Identification of Apraxia of Speech from PICA Verbal Tests and Selected Oral-Verbal Apraxia Tests

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Intersystematic Reorganization for Apraxia of Speech

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Some comparisons between auditory and reading comprehension in aphasic adults

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Effects of Therapy in Oropharyngeal Dysphagia by Speech and Language Therapists: A Systematic Review

Medical and paramedical treatments should be evaluated according to current standards of evidence-based medicine. Evaluation of therapy in oropharyngeal dysphagia fits into this growing interest. A systematic review is given of the literature on the effects of therapy in oropharyngeal dysphagia carried out by speech therapists. Thus, the review excludes reports of surgical or pharmacological treatments. The literature search was performed using the electronic databases PubMed and Embase. All available inclusion dates up to November 2008 were used. The search was limited to English, German, French, Spanish, and Dutch publications. MESH terms were supplemented by using free-text words (for the period after January 2005). Fifty-nine studies were included. In general, statistically significant positive therapy effects were found. However, the number of papers was rather small. Moreover, diverse methodological problems were found in many of these studies. For most studies, the conclusions could not be generalized; comparison was hindered by the range of diagnoses, types of therapies, and evaluation techniques. Many questions remain about the effects of therapy in oropharyngeal dysphagia as performed by speech and language therapists. Although some positive significant outcome studies have been published, further research based on randomized controlled trials is needed

The effects of neuromuscular electrical stimulation for dysphagia in opercular syndrome: a case study

A 76-year-old man with opercular syndrome characterized by complete bilateral loss of voluntary control of facial, lingual, pharyngeal and masticatory muscles is presented with focus on the severe dysphagia. Three years earlier the patient had experienced two strokes resulting in opercular syndrome with severe dysphagia. Despite initial logopedic dysphagia treatment, swallowing did not improve. A new treatment for dysphagia, consisting of neuromuscular electrical stimulation was applied on the patient. He returned to oral feeding. Clinical and treatment observations are reported

Tactile thermal oral stimulation increases the cortical representation of swallowing

<p>Abstract</p> <p>Background</p> <p>Dysphagia is a leading complication in stroke patients causing aspiration pneumonia, malnutrition and increased mortality. Current strategies of swallowing therapy involve on the one hand modification of eating behaviour or swallowing technique and on the other hand facilitation of swallowing with the use of pharyngeal sensory stimulation. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Little is known about the possible mechanisms by which this interventional therapy may work. We employed whole-head MEG to study changes in cortical activation during self-paced volitional swallowing in fifteen healthy subjects with and without TTOS. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of individual SAM data was performed using a permutation test.</p> <p>Results</p> <p>Compared to the normal swallowing task a significantly increased bilateral cortical activation was seen after oropharyngeal stimulation. Analysis of the chronological changes during swallowing suggests facilitation of both the oral and the pharyngeal phase of deglutition.</p> <p>Conclusion</p> <p>In the present study functional cortical changes elicited by oral sensory stimulation could be demonstrated. We suggest that these results reflect short-term cortical plasticity of sensory swallowing areas. These findings facilitate our understanding of the role of cortical reorganization in dysphagia treatment and recovery.</p

Patients' Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA).

BACKGROUND: Previous work has found that people with diabetes do not wear their therapeutic footwear as directed, but the thinking behind this behaviour is unclear. Adherence to therapeutic footwear advice must improve in order to reduce foot ulceration and amputation risk in people with diabetes and neuropathy. Therefore this study aimed to explore the psychological influences and personal experiences behind the daily footwear selection of individuals with diabetes and neuropathy. METHODS: An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of therapeutic footwear use in people living at risk of diabetic neuropathic foot ulceration. This study benefited from the purposive selection of a small sample of four people and used in-depth semi structured interviews because it facilitated the deep and detailed examination of personal thoughts and feelings behind footwear selection. FINDINGS: Four overlapping themes that interact to regulate footwear choice emerged from the analyses: a) Self-perception dilemma; resolving the balance of risk experienced by people with diabetes and neuropathy day to day, between choosing to wear footwear to look and feel normal and choosing footwear to protect their feet from foot ulceration; b) Reflective adaption; The modification and individualisation of a set of values about footwear usage created in the minds of people with diabetes and neuropathy; c) Adherence response; The realignment of footwear choice with personal values, to reinforce the decision not to change behaviour or bring about increased footwear adherence, with or without appearance management; d) Reality appraisal; A here and now appraisal of the personal benefit of footwear choice on emotional and physical wellbeing, with additional consideration to the preservation of therapeutic footwear. CONCLUSION: For some people living at risk of diabetic neuropathic foot ulceration, the decision whether or not to wear therapeutic footwear is driven by the individual 'here and now', risks and benefits, of footwear choice on emotional and physical well-being for a given social context

The Development of a Standardized Assessment of Phonology in Aphasia

The long-term goal of this research is to develop a valid and reliable impairment level measure of phonology in aphasia. The short-term goal, and focus of this abstract, is to present data collected from individuals with aphasia for 3 domains (or subtests) of this assessment: reading, repetition and perception. From the perspective of Item response theory (IRT), procedures will be presented on the development of the item bank. Results pertaining to the psychometric properties of the items when tested on individuals with aphasia show a reasonable fit to the Rasch model. Further research will validate and refine existing items

Repeated attempts, phonetic errors, and syllabifications in a case study:Evidence of impaired transfer from phonology to articulatory planning

Background: In aphasia, impairments affecting stages after lexical access have been subdivided into three types: 1. impairments specifying a sequence of phonemes after lexical access (the reproduction variety of conduction aphasia, CA); 2. impairments holding on to these representations during articulatory planning (the short-term memory (STM) variety of CA); and 3. Impairments specifying integrated articulatory/motor plans for clusters of phonemes (apraxia of speech, AoS). Models of speech production, however, suggest more articulated possibilities (i.e., different subtypes of articulatory impairments). Aims: We investigated the impairment in a person with aphasia whose preliminary assessment revealed mixed speech characteristics, combining features typically used to identify CA – phonological errors across tasks and repeated attempts at the target – with features typically used to identify AoS – phonetic errors and word dysfluencies (phoneme elongations and syllabifications). Our preliminary hypothesis was that there was a difficulty transferring information from an (intact) phonological output buffer to articulatory planning. Slow/noisy transfer would predict dysfluencies, errors selecting motor programs, but also repeated attempts (RA) at revising the output in the face of intact feedback and intact original representations. This hypothesis also predicts effects of position and phonological complexity. Method and Procedure: We tested CS’s word and nonword repetition, word reading, and picture naming. We quantified lexical and non-lexical errors, repeated attempts, phonetic errors, and syllabifications. We assessed effects of word frequency, word length, phoneme position, and syllabic and phonological complexity. Results: CS made similar errors across tasks, consistent with a post-lexical impairment. His RAs most often built up a correct target from fragments and/or previously incorrect attempts, similar to a conduite d’approche. He also produced more errors in later positions, and more repeated attempts on longer words. However, inconsistent with decay from an output buffer, phonological errors did not increase with word length. Finally, frequency mattered, consistent with easier/faster access to simpler/more practiced motor plans. Conclusions: CS’s speech characteristics and anatomical lesion are consistent with transfer limitations between phonology and articulatory planning. However, CS has more difficulties in computing articulatory plans than in selecting and retaining phonological representations, as commonly attributed to CA. CS’s case suggests that different varieties of phonological and articulatory disorders need to be distinguished, beyond a strict dichotomy AoS/CA (e.g., involving transfer limitations and difficulties in computing, selecting,, and/or initiating articulatory plans)