NEURO-ONCOLOGY • JUNE 2018 reported in 25 patients, 7 of them also showed low level of psychosoci... more NEURO-ONCOLOGY • JUNE 2018 reported in 25 patients, 7 of them also showed low level of psychosocial and school QoL. The psychological assessment showed clinical levels of emotional distress in 10 children due to increase in anxiety, depression and social problems. CONCLUSIONS: Our preliminary data regarding late effects in childhood BT survivors show that fatigue affects 47% of them. This symptom, not always can be predicted by NES status. QoL was overall good although it worsens with the increase of NES. Further studies will be performed in order to better comprehend the relationship among risk factors and psychosocial outcome.
Journal de Réadaptation Médicale : Pratique et Formation en Médecine Physique et de Réadaptation, Sep 1, 2014
Titre Métacognition : intervention thérapeutique autour de la conscience des troubles chez des pa... more Titre Métacognition : intervention thérapeutique autour de la conscience des troubles chez des patients souffrant de traumatisme crânio-cérébral grave Type de publication Article de revue
The challenge of apraxia: Toward an operational definition?
Cortex, Aug 1, 2021
The diagnosis of limb apraxia relies mainly on exclusion criteria (e.g., elementary motor or sens... more The diagnosis of limb apraxia relies mainly on exclusion criteria (e.g., elementary motor or sensory deficits, aphasia). Due to the diversity of apraxia definitions and assessment methods, patients may or may not show apraxia depending on the chosen assessment method or theory, making the definition of apraxia somewhat arbitrary. As a result, "apraxia" may be diagnosed in patients with different cognitive impairments. Based on a quantitative and critical review of the literature, it is argued that this situation has its roots in the evolution from a task-based approach (i.e., the use of gold standard tests to detect apraxia) toward a process-based approach, namely, the deconstruction of the conceptual or production systems of action into multiple cognitive processes: language, executive functions, working memory, semantic memory, body schema, body image, visual-spatial skills, social cognition, visual-kinesthetic engrams, manipulation knowledge, technical reasoning, structural inference, and categorical apprehension. The coexistence of both approaches in the current literature is a major challenge that stands in the way of a scientific definition of apraxia. As a step toward a solution, we suggest to focus on symptoms, and on two complementary definition criteria (in addition with traditional exclusion criteria): Specificity (i.e., is apraxia explained by the alteration of cognitive processes specifically dedicated to gesture production?), and consistency (i.e., is the gesture production impairment consistent across tasks?). Two categories of limb apraxia are proposed: symptomatic apraxia (i.e., gesture production deficits that are secondary to more general cognitive impairments) and idiopathic apraxia (i.e., gesture production deficits that can be observed in isolation). It turns out that the only apraxia subtype that fulfills exclusion, specificity, and consistency criteria is limb-kinetic apraxia. A century after Liepmann's demonstration of the autonomy of apraxia toward language, the autonomy of this syndrome toward the rest of cognition remains an open question, while it poses new challenges to apraxia studies.
Assessing the construct validity of a theory of mind battery adapted to Tunisian school-aged chil... more Assessing the construct validity of a theory of mind battery adapted to Tunisian school-aged children.
Associations between Adult Primary Brain Tumor Survivors’ Behavioral Executive Functions, Health Related Quality of Life and their Caregivers’ Health Related Quality : A cross-sectional study
Psychology Health & Medicine, Mar 15, 2023
Sensory Integration Deficits in Neurodegenerative Diseases: Implications for Apraxia
Archives of Clinical Neuropsychology, Mar 27, 2023
Objective Apraxia is the inability to perform voluntary, skilled movements following brain lesion... more Objective Apraxia is the inability to perform voluntary, skilled movements following brain lesions, in the absence of sensory integration deficits. Yet, patients with neurodegenerative diseases (ND) may have sensory integration deficits, so we tested the associations and dissociations between apraxia and sensory integration. Methods A total of 44 patients with ND and 20 healthy controls underwent extensive testing of sensory integration (i.e., localization of tactile, visual, and proprioceptive stimuli; agraphesthesia; astereognosis) and apraxia (i.e., finger dexterity, imitation, tool use). Results The results showed (i) that patients with Alzheimer’s disease, corticobasal syndrome, or posterior cortical atrophy were impaired on both dimensions; (ii) An association between both dimensions; (iii) that when sensory integration was controlled for, the frequency of apraxia decreased dramatically in some clinical subgroups. Conclusion In a non-negligible portion of patients, the hypothesis of a disruption of sensory integration can be more parsimonious than the hypothesis of apraxia in case of impaired skilled gestures. Clinicians and researchers are advised to integrate sensory integration measures along with their evaluation of apraxia.
Meaningless imitation in neurodegenerative diseases: Effects of body part, bimanual imitation, asymmetry, and body midline crossing
We report the case of M.B. who demonstrated severe optic ataxia with the right hand following str... more We report the case of M.B. who demonstrated severe optic ataxia with the right hand following stroke in the left hemisphere. The clinical picture may shed light on both the pathological characteristics of reaching and grasping actions, and potential rehabilitation strategies for optic ataxia. First, M.B. demonstrated a dissociation between severely impaired reaching and relatively spared grasping and tool use skills and knowledge, which confirms that grasping may be more intermingled with non-motoric cognitive mechanisms than reaching. Besides, M.B.'s reaching performance was sensitive to movement repetition. We observed a substitution effect: Reaching time decreased if M.B. repeatedly reached toward the same object but increased when object identity changed. This may imply that not only object localization but also object
Imitation and matching of meaningless gestures: distinct involvement from motor and visual imagery
HAL (Le Centre pour la Communication Scientifique Directe), 2017
AbstractThe aim of the present study was to understand the underlying cognitive processes of imit... more AbstractThe aim of the present study was to understand the underlying cognitive processes of imitation and matching of meaningless gestures. Neuropsychological evidence obtained in brain damaged patients, has shown that distinct cognitive processes supported imitation and matching of meaningless gestures. Left-brain damaged (LBD) patients failed to imitate while right-brain damaged (RBD) patients failed to match meaningless gestures. Moreover, other studies with brain damaged patients showed that LBD patients were impaired in motor imagery while RBD patients were impaired in visual imagery. Thus, we hypothesize that imitation of meaningless gestures might rely on motor imagery, whereas matching of meaningless gestures might be based on visual imagery. In a first experiment, using a correlational design, we demonstrated that posture imitation relies on motor imagery but not on visual imagery (Experiment 1a) and that posture matching relies on visual imagery but not on motor imagery (Experiment 1b). In a second experiment, by manipulating directly the body posture of the participants, we demonstrated that such manipulation evokes a difference only in imitation task but not in matching task. In conclusion, the present study provides direct evidence that the way we imitate or we have to compare postures depends on motor imagery or visual imagery, respectively. Our results are discussed in the light of recent findings about underlying mechanisms of meaningful and meaningless gestures.
HAL (Le Centre pour la Communication Scientifique Directe), 2017
While several cognitive domains have been widely investigated in the field of aging, the age-rela... more While several cognitive domains have been widely investigated in the field of aging, the age-related effects on tool use are still an open issue and hardly any studies on tool use and aging is available. A significant body of literature has indicated that tool use skills might be supported by at least two different types of knowledge, namely, mechanical knowledge and semantic knowledge. However, neither the contribution of these kinds of knowledge to familiar tool use, nor the effects of aging on mechanical and semantic knowledge have been explored in normal aging. The aim of the present study was to fill this gap. To do so, 98 healthy elderly adults were presented with three tasks: a classical, familiar tool use task, a novel tool use task assessing mechanical knowledge, and a picture matching task assessing semantic knowledge. The results showed that aging has a negative impact on tool use tasks and on knowledge supporting tool use skills. We also found that aging did not impact mechanical and semantic knowledge in the same way, confirming the distinct nature of those forms of knowledge. Finally, our results stressed that mechanical and semantic knowledge are both involved in the ability to use familiar tools.
Utilisation d'objets chez l'enfant TDC : Altération spécifique du système de production gestuelle ?
HAL (Le Centre pour la Communication Scientifique Directe), 2017
Peu d’etudes s’interessant au Trouble Developpemental de la Coordination (TDC) chez l’enfant exam... more Peu d’etudes s’interessant au Trouble Developpemental de la Coordination (TDC) chez l’enfant examinent l’impact de ce trouble d’apprentissage sur les activites de vie quotidienne [1] et l’utilisation reelle d’objets, alors meme que les plaintes decrites par l’entourage des enfants se cristallisent a ce niveau (e.g., utilisation des couverts, habillage, graphisme...). Cette etude a pour objectif d’evaluer les difficultes d’utilisation effective d’objets chez les enfants TDC et d’apprehender les processus cognitivo moteurs impliques : l’anticipation motrice, la dexterite manuelle, ou encore le raisonnement technique et les connaissances semantiques [2].Methode : Vingt-trois enfants diagnostiques TDC d’apres les criteres du DSM-5 [3] ont ete apparies avec 44 enfants ne presentant pas de trouble d’apprentissage, au niveau de l’âge (7-13 ans), du genre, du niveau socioculturel parental et de la lateralite. Le protocole experimental comprenait des epreuves de selection et d’utilisation d’objets familiers (utilisation reelle), de resolution de problemes mecaniques (raisonnement technique), d’appariement d’images d’objets selon leur fonction (connaissances semantiques), de saisie et de transport de bâton (anticipation motrice) et d’insertion de petites tiges dans une planche (dexterite manuelle). Resultats : Des difficultes d’utilisation effective d’objets sont relevees chez le groupe TDC (p
Journal of Clinical and Experimental Neuropsychology
Introduction. Few studies have considered health-related quality of life (HRQOL) as a primary out... more Introduction. Few studies have considered health-related quality of life (HRQOL) as a primary outcome measure in adult survivors of primary brain tumor (PBT), and fewer still have studied the cognitive factors that may influence it. Research suggests that executive functions (EFs) are associated with HRQOL, but there is scant evidence to support this. The present study was conducted to (1) extend prior findings about HRQOL limitations in a sample of stable, longterm adult survivors of PBT, (2) investigate the associations between objective/reported EFs and HRQOL, and (3) identify the EFs that contribute most to HRQOL. Method. We recruited 40 survivors of PBT (> 2 years post-treatment) and 40 matched healthy controls. Participants completed an objective EF assessment (inhibition, working memory, shifting, and rule detection) and two self-report questionnaires probing EFs (Behavior Rating Inventory of Executive Function-Adult) and HRQOL (Medical Outcomes Study Short-Form 36). Participants' relatives completed observer-rated versions of these questionnaires. Results. Patients' objective EF performances were relatively intact. However, patients and caregivers reported significantly more problems than healthy controls and their relatives, for both EFs and HRQOL. There were only negligible links between objective EFs and HRQOL, whereas numerous associations were found between reported EFs and HRQOL components. ANCOVA models revealed that specific reported EF processes contributed to both the physical and mental components of HRQOL, regardless of group. Conclusions. From a clinical point of view, this study demonstrates that even several years after end of treatment, adult PBT survivors experience substantial problems across different HRQOL domains. HRQOL assessment should therefore be part of the long-term follow-up of PBT survivors, and clinicians should consider EF limitations when designing appropriate survivorship care plans. These findings indicate that cognitive interventions targeting EFs could improve HRQOL.
Dans cet article, nous proposons d'analyser la perte d'autonomie caractérisée par les phénomènes ... more Dans cet article, nous proposons d'analyser la perte d'autonomie caractérisée par les phénomènes de dépendance à l'environnement observés chez certains patients neurologiques présentant des lésions des lobes frontaux. Des propositions théoriques issues de la neuropsychologie cognitive et de la théorie de la médiation sont développées et confrontées. La démarche offre l'occasion, au plan théorique, de questionner la détérioration possible du système de la personne suite à des lésions cérébrales et, au plan méthodologique, d'interroger notre manière d'examiner ces patients en confrontant les modèles théoriques aux observations cliniques.
Je commence par remercier toutes les personnes qui ont contribué au succès de ce travail et qui m... more Je commence par remercier toutes les personnes qui ont contribué au succès de ce travail et qui m'ont aidé lors de la rédaction de cette thèse. Je voudrais, dans un premier temps, remercier mon Directeur de thèse, M. Arnaud Roy, qui, au cours de ces dernières années, malgré la distance géographique qui nous séparait et son emploi de temps très chargé, a été disponible à tout moment pour accompagner ma réfléxion et calmer mes angoisses. Il a également montré une grande curiosité de mon contexte culturel et à travers ses questions, m'a éclairé sur différents aspects de mon pays. Je remercie également M. Le Gall, qui, depuis mon premier entretien en 2013, m'a donné une chance en acceptant ma candidature en Master 2. Il m'a accompagné durant mon déménagement en France et m'a aidé à intégrer la culture et travailler sur mes lacunes. Tout au long de ce travail de thèse, il a été disponible avec des conseils judicieux qui ont contribué à alimenter mes réflexions. Merci à Amanda et Marie. Nous avons partagé toutes les étapes de ce travail et vous avez été à mon écoute tout en partagant vos expertises respectives. Malgré la distance qui nous separait, vous avez été des amies et des confidentes. Merci à Mme Ghannage et aux étudiants de l'USJ pour l'intérêt porté à cette étude. Merci aux familles et aux enfants qui ont participé à ce travail. Pia, thank you for your mentoring, your support, your faith in my knowledge and expertise, your valuable suggestions expecting nothing in return, and your neverending friendship. Hussein, thank you for your kindness, your help with all those tricky Arabic words, and your availability whenever needed.
Daily life activities in patients with Alzheimer’s disease or semantic dementia: Multitasking assessment
Neuropsychologia, 2021
The aim of the present study was to compare patients with mild to moderate Alzheimer's diseas... more The aim of the present study was to compare patients with mild to moderate Alzheimer's disease (AD) or semantic dementia (SD) on their cognitive processes and the severity of their daily life activity impairments. Three types of tasks were administered to patients (SD = 15; AD = 31) and 30 healthy controls (HC): 1) informant-based scales and questionnaires, 2) a neuropsychological assessment exploring executive functions, episodic and semantic memory, and 3) a new original test featuring multi-step naturalistic actions and multitasking: the Sequential Daily Life Multitasking (SDLM). We predicted that patients with AD would mainly exhibit task perplexity, associated with episodic and executive deficits on the SDLM, while the behavior of patients with SD would mostly be characterized by object perplexity, associated with semantic memory deficits. Results showed that patients with AD or SD were impaired across all neuropsychological tests, particularly episodic memory in AD and semantic memory in SD. General performance on the SDLM also appeared dramatically impaired in both patient groups, and correlated with results of questionnaires about instrumental activities and memory impairments. However, specific qualitative measurements on the SDLM did not allow us to pinpoint different patterns of errors and behavior in patients with AD versus SD. We suggest that the inability of patients in both groups to perform the SDLM may derive from a constellation of disorders or else from more subtle impairment of cognitive and conative processes that requires further exploration.
Executive dysfunctions are central symptoms in different neurological, developmental, and context... more Executive dysfunctions are central symptoms in different neurological, developmental, and context-related conditions. The assessment of these functions is then essential in neuropsychological pediatric clinical practice. Given the need for reliable and valid evaluation batteries for clinical practice in Brazil, this study aimed to present the pieces of evidences of reliability of the Child Executive Functions Battery (CEF-B). A total of 230 Brazilian children with typical development aged between 7 and 12 years participated in the study. Internal consistency was determined by the split-half method, Cronbach’s α, and Ω. In addition, measurements of test-retest reliability and intraclass coefficient were also performed. Retest indicators were mostly weak and moderate (between .43 and .75). Overvall, coefficients show a satisfactory internal consistency reliability for planning and inhibition measures (between .72 and .92). Considering the measures of WM, results were also satisfactory...
The development of executive functions (EF) is recognizably correlated to culture, contextual and... more The development of executive functions (EF) is recognizably correlated to culture, contextual and social factors. However, studies considering all the basic EF are still scarce in Brazil, most notably in the Northeast region, which is known for its social inequality and economic gap. This study aimed to analyze the developmental trajectories and structure of four EF, namely inhibition, flexibility, working memory and planning. In addition, the potential effects of socioeconomic status (SES) and gender were examined. The sample included 230 Brazilian children between 7-12 years old, homogeneously distributed by age, gender and type of school. The EF were assessed through the Brazilian version of the Child Executive Functions Battery (CEF-B). A global effect of age was found for most of the EF measures evaluated. Gender effect was mostly non-significant, except for 4 of the 12 tasks. There was a significant SES effect on 8 tasks, all in favor of private school children. Exploratory fa...
Uploads
Papers by Didier Le Gall