Physiological characteristics of dysphagia following thermal burn injury

The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing

Phenotypic variability in acquired and idiopathic dystonia

BackgroundTo date, a few studies have systematically investigated differences in the clinical spectrum between acquired and idiopathic dystonias. ObjectivesTo compare demographic data and clinical features in patients with adult-onset acquired and idiopathic dystonias. MethodsPatients were identified from among those included in the Italian Dystonia Registry, a multicenter Italian dataset of patients with adult-onset dystonia. Study population included 116 patients with adult-onset acquired dystonia and 651 patients with isolated adult-onset idiopathic dystonia. ResultsComparison of acquired and idiopathic dystonia revealed differences in the body distribution of dystonia, with oromandibular dystonia, limb and trunk dystonia being more frequent in patients with acquired dystonia. The acquired dystonia group was also characterized by lower age at dystonia onset, greater tendency to spread, lower frequency of head tremor, sensory trick and eye symptoms, and similar frequency of neck pain associated with CD and family history of dystonia/tremor. ConclusionsThe clinical phenomenology of dystonia may differ between acquired and idiopathic dystonia, particularly with regard to the body localization of dystonia and the tendency to spread. This dissimilarity raises the possibility of pathophysiological differences between etiologic categories

Translating Dental Flossing Intentions into Behavior: a Longitudinal Investigation of the Mediating Effect of Planning and Self-Efficacy on Young Adults

Purpose: Although poor oral hygiene practices can have serious health consequences, a large number of adults brush or floss their teeth less than the recommended time or not at all. This study examined the mediating effect of two key self-regulatory processes, self-efficacy and planning, as the mechanisms that translate dental flossing intentions into behavior. Method: Participants (N = 629) comprised young adults attending a major university in Queensland, Australia. A longitudinal design guided by sound theory was adopted to investigate the sequential mediation chain for the effect of dental flossing intentions (time 1) on behavior (time 3) via self-efficacy and planning (time 2). Results: A latent variable structural equation model with standardized parameter estimates revealed the model was a good fit to the data. Controlling for baseline flossing, the effect of intentions on behavior was mediated via self-efficacy and planning, with 64 % of the flossing variance accounted for by this set of predictors. Controlling for age and sex did not change the results. Concluson: The results extend previous research to further elucidate the mechanisms that help to translate oral hygiene intentions into behavior and make a significant contribution to the cumulative empirical evidence about self-regulatory components in health behavior change.Griffith Health, School of Applied PsychologyFull Tex