p<0.001). There were no differences between genres (t=1.22; p=0.22). However, a significant difference was verified between children from municipal public schools and other schools (F =24.75; p<0.001), as well as between right-handed and left-handed (t=2.03; p=0.04). In conclusion, normative tables were developed considering the differences found between the ages (F=23.26; p<0,001).

The present study is a cross-validation of the Validity-10 embedded symptom validity indicator from the Neurobehavioral Symptom Inventory (NSI) for the detection of questionable response validity during evaluation for mild traumatic brain injury (TBI). The sample and data derived from a three-site Veterans Affairs (VA) parent study to validate the TBI Clinical Reminder, a routine set of questions asked of all recently returned veterans at VA facilities to screen for history of TBI. In the parent study, veterans recently returned from Iraq and Afghanistan underwent an evaluation for TBI with a physician and completed an assessment battery including neuropsychological tests of cognitive performance and indicators of symptom and performance validity, psychiatric assessment measures, a structured interview for post-traumatic stress disorder (PTSD), and various behavioral health questionnaires. The present study estimated the test operating characteristics of Validity-10, using NSI results gathered during the physician evaluation to compute Validity-10 scores, and using results on several other measures of symptom and performance validity from the assessment battery as criteria for questionable response validity. Only individuals who had positive screen results for TBI on the TBI Clinical Reminder prior to full evaluation were included in the present sample. Sensitivity of Validity-10 to questionable validity was moderately high (.60 - .70) to excellent (.90 - 1.00) at high levels of specificity (> .80). Effects of different base rates of and different criteria for questionable validity on the utility of Validity-10 were explored as well. Chi-square analyses to determine the effect of PTSD symptoms on the utility of Validity-10 demonstrated overall classification accuracy in general, and false positive rate in particular, were relatively poorer when used with individuals who reported significant PTSD symptoms. Overall, these findings support the use of Validity-10 (at cut score Validity-10 ≥ 19) to identify those veterans being evaluation for mild TBI in the VA system who should be referred for comprehensive secondary evaluation by a clinical neuropsychologist using multiple forms of symptom and performance validity testing. Further studies of the effects of PTSD symptoms on the accuracy of Validity-10 for this purpose are recommended.

Dans sa conception contemporaine, l’hallucination est simplement définie comme une ‘perception sans objet à percevoir’. Elle reste cependant complexe à mettre en évidence et à appréhender en pratique clinique, notamment en population pédiatrique. L’anamnèse, au cours de laquelle le praticien devra éviter des écueils, tels que l’immaturité psychique et la potentielle existence d’un compagnon imaginaire, peut être complétée par des méthodes d’évaluation lui permettant une caractérisation plus spécificique du phénomène. Ce symptôme a fait l’objet d’un regain d’intérêt ces 30 dernières années dans le domaine scientifique. Il est maintenant admis que les hallucinations ne se retrouvent pas exclusivement dans un contexte étiologique schizophrénique, mais qu’elles peuvent également apparaître au cours du développement normal et être de résolution spontanée. Malgré cela, encore peu d’études à l’heure actuelle se sont spécifiquement intéressées à son caractère précoce, transdiagnostique et à sa thérapeutique chez l’enfant et l’adolescent. Néanmoins différentes pistes d’intervention sont à notre disposition pour nous aider à mieux appréhender ce symptôme, qu’il s’agisse de son évaluation ou de sa thérapeutique. Au cours de ce doctorat, nous nous sommes intéressés dans un premier temps aux aspects cognitifs de l’hallucination. Sur la base du modèle de défaut d’attribution de la source, postulant que les hallucinations seraient le résultat d’une tendance à attribuer plus souvent les évènements auto-générés à un sujet externe, nous avons normalisé une tâche évaluant cette capacité cognitive. Nous avons pu mettre en évidence d’une part, chez nos sujets sains recrutés pour l’étude de normalisation, un effet du vieillissement pathologique préférentiellement pour le reality monitoring (distinguant une source interne au sujet d’une source externe à lui) ; d’autre part, ces données confrontées à la pathologie, ont révélé des performances réellement déficitaires chez des patients souffrant de schizophrénie et présentant des hallucinations pharmaco-résistantes pluri-modales. Notre objectif est par la suite d’obtenir des données normatives pour une population pédiatrique. Dans un second temps, nous nous sommes intéressés à l’évaluation psychométrique des hallucinations précoces. Au vu du manque d’outils, nous avons associé l’aspect ludique des nouvelles technologies à une évaluation complète et rigoureuse du symptôme. Ainsi, nous avons développé une application pour tablette tactile combinant l’évaluation de la cognition, notamment de la théorie de l’esprit, et de la sévérité du symptôme. En effet, les capacités de théorie de l’esprit ont récemment été identifiées comme marqueurs pronostiques dans la résolution des hallucinations chez l’enfant. L’objectif premier de ce travail est donc de fournir un outil fiable d’évaluation de l’hallucination précoce, l’objectif sous-jacent de cet outil étant de permettre un suivi longitudinal de l’enfant et d’adapter au mieux sa thérapeutique. Enfin, nous nous sommes attelés à la mise en place d’une thérapeutique innovante chez l’enfant et l’adolescent, qui n’est autre que la stimulation magnétique transcrânienne répétée (rTMS). Cette technique de neuromodulation a pour avantage de cibler un symptôme et non une pathologie et peut donc s’appliquer à un certain nombre de sujets hallucinés. L’objectif de ce travail était d’étudier plus en avant l’hallucination précoce au moyen d’approches diverses et variées facilitant la mise en confiance de l’enfant et la caractérisation tant phénoménologique que cognitive du symptôme par le praticien. Les résultats réunis dans ce travail de doctorat mettent en évidence qu’il est possible d’appréhender le symptôme hallucinatoire précoce grâce à la cognition et aux nouvelles technologiques. Ces approches nous permettent d’améliorer notre prise en charge en nous donnant une meilleure compréhension du symptôme et des mécanismes associés. / In its contemporary conception, the hallucination is simply defined as a ‘perception without object to perceive’. It remains however complex to highlight it in clinical practice, in particular in pediatric population. The clinical interview, during which the clinician have to avoid stumbling blocks, such as psychic immaturity and potential existence of an imaginary companion, can be completed by methods allowing a more specific caracterisation of the phenomenon. This symptom has been a renewed interest in the last 30 years in scientific domain. It is now accepted that the hallucinations are not found exclusively in schizophrenic etiological context, but they can also occur during normal development and be spontaneous resolution. Despite this, few studies currently have a specific interest in its early and transdiagnostic character, and his treatment in children and adolescents.Nevertheless, differents strategies for actions are available to help us better understand this symptom, whether its evaluation or therapeutic. In this PhD work, we initially focused on cognitive aspects of hallucination. Based on the source monitoring framework, assuming that hallucinations are the result of a tendency to attribute more often self-generated events to an external subject, we standardized a task assessing this cognitive ability.We first highlight an age effect in our healthy subjects enrolled in the study of standardization, preferentially for the reality monitoring task (distinction between an external source and an internal source). We then compare these data with those obtained from patients suffering from schizophrenia, revealing loss performance for both tasks. Our goal is then to obtain normative data for a pediatric population.In a second step, we are interested in the psychometric assessment of early-onset hallucinations. Given the lack of tools, we have combined the playfulness of new technologies in a comprehensive and rigorous assessment of the symptom. We thus developed an application for touchpad associating the assessment of cognition, including the theory of mind, and symptom severity. Theory of mind developpement have recently been identified as prognostic marker in the resolution of hallucinations in children. The first objective of this work is to provide a reliable assessment or early-onset hallucinations, the underlying objective is to allow longitudinal assessment of this symptom in children and adolescents and to better adapt its therapeutic. Finally, we are interested in the development of an innovative therapy in children and adolescents, which is the repetitive trancranial magnetic stimulation (rTMS). This neuromodulation technique has the advantage to target a symptom, not a disease, and can therefore be applied to a number of hallucinated subjects.The objective of this work was to study early-onset hallucination through diverse approaches facilitating the trust of the child and both phenomenological and cognitive caracterisation of the symptom by the clinician.The results gathered in this PhD work demonstrate that it is possible to understand the early-onset hallucinatory symptoms through cognition and new technologies. These approaches allow us to adapt our daily practice, gives us a better understanding of the symptoms and associated cognitive mechanisms, thereby improving our therapeutic management .

The aim of this study was to determine executive function outcomes after an equi-therapy intervention in a group of Tourette syndrome children. Equi-therapy is a new form of therapeutic horse riding, which is related to the stimulation of the vestibular system through sensory integration in the brain. For this study a non-equivalent control group design was implemented. The study consisted of 8 Tourette syndrome children aged between 9 and 15, who were referred after a definite Tourette syndrome diagnosis from various neurologists and paediatricians. Both groups were evaluated on a battery of 6 neuropsychological tests measuring various aspects of executive function before and after receiving the therapeutic horse riding intervention. The tests used were the Wisconsin Card Sorting Test, the Stroop Colour Word Test, the Rey-Osterrieth Complex Figure Test, the Trail Making Test A and B, the Raven’s Standard Progressive Matrices and the Symbol Digit Modalities Test. Qualitative inputs were also included in the study. These consisted of behavioural checklists completed by the participants’ parents, the evaluation of the participants’ copy drawings as ’frontal’ or ’normal’ obtained from the Rey-Osterrieth Complex Figure test, and results of tests that were administered by an occupational therapist as part of the required evaluation for the therapeutic horse riding (equi-therapy) itself. Results of the neuropsychological tests indicated significant differences for the Wisconsin Card Sorting Test, Stroop Colour Word Test and the Symbol Digit Modalities Test, indicating improvements in selective attention, cognitive flexibility, visualspatial constructional ability, visuomotor integration, visual memory and organisational strategies. The qualitative results indicted improvements in emotional and behavioural aspects. Executive abilities are a very complex system and evaluation should always include robust and sensitive neuropsychological tests. It seems as if Tourette syndrome could be directly related to executive dysfunction, but not in a simple manner as aspects may vary due to other more complex factors that may contribute to these dysfunctions. However, for equi-therapy as an alternative form of therapy, the opportunity should not be lost to establish its efficacy because of the possible beneficial outcome. / Thesis (MA (Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.

No description available.

No description available.

No description available.