Telepractice for Pediatric Dysphagia: A Case Study

A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger’s Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Development of a competency standard for non-degree workers who undertake an assessment of an adult with challenging behavior

Amendments to the Queensland (Australian state jurisdiction) Disability Services Act 2006 were enacted in July 2007. The Journal of Policy and Practice in Intellectual Disabilities Volume 6 Number 2 June 2009 IASSID Asia-Pacific Program Committee • Abstracts for the 2nd IASSID Asia-Pacific Conference 111 amendments are aimed at both improving the quality of life and enhancing the human rights of adults who have an intellectual or cognitive disability and have challenging behavior. A central tenet to the amendments is the specification of a legally enforceable practice framework for the management of restrictive practices that are associated with challenging behavior. A key principle underpinning this practice framework is the requirement for an assessment of the adult with the outcomes of the assessment informing the design and implementation of a positive behavior support plan. For chemical, mechanical, and physical restraint the legislation requires at least one appropriately qualified person to complete the assessment. For the purpose of the legislation a person is considered appropriately qualified “if the person has the qualifications or experience appropriate to conduct the assessment” (s.123K). The use of the words “or experienced” has the potential for a diverse scope of interpretation. The Centre of Excellence for Behavior Support (CEBS) identified the requirement for a common approach to describing this concept of “or experienced” person who may not have an academic qualification. Method Through the use of nominal group research, CEBS has developed a competency standard for the “or experienced” person. Two nominal groups were conducted to describe the competency required to undertake an assessment of an adult with challenging behavior. Groups were representative of a range of allied health professionals and direct support staff. Group one provided initial qualitative descriptors of the knowledge and skill required to complete an assessment, while group two validated the knowledge and skill descriptors developed by group one. Results The competency standard represents a best practice approach to the assessment of an adult with challenging behavior. The target cohort for the assessment is an adult with challenging behavior and who is managed through the use of chemical, mechanical, or physical restraint. Conclusions The use of the competency standard is intended to build confidence in the relevant decision makers for the adult in both the quality of the assessment and the development of the subsequent positive behavior support plan

The role of the corpus callosum in pediatric dysphagia: preliminary findings from a diffusion tensor imaging study in children with unilateral spastic cerebral palsy

The purpose of this study is to determine the relationship between the structural integrity of the corpus callosum (CC) and clinical feeding/swallowing performance in children with unilateral spastic cerebral palsy (USCP). Twenty children with USCP, (11 males, 5.11–17.6 yoa) were assessed via the Dysphagia Disorder Survey (DDS) and diffusion tensor imaging. Children were grouped into left hemisphere lesion (LHL; n = 13) and right hemisphere lesion (RHL; n = 7) groups. DTI variables analyzed for three CC regions (anterior, middle, posterior) were: fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and fibers count. Children with RHL presented with higher clinical dysphagia severity (p = 0.03). Six of seven children with RHL had lesions affecting periventricular/subcortical areas, and 8/13 children with LHL had lesions affecting the sensorimotor cortex. In the LHL group, as FA and fiber count of the anterior CC decreased and RD increased (all indicating reduced CC structural integrity), signs of dysphagia increased (r = −0.667, p = 0.013; r = −0.829, p ≤ 0.001; r = 0.594, p = 0.032, respectively). Reduced fiber count in the middle and posterior CC was also significantly associated with increased DDS scores (r = −0.762, p = 0.002; r = −0.739, p = 0.004, respectively). For the RHL group no significant correlations were observed. We provide preliminary evidence that corpus callosum integrity correlates with feeding/swallowing performance in children with USCP, especially when cortical sensorimotor areas of the left hemisphere are impacted. In this sample, CC integrity appeared to enable interhemispheric cortical plasticity for swallowing, but was not as critical when intrahemispheric connections were disrupted, as seen in the RHL group.32703713FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2013/26715-