Need for needle and syringe programmes in Africa

A narrative review was conducted, drawing on peer reviewed literature and relevant grey literature on injecting drug use in African countries and ethical dilemmas facing harm reduction especially the provision of sterile needles and syringes to injecting drug users. This review aimed at highlighting evidence and the arguments for and against the provision of sterile injecting equipment to people who inject drugs (PWID), and to consider the implications for the African context. The narrative established that high risk injecting drug  practices are common among PWID in many African communities, and soare HIV and hepatitis. Current services for this population in Africa are less pragmatic and inadequate. Needle and syringe programmes are both effective and ethical and should be part of the response to injecting drug use in Africa.Key words: Needle and syringe programmes, injecting drug use, ethics, HI

Relationships Among Subjective and Objective Measures of Tongue Strength and Oral Phase Swallowing Impairments

A growing literature documents the relationship between tongue strength and oral phase swallowing function. Objective measures of strength have been recommended as more valid and reliable than subjective measures for the assessment of tongue function, yet subjective measures remain the more commonly used clinical method for assessing tongue strength. This study assessed the relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Both subjective and objective measures of tongue strength were observed to be good predictors of the presence of oral phase swallowing impairments. The specific oral phase swallowing functions of bolus manipulation, mastication, and clearance were moderately correlated with subjective ratings of tongue strength. Experienced and inexperienced raters appeared to judge tongue strength differently, with the ratings of experienced raters being more predictive of swallowing function

Age and Sex Differences in Orofacial Strength

This study explored age- and sex-related differences in orofacial strength. Healthy adult men (N = 88) and women (N = 83) participated in the study. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI). Anterior and posterior tongue elevation strength measures were obtained using a standard method. Tongue protrusion and lateralization, cheek compression, and lip compression measures utilized adaptors allowing the participant to exert pressure against the bulb in different orientations. Lip and cheek strength measures were greater for men than women, but tongue strength did not differ between sex groups. Strong correlations between age and strength were not observed. However, group comparisons revealed lower tongue protrusion and lateralization strength in the oldest participants. The oldest participants also exhibited lower anterior and posterior tongue elevation strength relative to the middle-age group. Cheek and lip compression strength demonstrated no age-related differences. The current study supplements and corroborates existing literature that shows that older adults demonstrate lower tongue strength than younger adults. Sex differences were noted such that men demonstrated greater lip and cheek strength but not tongue strength. These data add to the literature on normal orofacial strength, allowing for more informed interpretations of orofacial weakness in persons with dysphagia

The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review

Aim: The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. Method: A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. Results: Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. Interpretation: Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians’ knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children

Assessment of Orofacial Strength in Adults with Dysarthria

Assessment of orofacial weakness is common during the evaluation of patients with suspected dysarthria. This study addressed the validity of clinical assessments of orofacial eakness by comparing clinical (subjective) ratings to instrumental (objective) measures. Forty-four adults referred to a speech pathology clinic for dysarthria evaluation were tested for strength of the tongue during elevation, lateralization, and protrusion, and for the strength of the muscles of the lower face during buccodental and interlabial compression. Subjective assessment of weakness involved rating maximum resistance against a firmly held tongue depressor, using a 5-point scale. Objective assessment involved the Iowa Oral Performance Instrument (IOPI), measured as the maximal pressure generated against an air- filled bulb. A recent adaptation to the IOPI permitted testing of tongue and cheek strength using tasks that are comparable to the subjective tasks. Moderate correlations were found between the objective and subjective evaluations, with the strongest correlations for tongue lateralization. Lower pressure values were associated with higher subjective ratings of weakness for each task, although there was substantial overlap in the data. These results, combined with the notion that examiner bias is inherent to clinical assessment, support the use of instrumentation to improve objectivity and precision of measurement in the clinic

Identifying Evolutionary Significant Units in Spiraea virginiana

Spiraea virginiana Brit. (Rosaceae) is a rare clonal shrub found in isolated populations within the Cumberland, Tennessee, and Ohio River drainages. This species has been listed as federally endangered since June 1990 due to anthropogenically induced habitat loss and population fragmentation as a result of river damming. Reproduction consists of a mixed mating system that is mostly asexual by ramet formation, with occasional dispersal via vegetative fragmentation downstream. Successful sexual reproduction is limited, and could result from self-fertilization or outcrossing. The species does appear to outcompete other shrub species by vigorous rhizome production and its ability to withstand scouring floods.The lack of sexual reproduction could potentially result in an extremely limited effective population size in each river. This study aims to assess the genetic diversity of S. virginiana populations along the New and Cheoah Rivers in North Carolina using eight previously published microsatellite markers. Our results suggest a small effective population size within each of the two rivers. These results are consistent with earlier investigations and could have management implications, possibly treating each river drainage as its own evolutionary significant unit for (ESU)

Generalized motor programme and parameterization accuracy in apraxia of speech and conduction aphasia

The present study examined three aspects of motor programming (generalized motor programme (GMP) accuracy, temporal parameterization accuracy, and amplitude parameterization accuracy) in subjects with apraxia of speech (AOS) or conduction aphasia (CA) and normal speaking participants. Subjects were presented with a movement pattern on a monitor that they were required to produce with the jaw, after the target pattern had been removed from view. Analyses examined differences in relative (parameterization) and absolute (GMP) timing and amplitude between the target and actual movement. Examination of individual subject performance revealed inter-subject variability within the AOS group, with two of the four subjects demonstrating unimpaired GMP accuracy but poor parameterization accuracy, while the other two subjects exhibited the opposite pattern, impaired GMP accuracy but normal parameterization. No clear pattern of deficit was noted for the subjects with CA. Results are discussed with respect to motor control theories of AOS and CA

Evidence-Based Systematic Review (EBSR): The Effects of Oral Motor Interventions on Feeding and Swallowing in Preterm Infants

Purpose: To conduct an evidence-based systematic review and provide an estimate of the effects of oral motor interventions (OMIs) on feeding/swallowing outcomes (both physiological and functional) and pulmonary health in preterm infants. Method: A systematic search of the literature published from 1960 to 2007 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality. Results: Twelve studies were included and focused on 3 OMIs—nonnutritive sucking (NNS), oral/perioral stimulation, and NNS plus oral/ perioral stimulation. Six studies addressed the effects of OMI on the feeding/swallowing physiology outcomes of feeding efficiency or sucking pressures. Ten studies addressed the functional feeding/swallowing outcomes of oral feeding or weight gain/growth. No studies reported data on pulmonary health. Methodological quality varied greatly. NNS alone and with oral/perioral stimulation showed strong positive findings for improvement in some feeding/swallowing physiology variables and for reducing transition time to oral feeding. Prefeeding stimulation showed equivocal results across the targeted outcomes. None of the OMIs provided consistent positive results on weight gain/growth. Conclusions: Although some OMIs show promise for enhancing feeding/swallowing in preterm infants, methodological limitations and variations in results across studies warrant careful consideration of their clinical use

Visuomotor Tracking Abilities of Speakers with Apraxia of Speech or Conduction Aphasia

This investigation examined the visuomotor tracking abilities of persons with apraxia of speech (AOS) or conduction aphasia (CA). In addition, tracking performance was correlated with perceptual judgments of speech accuracy. Five individuals with AOS and four with CA served as participants, as well as an equal number of healthy controls matched by age and gender. Participants tracked predictable (sinusoidal) and unpredictable signals using jaw and lip movements transduced with strain gauges. Tracking performance in participants with AOS was poorest for predictable signals, with decreased kinematic measures of cross-correlation and gain ratio and increased target-tracker difference. In contrast, tracking of the unpredictable signal by participants with AOS was performed as well as for other groups (e.g. participants with CA, healthy controls). Performance of the subjects with AOS on the predictable tracking task was found to strongly correlate with perceptual judgments of speech. These findings suggest that motor control capabilities are impaired in AOS, but not in CA. Results suggest that AOS has its basis in motor programming deficits, not impaired motor execution

Quantifying Orofacial Muscle Stiffness Using Damped Oscillation

Muscle stiffness can reflect muscle tone, often presumed to be aberrant in persons with dysarthria. This exploratory study used the Myoton-3 to assess stiffness of the lateral tongue and mid-cheek in 10 participants with various neurologic disorders--primarily lower motor neuron (n = 6), primarily upper motor neuron (n = 4), and neurolsgically normal adults (n = 4). The Myoton delivered a 25-ms pulse perturbation to the surface of the structure of interest and sensed the response with an internal accelerometer. The resulting acceleration curve was used to determine frequency of oscillation and decrement of damping; stiffness was derived from the linear displacement of tissue perforce of the perturbation. Tongue stiffness was significantly lower for the LMN group than for the normal control group, consistent with the assumption that hypotonia accompanies flaccidity. Tongue stiffness did not differ for the UMN group, nor did cheek stiffness, oscillation frequency or decrement differ between any groups. These preliminary findings indicate that stiffness can be determined from the surface of the tongue and cheek, and may be indicative of low muscle tone in LMN lesions. Although methodologic challenges remain, this novel approach has the potential to quantify orofacial muscle stiffness and document potential changes in muscle tone with disease and treatment