Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease

Objective: To investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT®) in improving prosody in patients with Parkinson's disease over medium-term follow-up. Methods: 15 patients with Parkinson's disease were assessed before LSVT®, within one week, and 3 and 6 months after treatment. Subjective and objective evaluation included: Voice Handicap Index - 10 (VHI-10), perceptual assessment by GRBAS scale and item 18 of the Unified Parkinson's Disease Rating Scale III (UPDRS III), maximum phonation time (MPT /s/) and acoustic analysis by means the Voice Range Profile (VRP) and the "Intonation Stimulability Protocol" of the Motor Speech Profile (MSP). Results: A significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p < 0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvF0) (p = 0-01) improved significantly after 3 months, but returned to pre-therapy levels after 6 months. The score of item 18 of the UPDRS III increased significantly early post-therapy (p = 0.03), but did not maintain the improvement at 3 and 6 months. Median values of Grade (G), Asthenia (A) and mean values VHI-10 score significantly decreased at each post-therapy control (p < 0.05). Conclusions: In addition to the subjective and perceptual beneficial effect of LSVT®, we found a long-lasting increase of loudness and fundamental frequency. There was also improvement of acoustic parameters related to prosody, although it was temporary

Oropharyngeal Dysphagia After Hospitalization for COVID-19 Disease: Our Screening Results

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology

Neuro-Oncology Multidisciplinary Tumor Board: The Point of View of the Neuroradiologist

Background: The multi-disciplinary tumor board (MTB) is essential to quality cancer care and currently recommended to offer the best personalized clinical approach, but little has been published regarding MTBs in neuro-oncology (nMTBs). The aim of the present paper is to describe our nMTB, to evaluate its impact on clinical management decisions, and to assess the role of neuroradiologists. Methods: The retrospective evaluation of the cases discussed at our nMTB from March 2017 to March 2020. From the electronic records, we extracted epidemiological, clinical and other specific data of nMTB. From the radiological records, we calculated data relating to the number, time for revision, and other specifications of MRI re-evaluation. Statistical analysis was performed. Results: a total of 447 discussions were analyzed, representing 342 patients. The requests for case evaluations came from radiation oncologists (58.8%) and neurosurgeons (40.5%), and were mainly addressed to the neuroradiologist (73.8%). The most frequent questions were about the treatment's changes (64.4%). The change in patient treatment was reported in 40.5% of cases, 76.8% of these were based on the neuroradiologic assessment. A total of 1514 MRI examinations were re-evaluated, employing approximately 67 h overall. The median of the MRI exams reviewed per patient was 3 (min-max 1-12). Conclusions: Our study supported that the multidisciplinary approach to patient care can be particularly effective in managing brain tumors. A review by an expert neuroradiologist impacts patient management in the context of nMTBs, but has costs in terms of the time and effort spent preparing for it

Long-term voice outcomes and quality of life after open partial horizontal laryngectomy type II vs. total laryngectomy: A cross-sectional study

Objectives: We aim to analyse long-term voice outcomes and quality of life (QoL) in patients undergoing open partial horizontal laryngectomy type II (OPHL type II) and to compare them to those obtained by patients undergoing total laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study. Setting: Patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL group and TL group. Main outcomes measures: Acoustic analysis, maximum phonation time, INFV0 scale, I-SECEL, UW-QoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomised patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the social domain of QoL were higher in OPHL group. Conclusions: Open partial horizontal laryngectomy Type II allows an acceptable voice recovery and

Disfonie funzionali ed aspetti psicologici

La voce oltre a veicolare in forme linguistiche i contenuti della mente permette anche di trasmettere i sentimenti, gli stati d’animo e le intenzioni del parlante. Chi ascolta decodifica il significato di ciò che viene espresso non soltanto attraverso l’analisi del contenuto verbale (7%), ma anche utilizzando indizi forniti dalle espressioni facciali (55%) e dai tratti paralinguistici della voce (38%) (Mehrabian, 1971). Nella produzione e nella decodifica di quest’ultimi sono coinvolte strutture del sistema limbico (cervello emotivo). Secondo alcuni Autori la voce è il “barometro delle emozioni” (Aronson, 1990; Roy e Bless, 2000a), ed emozioni negative indotte da eventi stressanti, soprattutto se associate a particolari tratti di personalità che influenzano le strategie di coping allo stress, possono determinare l’insorgenza di un disturbo funzionale della voce (Baker, 2008). Il termine “Disfonia Funzionale” implica la presenza di un disturbo di voce in assenza di alterazioni della struttura e della motilità laringea. Si tratta di una categoria diagnostica che include un vasto assortimento di disturbi vocali: psicogeni, da conversione, isterici, da tensione, da iperfunzione, da cattivo uso. La differente terminologia utilizzata suggerisce che l’eziologia della disfonia funzionale è eterogenea, anche se non è ancora sufficientemente chiaro quanto questi disturbi siano qualitativamente differenti ed eziologicamente distinti (Roy, 2003). In particolare, mentre alcune etichette diagnostiche presumono la presenza di problematiche psicologiche, altre suggeriscono l’esistenza di un comportamento disfunzionale caratterizzato dalla presenza di tensioni muscolari e cattive abitudini vocali. Attualmente molti Autori, ritenendo che stress e caratteristiche della personalità possano interferire sull’equilibrio della muscolatura laringea intrinseca ed estrinseca, preferiscono utilizzare l’etichetta “Disfonia Muscolo-Tensiva Primaria (MTD I)” (Morrison et al, 1983; Morrison e Rammage, 1994; Roy et al, 1996). Quest’ultima secondo il “Classification Manual for Voice Disorders - I (CMVD-1)” (Verdolini et al, 2005) è un’alterazione della voce che si manifesta in assenza di lesioni organiche delle corde vocali, non riconducibile a una chiara eziologia psicogena o neurologica, associata a movimenti laringei eccessivi, atipici o abnormi durante la fonazione. Clinicamente la MTD I può manifestarsi in modo diverso. Il termine “ombrello” che la definisce è l’iperfunzione, ma questa può estrinsecarsi sia con l’iper- che con l’ipoadduzione delle corde vocali. L’iperadduzione determina fonotrauma ed è causalmente correlata allo sviluppo di lesioni delle corde vocali. L’ipoadduzione, che sembra maggiormente associata a particolari profili psicologici, si manifesta invece con rigidità delle corde vocali e co-contrazioni della muscolatura adduttoria e abduttoria che ostacolano l’emissione della voce, ma che non determinano alterazioni della mucosa cordale. Riguardo al ruolo svolto dai fattori psicologici nella MTD I, il CMVD- I (Verdolini et al, 2005) sottolinea che questi non possono essere presi in considerazione in assenza di elementi specifici e rilevanti e che la diagnosi di disturbo “psicogeno” della voce non è mai una diagnosi di esclusione. È tuttavia opinione condivisa che alla disfonia possano essere associati stati psicologici, come ad esempio quelli legati allo stress, che non costituiscono condizioni di psicopatologia franca, ma che possono comunque influenzare la voce. In generale, infatti, nei pazienti affetti da MTD I i problemi psicologici sembrano essere in relazione non tanto a reali problemi psichiatrici quanto piuttosto ad ansia che non supera la soglia per la diagnosi clinica (House e Andrews, 1987, 1988; Seifert e Kollbrunner, 2005). In quest’ottica appare dunque ragionevole supporre che la MTD I sia un disturbo ad eziologia multifattoriale in cui fattori fisiologici e psicologici interagiscono lungo un continuum (Altman et al., 2005; Roy e Bless, 2000b; Seifert e Kollbrunner, 2005; Verdolini et al., 2005)

Head CT Scans in the Emergency Department during the COVID-19 Pandemic: Use or Overuse?

Background: The COVID-19 pandemic seemed to mainly involve the respiratory system, but it was realized that it could affect any organ, including the CNS. The pandemic has followed a wave-like trend, with its peaks being due to the COVID-19 different variants and the introduction of the vaccine, which led to an apparent reduction in hospitalizations but also brought about perplexities related to its adverse effects. The aim of this study was to analyze the changes in the use of head CT/contrast CT and their impacts on the onset of cerebrovascular disease in our emergency department during the COVID-19 period and the vaccine rollout. Methods: Patients ≥ 18 years old admitted to our emergency department from January 2018 to September 2021 were enrolled. The patients were divided into three groups. The COVID-19 period included patients who visited our emergency department from 1 March 2020 to 31 January 2021; the vaccine period was considered to range from 1 February 2021 to 30 September 2021. The patients who visited the emergency department from 1 January 2018 to 31 January 2020 were considered the controls. Results: We found an increase in head CT/contrast CT requests during the COVID-19 period and increase in head contrast CT during the vaccine period, without an increase in the incidence of cerebrovascular disease. Conclusions: The uncertainty regarding the possible thrombotic events associated with COVID-19 and its vaccine increased the relative use of head CT/contrast CT by about 20% compared to the control perio

Oral and Swallowing Abilities Tool (OrSAT) in nusinersen treated patients

Introduction The aim of the study was to longitudinally assess swallowing abilities in nusinersen-treated patients with type 1 spinal muscular atrophy. Methods Twenty infants with type 1 SMA (11 female and 9 male) treated with nusinersen between 3 weeks and 15 months of age, were assessed using the Oral and Swallowing Abilities Tool (OrSAT). The duration of the follow-up after treatment ranged between 12 months and 62 months. Results Twelve of the 20 infants had normal swallowing and there was no need for tube feeding at the time treatment started. Ten of the 12 had consistently normal swallowing with no need for tube feeding on follow-up. The other two required tube feeding but they regained the ability to eat some food by mouth. The remaining 8 infants already had tube feeding inserted at the time treatment started: 4 of them also had tracheostomy and they showed no changes on the OrSAT Scale. The other 4 who had tube feeding but no tracheostomy had partial functional improvement. Conclusion Our results suggest that the degree of functional impairment at the time treatment is started can help to predict the progression of swallowing abilities. The use of a structured assessment also helped to detect partial improvements.New interventions have radically altered the natural history of Spinal Muscular Atrophy. In this report, oral and swallowing outcomes are report following interventions, widening our understanding of the potential benefits of early treatment

Psychological Distress After Covid-19 Recovery: Reciprocal Effects With Temperament and Emotional Dysregulation. An Exploratory Study of Patients Over 60 Years of Age Assessed in a Post-acute Care Service

To study the long-term psychological effects of Covid-19 disease, we recruited 61 patients older than 60 years of age and administered the Kessler questionnaire K10 to assess psychological distress and classify them according to mental health risk groups. Patients' affective temperaments were assessed with the 39-item form of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A-39) and emotional dysregulation with the Difficulties in Emotion Regulation Scale (DERS). Patients were divided in two samples according to their scores on the K10, i.e., a high likelihood of psychological distress group (N = 18) and a low likelihood of psychological distress group (N = 43). The two groups differed on their gender composition, in that more women (N = 11) were in the former and more men in the latter (N = 29) (χ2 = 4.28; p = 0.039). The high likelihood of psychological distress group scored higher on the Cyclothymic (3.39 ± 3.45 vs. 0.93 ± 1.08, p < 0.001) and the Depressive (2.28 ± 2.82 vs. 0.65 ± 1.09, p = 0.01) affective temperaments of the TEMPS and on the lack of Impulse control (12.67 ± 4.04 vs. 9.63 ± 3.14, p = 0.003) and lack of Clarity (15.00 ± 5.56 vs. 9.85 ± 4.67, p = 0.004) scales of the DERS. Our results show that having had Covid-19 may be related with high likelihood for psychological distress in advanced-age people and this may in turn be associated with impaired emotional regulation and higher scores on depressive and cyclothymic temperaments