外周性眩晕者计算机动态姿势图的特点

目的通过对外周性眩晕患者进行计算机动态姿势图检查,定量分析前庭功能障碍者姿势控制的能力。方法对91例经双耳变温试验证实为外周性眩晕的患者按照试验结果分为单侧前庭功能障碍组(单侧组)和双侧前庭功能障碍组(双侧组)。两组均进行计算机动态姿势图检查,包括感觉整合试验(sen-sory organization test,SOT)、运动控制试验(motor control test,MCT),并与正常参考值通过t检验进行比较。结果单侧组的SOT结果与正常参考值的差异无统计学意义(P0.05),双侧组SOT平衡综合分低于正常参考值,在平台及视觉刺激变化下更明显(P0.05)。两组MCT的潜伏期与正常参考值的差异无统计学意义(P0.05)。结论外周性前庭功能障碍者在眩晕发作的非急性期,均能维持静态平衡,单侧前庭功能障碍者能维持动态姿势平衡,但双侧前庭功能障碍者的动态姿势平衡功能较正常人降低。     

下肢损伤者姿势诱发反射下的动态姿势图分析

目的利用动态姿势图分析下肢损伤者的平衡功能。方法利用动态姿势图测试仪对62例正常人和258例下肢骨关节损伤者进行姿势诱发反射检测,包括感觉整合测试、适应性测试,将两组实验对象的检测结果进行t检验。结果与正常人相比,下肢损伤者动态姿势图中的感觉整合测试平衡分(SOT3~SOT6)及动态本体感觉比例分差异有统计学意义(P0.05),适应性测试无明显下降趋势。结论下肢损伤可导致平衡功能降低。     

下肢损伤者姿势诱发反射下的动态姿势图分析CSCD

目的利用动态姿势图分析下肢损伤者的平衡功能。方法利用动态姿势图测试仪对62例正常人和258例下肢骨关节损伤者进行姿势诱发反射检测,包括感觉整合测试、适应性测试,将两组实验对象的检测结果进行t检验。结果与正常人相比,下肢损伤者动态姿势图中的感觉整合测试平衡分（SOT3～SOT6）及动态本体感觉比例分差异有统计学意义（P〈0.05）,适应性测试无明显下降趋势。结论下肢损伤可导致平衡功能降低。     

颅脑损伤后动态姿势平衡评估

目的探讨颅脑损伤后平衡功能障碍的特点和原因。方法对95例交通事故致颅脑损伤的患者进行动态姿势图检查,将其测试结果与正常值比较;并按照原发颅脑损伤程度和是否伴有听力障碍对患者进行分组,将测试结果进行组间比较。结果颅脑损伤患者平衡总分较正常值低,对视觉和前庭觉等信息的利用能力下降,以前庭觉下降明显;原发颅脑损伤的严重程度以及是否伴听力下降对姿势稳定性无明显影响。结论不伴有肢体功能障碍的颅脑损伤患者的姿势稳定性差,对环境的反应与适应能力下降,可能与外周前庭器官及平衡中枢的损伤有关。     

等速肌力检测在辨别伪肢体瘫中的应用

目的：探讨等速肌力检测在法医学鉴定中辨别伪肢体瘫的应用价值,为建立规范、统一的法医学肌力评价方法提供科学依据。方法选取骨折或神经损伤者57例（损伤组）和伪装者128例（伪装组）,应用等速肌力测试系统对损伤组两侧膝关节与伪装组膝关节进行检测,对双侧膝关节屈、伸肌的峰力矩（peak torque,PT）、峰力矩角度（peak torque angle,PTA）进行比较,归纳两组膝关节的力矩-时间图特征。结果损伤组膝关节屈、伸肌的双侧PT的比较差异有统计学意义（P＜0.05）,PTA的比较差异无统计学意义（P＞0.05）;伪装组膝关节屈、伸肌的双侧PT、PTA的比较差异均有统计学意义（P＜0.05）。损伤组两侧膝关节力矩-时间图主要为单峰前置型,伪装组膝关节力矩-时间图主要为多峰型。结论在法医学鉴定中,等速肌力检测在辨别伪肢体瘫方面可以通过力矩-时间图的相关特点进行评价。     

道路交通事故眼损伤伤残评定的标准化和规范化

GB18667-2002《道路交通事故受伤人员伤残评定》标准（以下简称“标准”）中有关眼损伤的条款较为原则和笼统。随着“标准”的广泛应用,加之法医学和临床眼科学技术的不断进步,对眼损伤后遗症的检验技术和认识水平已有较大的提高。建议采用视力表投影仪代替国际视力表进行行为视力检查,存在屈光不正的应了解屈光度后再检查其矫正视力;疑有伪盲或伪装视力降低时,可行伪盲试验或伪装视力降低的检验,视觉电生理技术是测试伪盲或伪装视力降低的有效方法。运用电脑视野计可进行视野检查,动态视野检查结果可通过视野有效值换算为残存视野半径（或直径）;视野检查存在一定的干扰因素,分析时应密切结合原发损伤及其他检查结果。对于遗留复视等双眼视障碍的,可采用同视机等检查方法,检验结果应考察功能障碍与眼肌等原发性损伤的符合性。泪器损伤后遗留溢泪症状的,应采用相应的检查方法证实泪道狭窄或梗阻。眼睑下垂及眼睑畸形分为轻度及重度;眼睑畸形包括闭合不全、眼睑缺损及眼睑外翻等情形。影响视力的外伤性白内障符合“标准”相关条款的规定。根据现行“标准”对道路交通事故所致眼损伤进行伤残评定,应进行视觉功能检测、眼球结构检查、伪盲试验及视觉电生理检测,最后综合病史材料及既往情况综合分析,得出评定结果。统一对现行“标准”的理解,规范检测手段和结果评价原则,有助于道路交通事故眼损伤伤残评定的标准化和规范化。     

眼损伤夸大伪装视力下降20例分析

眼损伤夸大伪装视力下降２０例分析张经伟（湖南省高级人民法院；长沙４１０００１）１９９１年４月至１９９４年５月我室检查评定视力损害程度案共９６例，本文收集其中眼外伤后夸大或伪装视力下降的２０例进行分析．玉资料分析２０例中男１４例，女６例，年龄为６～７２...     

体感诱发电位检查在法医学鉴定中的应用探讨

目的探讨体感诱发电位(SEP)检查在法医学鉴定中的应用价值。方法将60例神经系统外伤(不包括周围神经损伤)并功能障碍者分为脊髓损伤组(33例)和颅脑损伤组(27例),分别进行神经系统查体及SEP检查,并对其结果进行相关分析。结果脊髓损伤组SEP结果33例均表现为异常,异常率100%,且随着功能障碍程度的加重,SEP异常的程度亦加重,两者呈正相关(R=0.72,P<0.01,n=33)。27例颅脑损伤者,仅有9例异常,异常率为33%,功能障碍程度与SEP异常相关性分析(R=0.36,P>0.05)。结论SEP检查是客观评定脊髓功能较为敏感而准确的辅助检查手段;但对颅脑损伤功能障碍的客观评价价值相对有限。     

伪装命案现场的判别勘验33例分析

本文收集了３３例伪装命案现场的案件，对其种类、特点等进行了分析研究，并对这一类案件的判别勘验方法进行了探讨，供参考。１案例资料本文收集的３３例伪装现场的案件，均为已破案件，其中有１８例在勘验现场后能及时识破伪装，迅速破案，占５４．５４％，有１０例在案发后未能及时识破伪装，而是经过系统全面的尸体检验和综合了现场勘验、案情调查等情况后，识破伪装，致使案件侦破，占３０．３０％，有５例则是经过较长时间的侦查，未能破案，最后从伪装现场的角度出发，重新审查复核有关资料，运用技术侦查手段，最后侦破案件，占１５…     

心理生理测试技术在鉴定模拟造作伤诈病中的应用研究

目的探讨心理生理测试技术在鉴定造作伤诈病中的应用价值。方法采用同方神火多导心理生理测试仪(TH型4.0.0.15)对50名学生分别进行伪装疼痛和造作鼓膜穿孔为主题的CQT问题测试。采用t检验和χ2检验进行数据统计分析。结果诚实组结果有效率大于说谎组(P0.01);自动评分和手动打分的结果有效率无显著差异;伪装疼痛问题测试和造作鼓膜穿孔问题测试的结果有效率无显著差异。结论本实验为后续的实案测试提供了良好的研究基础。     

Detection of malingering in competency to stand trial evaluations

A simulation design with multiple contrast groups was used to test the effectiveness of two instruments, the Structured Interview of Reported Symptoms (SIRS) and the Georgia Court Competency Test—Mississippi State Hospital (GCCT-MSH) in detecting malingering of competency to stand trial. Thirty simulators were compared with 23 incompetent defendants, 25 competent defendants, 30 offender controls, and 7 suspected malingerers on both instruments. Results revealed that the simulators and suspected malingerers scored significantly higher on all of the SIRS primary scales and significantly lower on the GCCT-MSH than the three comparison groups. The SIRS had an overall hit rate of 97.8% using three or more primary scales as the criterion for malingering. Information concerning the simulator's strategies of deception is presented.     

Use of the MMPI-2 Restructured Clinical (RC) Scales in Detecting Criminal Malingering

The purpose of the present study was to assess the effects of criminal malingering on the MMPI-2 Restructured Clinical (RC) scales. Sixty undergraduate students were given the MMPI-2 twice. One administration was conducted according to the MMPI-2 manual, and the other was given with a special set of malingering instructions specific to a prison setting. The two MMPI-2 profiles for each participant were scored for both the Basic and RC scales. Eight participants were eliminated from the data analysis due to validity (VRIN or TRIN) concerns. Data from the remaining 52 participants were analyzed using a 2 × 2 repeated measures ANOVA. Results showed that, as expected, the participants achieved higher MMPI-2 scores in the malingering condition. Also, participants achieved higher scores overall on the Basic scales and a significant interaction showed that participants achieved higher scores on the Basic Scales in the malingering condition than on the RC scales in that condition. These results supported prior research, indicating that malingerers produce elevated RC profiles. However, the present results also suggest that the Basic scales may be more effective in actually detecting malingerers, mainly due to the much lower ceiling on the RC scaled scores. Further implications of these findings for research and clinical work are also discussed.     

Symptom Validity Testing for the detection of simulated amnesia: Not robust to coaching

Abstract

Symptom Validity Testing (SVT) has been proposed as a method to assess the veracity of claims of amnesia. Performance below chance levels on a forced choice task is indicative of malingering. Previous research has shown that the Symptom Validity Test is a promising challenge test: at levels of high specificity, it may detect approximately half of those who malinger. The present study investigated the effect of coaching on the sensitivity of the Symptom Validity Test. Participants were instructed to feign complete amnesia and tested about their identity using the Symptom Validity Test. Half of the participants were coached not to perform below chance levels. Results were straightforward: 58% of 19 naive malingerers were detected, but none of 19 coached malingerers were detected. The results show that the Symptom Validity Test is not resistant to coaching.     

Development of a new classificatory model of malingering

Inclusion criteria for the classification of malingering are shaped and largely predetermined by our explanatory theories. Current theories have postulated the motivation to malinger is either the product of underlying psychopathology (pathogenic model) or criminal backgrounds (DSM III-R model). I have proposed a third model that malingering is typically an adaptive response to adverse circumstances which may best be understood in the context of decision theory. Based on this approach I have argued that indices of malingering should be empirically derived and focused on clinical presentation. Finally, I have proposed a preliminary model for the classification of malingerers which combines clinical data with corroborative evidence.     

The Word Memory Test in medicolegal assessment: a measure of effort and malingering?

The Word Memory Test (WMT) is claimed to measure effort and to detect cognitive response bias. Archival data from n = 2526 cases referred in 2009–2016 for medicolegal assessment were analyzed. Each participant underwent a medical and a psychological examination including a cognitive test battery and several validity measures including the WMT. The WMT validity test scores do not approximately follow a normal distribution. Thus, parametric statistics for WMT validity scores may not be appropriate. WMT performance explains 0–20% of the variance in cognitive test performance. This is more than what substantial brain damage accounts for. The standard uniform cutoff indicating a ‘fail’ in all three WMT effort subtests (equal or less than 82.5% correct responses) seems not supported by the data. Taking into account the context of the testing, cutoffs may be chosen according to the desired sensitivity or specificity. ROC-statistics with modified Slick criteria as gold standard for malingering look alike for the three WMT effort subtests, with a AUC between 0.86 and 0.88. The WMT seems a good indicator of both effort and (Slick) malingering, however, little is gained by administering the entire test.     

An Evaluation of Malingering Screens with Competency to Stand Trial Patients: A Known-Groups Comparison

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n=21) or nonmalingerers (n=79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context.     

对比度视力容许区间在鉴别伪装视力降低中的应用

目的探索法医学鉴定中运用对比度视力方法鉴别被鉴定人伪装或夸大视力降低的价值。方法根据前期对比度视力与投影仪视力相关性的研究结果,收集正常志愿者166眼作为对照组,分别检测投影仪视力与100%、25%、10%视标对比度下的对比度视力,获得不同投影仪视力水平与以上视标对比度下相应的视力95%容许区间;收集眼外伤被鉴定人64眼,根据其100%对比度视力值是否在相应对比度视力的容许区间内,分为A组（初步排除伪装或夸大视力降低）与B组（疑有伪装或夸大视力降低组）。运用统计学软件进行数据分析。结果投影仪视力检测值≤0.3以及0.4~0.7组的受检眼,在不同对比度视标检测下,A、B组的差异均有统计学意义（P≤0.05）;投影仪视力检测值≥0.8组的受检眼,在不同对比度下,A、B组的差异无统计学意义（P≥0.05）。结论当被鉴定人受伤眼的投影仪视力在0.8以下,可加测对比度视力。参照投影仪视力对应的对比度视力容许区间,当受检眼对比度视力值在容许区间以外,应考虑其存在伪装或夸大视力降低。     

不同听力水平听性稳态反应阈值与纯音测听阈值比较

目的探讨不同频率下不同听力水平的听性稳态反应（auditory steady-state responses,ASSR）阈值与纯音测听（pure tone audiometry,PTA）阈值的关系。方法对听力正常的志愿者及不同听力水平的感音神经性聋的志愿者共86例（172耳）,分别行PTA及500、1000、2000和4000Hz的ASSR,得出PTA阈值及ASSR阈值（单频刺激）。比较不同频率（500、1000、2000、4000Hz）下不同听力水平组（≤20、21～39、40～59、60～79、≥80dB）的ASSR阈值与PTA阈值之间的关系。结果各频率的ASSR阈值与PTA阈值均具有良好的相关性。但各频率下不同听力水平校正后的校正值均高于PTA阈值。结论应用ASSR阈值进行听阈级评估时需要进行校正,ASSR检测技术可以用于听力障碍法医学鉴定听阈级评估。     

The Verifiability Approach to detection of malingered physical symptoms

Inspired by recent research showing that liars are reluctant to include verifiable details in their accounts, we explored in two studies (N?=?125; N?=?105) whether participants who report fabricated symptoms (‘malingerers’) present fewer verifiable details than participants who report genuine ill-health symptoms. In Study 1, participants were instructed to describe a typical day on which they had experienced a genuine or malingered symptom. Truth tellers’ statements included significantly higher proportions of verifiable details concerning the reported symptoms than malingerers’ statements. Compared with truth tellers, malingerers generated longer statements with more unverifiable details. In Study 2, we informed participants that their statements may be assessed for verifiable or checkable details. Malingerers often mentioned ‘false’ witnesses to provide checkable information and differences between malingerers and truth tellers in statement length, and checkable and uncheckable details were no longer significant. The utility and implications of the Verifiability Approach to detection of malingering are discussed.