High-Level Language Production in Parkinson's Disease: A Review

This paper discusses impairments of high-level, complex language production in Parkinson's disease (PD), defined as sentence and discourse production, and situates these impairments within the framework of current psycholinguistic theories of language production. The paper comprises three major sections, an overview of the effects of PD on the brain and cognition, a review of the literature on language production in PD, and a discussion of the stages of the language production process that are impaired in PD. Overall, the literature converges on a few common characteristics of language production in PD: reduced information content, impaired grammaticality, disrupted fluency, and reduced syntactic complexity. Many studies also document the strong impact of differences in cognitive ability on language production. Based on the data, PD affects all stages of language production including conceptualization and functional and positional processing. Furthermore, impairments at all stages appear to be exacerbated by impairments in cognitive abilities

Voluntary Cough and Clinical Swallow Function in Children with Spastic Cerebral Palsy and Healthy Controls

Dysphagia and resulting pulmonary sequelae are frequently observed in children with spastic cerebral palsy (SCP). However, physiological evidence regarding airway protective behaviors (specifically swallowing and cough function) in these children is sparse. The aim of this investigation was to quantify specific feeding, swallowing and cough impairments in children with SCP compared to controls. Eleven children with SCP (mean age: 7 + 2 years; GMFCS: I-V; MACS: I-V) and 10 age-matched controls participated. Clinical feeding and swallowing performance was evaluated with the Dysphagia Disorder Survey (DDS) using standardized liquid, puree, and chewable solid consistencies. Suprahyoid muscle activity and respiratory-swallow patterns were assessed with simultaneous surface electromyography and respiratory inductance plethysmography as children swallowed the various consistencies. Voluntary cough airflow measures were also obtained. Nonparametric tests were used for group comparisons and correlational analyses. Compared to controls, children with SCP demonstrated more signs of clinical feeding and swallowing impairment (p < .0001, η2 = .771), heightened suprahyoid muscle activity for puree (p = .014, η2 = .305) and chewable solids (p = .001, η2 = .528), more frequent post-swallow inhalation across liquid (p = .005, η2 = .401), puree (p = .014, η2 = .304) and chewable solids (p = .035, η2 = .223), and lower cough volume acceleration (p = .019, η2 = .289). Post-swallow inhalation for chewable solids was correlated with the DDS Part 1 (rs = .734, p = .010), DDS Part 2 (rs = .610, p = .046) and the DDS Total scores (rs = .673, p = .023). This study is the first to provide evidence of specific physiological deficits of both swallowing and voluntary cough in children with SCP. Potential hypotheses explaining these deficits and implications for physiologically driven management are explored

Development of a Communication Intervention to Assist Hospitalized Suddenly Speechless Patients

Healthcare staff face significant challenges while caring for hospitalized patients experiencing sudden inability to verbalize their needs (sudden speechlessness). Familiar methods of communication such as non-verbal strategies are limited and often fail to assist suddenly speechless patients (SS) communicate their needs. Consequently, strategies tailored to the needs of hospitalized speechless patients are necessary, and must consider factors intrinsic to the patients and the complexities of the acute care environment. The feasibility and usability of a multi-functional prototype communication system (speech-generating device) tailored to the needs of hospitalized SS patients was evaluated in this pilot study. Adult SS patients admitted to the intensive care setting (n=11) demonstrated independent use of a multi-functional communication system that integrated messages and strategies tailored to the needs of the hospitalized SS patient. Participants reported high satisfaction levels and considered the use of the technology of high importance during an SS event. Additional research should focus on evaluating the impact of technology specific communication interventions on enhancing the communication process between SS patients and healthcare staff

Respiratory kinematic and airflow differences between reflex and voluntary cough in healthy young adults

Background: Cough is a defensive behavior that can be initiated in response to a stimulus in the airway (reflexively), or on command (voluntarily). There is evidence to suggest that physiological differences exist between reflex and voluntary cough; however, the output (mechanistic and airflow) differences between the cough types are not fully understood. Therefore, the aims of this study were to determine the lung volume, respiratory kinematic, and airflow differences between reflex and voluntary cough in healthy young adults.Methods: Twenty-five participants (14 female; 18-29 years) were recruited for this study. Participants were evaluated using respiratory inductance plethysmography calibrated with spirometry. Experimental procedures included: 1) respiratory calibration, 2) three voluntary sequential cough trials, and 3) three reflex cough trials induced with 200 µM capsaicin. Results: Lung volume initiation (LVI; p=.003) and lung volume excursion (LVE; p<.001) were significantly greater for voluntary cough compared to reflex cough. The rib cage and abdomen significantly influenced LVI for voluntary cough (p<.001); however, only the rib cage significantly impacted LVI for reflex cough (p<.001). LVI significantly influenced peak expiratory flow rate for voluntary cough (p=.029), but not reflex cough (p=.610). Discussion: Production of a reflex cough results in significant mechanistic and airflow differences compared to voluntary cough. These findings suggest that detection of a tussigenic stimulus modifies motor aspects of the reflex cough behavior. Further understanding of the differences between reflex and voluntary cough in older adults and in persons with dystussia (cough dysfunction) will be essential to facilitate the development of successful cough treatment paradigms

Tailored deep brain stimulation optimization for improved airway protective outcomes in Parkinson's disease

AbstractThere is no consensus regarding the effects of deep brain stimulation (DBS) surgery on swallowing outcomes in Parkinson's disease (PD). No prospective studies have compared airway protective outcomes following DBS to the subthalamic nucleus (STN) versus globus pallidus interna (GPi). A recent retrospective study described swallowing outcomes pre- and post-STN vs. GPi DBS in a cohort of 34 patients with PD. The results revealed that the patients who received GPi DBS maintained their swallowing function post-DBS, while those in the STN group significantly worsened in swallowing safety. As DBS surgery becomes a common management option in PD it is important to understand the impact of DBS on airway protective outcomes; especially given that aspiration pneumonia is the leading cause of death in this population. We present a case report in which optimizing DBS settings with the goal of improving laryngeal function resulted in immediate improvements to swallowing safety