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      On the use of Different Methodologies in Cognitive Neuropsychology: Drink Deep and from Several Sources

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          Abstract

          Cognitive neuropsychology has championed the use of single-case research design. Recently, however, case series designs that employ multiple single cases have been increasingly utilized to address theoretical issues using data from neuropsychological populations. In this paper, we examine these methodologies, focusing on a number of points in particular. First we discuss the use of dissociations and associations, often thought of as a defining feature of cognitive neuropsychology, and argue that they are better viewed as part of a spectrum of methods that aim to explain and predict behaviour. We also raise issues regarding case series design in particular, arguing that selection of an appropriate sample, including controlling degree of homogeneity, is critical and constrains the theoretical claims that can be made on the basis of the data. We discuss the possible interpretation of “outliers” in a case series, suggesting that while they may reflect “noise” caused by variability in performance due to factors that are not of relevance to the theoretical claims, they may also reflect the presence of patterns that are critical to test, refine, and potentially falsify our theories. The role of case series in treatment research is also raised, in light of the fact that, despite their status as gold standard, randomized controlled trials cannot provide answers to many crucial theoretical and clinical questions. Finally, we stress the importance of converging evidence: We propose that it is conclusions informed by multiple sources of evidence that are likely to best inform theory and stand the test of time.

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          Most cited references61

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          Anterior temporal involvement in semantic word retrieval: voxel-based lesion-symptom mapping evidence from aphasia.

          Analysis of error types provides useful information about the stages and processes involved in normal and aphasic word production. In picture naming, semantic errors (horse for goat) generally result from something having gone awry in lexical access such that the right concept was mapped to the wrong word. This study used the new lesion analysis technique known as voxel-based lesion-symptom mapping to investigate the locus of lesions that give rise to semantic naming errors. Semantic errors were obtained from 64 individuals with post-stroke aphasia, who also underwent high-resolution structural brain scans. Whole brain voxel-based lesion-symptom mapping was carried out to determine where lesion status predicted semantic error rate. The strongest associations were found in the left anterior to mid middle temporal gyrus. This area also showed strong and significant effects in further analyses that statistically controlled for deficits in pre-lexical, conceptualization processes that might have contributed to semantic error production. This study is the first to demonstrate a specific and necessary role for the left anterior temporal lobe in mapping concepts to words in production. We hypothesize that this role consists in the conveyance of fine-grained semantic distinctions to the lexical system. Our results line up with evidence from semantic dementia, the convergence zone framework and meta-analyses of neuroimaging studies on word production. At the same time, they cast doubt on the classical linkage of semantic error production to lesions in and around Wernicke's area.
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            Phonology, reading acquisition, and dyslexia: Insights from connectionist models.

            The development of reading skill and bases of developmental dyslexia were explored using connectionist models. Four issues were examined: the acquisition of phonological knowledge prior to reading, how this knowledge facilitates learning to read, phonological and nonphonological bases of dyslexia, and effects of literacy on phonological representation. Compared with simple feedforward networks, representing phonological knowledge in an attractor network yielded improved learning and generalization. Phonological and surface forms of developmental dyslexia, which are usually attributed to impairments in distinct lexical and nonlexical processing "routes," were derived from different types of damage to the network. The results provide a computationally explicit account of many aspects of reading acquisition using connectionist principles.
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              Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale.

              Rating scales that assess methodological quality of clinical trials provide a means to critically appraise the literature. Scales are currently available to rate randomised and non-randomised controlled trials, but there are none that assess single-subject designs. The Single-Case Experimental Design (SCED) Scale was developed for this purpose and evaluated for reliability. Six clinical researchers who were trained and experienced in rating methodological quality of clinical trials developed the scale and participated in reliability studies. The SCED Scale is an 11-item rating scale for single-subject designs, of which 10 items are used to assess methodological quality and use of statistical analysis. The scale was developed and refined over a 3-year period. Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field, which were empirically tested against 85 published reports. Inter-rater reliability was assessed using a random sample of 20/312 single-subject reports archived in the Psychological Database of Brain Impairment Treatment Efficacy (PsycBITE). Inter-rater reliability for the total score was excellent, both for individual raters (overall ICC = 0.84; 95% confidence interval 0.73-0.92) and for consensus ratings between pairs of raters (overall ICC = 0.88; 95% confidence interval 0.78-0.95). Item reliability was fair to excellent for consensus ratings between pairs of raters (range k = 0.48 to 1.00). The results were replicated with two independent novice raters who were trained in the use of the scale (ICC = 0.88, 95% confidence interval 0.73-0.95). The SCED Scale thus provides a brief and valid evaluation of methodological quality of single-subject designs, with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings. Items from the scale can also be used as a checklist in the design, reporting and critical appraisal of single-subject designs, thereby assisting to improve standards of single-case methodology.
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                Author and article information

                Journal
                Cogn Neuropsychol
                Cogn Neuropsychol
                pcgn
                Cognitive Neuropsychology
                Taylor & Francis
                0264-3294
                1464-0627
                3 July 2012
                October 2011
                : 28
                : 7
                : 475-485
                Affiliations
                [1 ]ARC Centre of Research Excellence in Cognition and its Disorders (CCD), Macquarie University, Sydney, Australia
                [2 ]School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
                [3 ]Division of Psychology and Language Sciences, University College London, London, UK
                Author notes
                Correspondence should be addressed to Lyndsey Nickels, ARC Centre of Research Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, NSW 2019, Australia. (E-mail: Lyndsey.nickels@ 123456mq.edu.au ).

                During the preparation of this paper, Lyndsey Nickels was supported by a National Health and Medical Research Council Senior Research Fellowship, and Wendy Best was in receipt of a grant from the Economic and Social Research Council (RES-062-23-2721). We thank two anonymous reviewers and Professor Rapp as Editor for their helpful comments on an earlier version of this paper.

                Article
                10.1080/02643294.2012.672406
                3996528
                22746689
                81d4164c-62e7-4421-8061-6a11ed7d660b
                © 2011. The Author(s). Published by Taylor & Francis

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. http://www.psypress.com/cogneuropsychology

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                Categories
                Research Article

                Clinical Psychology & Psychiatry
                case series,single-case studies,cognitive neuropsychology,methodology

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