Communication difficulties following right hemisphere stroke : applying evidence to clinical management

Following reports in the 1960s that language may be affected by right hemisphere (RH) lesions, many limitations to effective communication in the right hemisphere damaged (RHD) population have been described and evidenced. However, stereotypical portrayals and descriptions of carefully selected cases may be misleading as to the extent of communication deficits. In many of the parameters in which RHD patients are presented as typically impaired, e.g. discourse skills, a less severe picture may emerge where data from the non-brain damaged (NBD) population are considered, with age and education variables controlled. Subsequent to RHD, some people show deficit on some communication measures, but many of these communication behaviours are also present in some NBD adults. Thus diagnosis of deficit must be made with reference both to the healthy peer population and the individual's pre-lesion behaviour. The authors' right RH stroke research programme includes studies of incidence of communication deficit, comparisons of RHD and NBD groups in various spoken discourse and comprehension tasks, comparison of RHD groups of different ages, detailed analysis of topic within discourse in RHD and NBD groups, family members' views of communication behaviour following RHD, and the natural course of communication change during the first year after RH stroke. The findings from several studies are summarised and used as the basis for management recommendations, which may guide future outcome research. There is an urgent need for the evaluation of communication management programmes, to determine whether therapists may with confidence offer an effective intervention service to those people whose communication skills are affected by RHD

Cognitive–linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis

Multiple sclerosis (MS) is a disabling neurological disease with varied symptoms, including dysarthria and cognitive and linguistic impairments. Association between dysarthria and cognitive-linguistic deficit has not been explored in clinical MS studies. In MS patients with chronic progressive (CP) MS, the study aimed to investigate the presence and nature of cognitive-linguistic deficit, association between levels of cognitive-linguistic ability and speech intelligibility and of both of these with functional disability and time since onset (TSO) of MS symptoms. The Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles and Tomoeda 1993), The Assessment of Intelligibility of Dysarthric Speech (AIDS) Sentence Intelligibility Task (Yorkston and Beukelman 1984) and the Modified Barthel Activities of Daily Living Index (MBADLI) (Shah1998) were administered to 24 CP MS participants with dysarthria. 24 non neurologically impaired participants, matched for gender, age and education, formed a control group. For MS participants, linear regression analysis showed a strong association between ABCD and AIDS (Beta = .89, p = 0.005), no association between ABCD and either MBADLI or TSO, a strong association between AIDS and MBADLI (Beta = 0.60, p = .001), and a trend towards association between AIDS and TSO (Beta = -.29, p = 0.08). Correlations between the four included ABCD construct scores and between these and the total ABCD score were significant (r >.60, p .80). The results revealed a strong association between dysarthria, as measured by connected speech intelligibility testing, and cognitive-linguistic deficit, in people with CP type MS. While some of the impairments which are associated with MS, including motor speech disorder, may influence performance on the ABCD, the data support the conclusion that marked cognitive-linguistic deficit is present in CP type MS patients with dysarthria. Deterioration was global, rather than being indicative of a construct specific deficit, and encompassed language, both expression and comprehension. Episodic memory and linguistic expression were especially affected. Speech and language therapists who work with dysarthric patients with CP MS should monitor cognitive-linguistic impairment. Awareness of this may influence assessment, intervention and management, including the information and advice given to patients and their relatives

Improved status following behavioural intervention in a case of severe dysarthria with stroke aetiology

There is little published intervention outcome literature concerning dysarthria acquired from stroke. Single case studies have the potential to provide more detailed specification and interpretation than is generally possible with larger participant numbers and are thus informative for clinicians who may deal with similar cases. Such research also contributes to the future planning of larger scale investigations. Behavioural intervention is described which was carried out with a man with severe dysarthria following stroke, beginning at seven and ending at nine months after stroke. Pre-intervention stability between five and seven months contrasted with significant improvements post-intervention on listener-rated measures of word and reading intelligibility and communication effectiveness in conversation. A range of speech analyses were undertaken (comprising of rate, pause and intonation characteristics in connected speech and phonetic transcription of single word production), with the aim of identifying components of speech which might explain the listeners’ perceptions of improvement. Pre- and post intervention changes could be detected mainly in parameters related to utterance segmentation and intonation. The basis of improvement in dysarthria following intervention is complex, both in terms of the active therapeutic dimensions and also the specific speech alterations which account for changes to intelligibility and effectiveness. Single case results are not necessarily generalisable to other cases and outcomes may be affected by participant factors and therapeutic variables, which are not readily controllable

Non-speech oro-motor exercise use in acquired dysarthria management : regimes and rationales

Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy (SLT) manuals, and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. The investigation sought to collect development phase data, in accordance with the Medical Research Council evaluation of complex interventions. The aims were to establish the extent of NSOMExs use in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. SLTs throughout Scotland, Wales and Northern Ireland, working with adult acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. One hundred and ninety one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of SLT experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute (HEI) teaching. More experienced SLTs were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended HEI was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but included also improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were 4-6 repetitions of each exercise, during three practice periods daily, each of 6-10 minutes. Conclusions & Implications: NSOMExs are a frequent component of dysarthria management in the UK devolved government countries. This confirmation, along with the details of SLT practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. SLT practice may be guided by evidence that speech outcome is or is not affected by NSOMExs

Comparing the Therapeutic Efficacy of Human Amniotic Membrane and Adipose-Derived Mesenchymal Stem Cells in Mitigation of Osteoarthritis

Osteoarthritis (OA) is a leading cause of disability and pain to patients worldwide, and is characterized by abnormal subchondral bone remodeling, such as sclerosis and osteophyte formation, synovial tissue inflammation, and the destruction of articular cartilage, with limited capability for intrinsic repair. Currently, only palliative options are available to help treat the debilitating effects of the disease as there are no therapies authorized to halt or prevent the progression of OA. Due to the destructive nature of OA and a lack of current treatment options, there is an urgent need to develop novel therapies to mitigate the progression of OA. Stem cell-based regenerative strategies hold promising opportunities to provide enhanced therapeutic efficacy due to their increasingly investigated and reported ability to regulate inflammation in vitro. Our lab has previously shown, in an in-vitro explant co-culture study, that human perinatal amniotic membrane-derived stem cells (hAMSCs) demonstrated an enhanced chondro-protective effect compared human adipose-derived stem cells (hADSCs), which are commonly utilized in regenerative applications. To further our previous findings, the overall purpose of this research was to investigate and compare the therapeutic efficacy of these two stem cell sources in mitigation of OA in vivo. This was achieved by directly comparing hAMSCs to hADSCs via various histological and biochemical outcome measures as well as longitudinal fluorescent cell tracking ensuing direct intra-articular injection into a spontaneous OA model; the Dunkin Hartley Guinea Pig (DHGP). Results indicate that the DHGP serves as a validated spontaneous OA model while histological trends demonstrated that use of stem cell treatments mitigated cartilage degradation in comparison to non-stem cell treated groups. However, it was observed that both stem cell sources did not provide a significant therapeutic effect in vivo as results revealed a limited residence time and lack of tissue engraftment of hAMSCs and hADSCs following injection. Altogether, these findings highlight the current limitations of stem cell-based therapy once indicated in a complex, pathological environment. Therefore, further investigations are warranted to evaluate the therapeutic capabilities of stem cells following transplantation in in vivo models of OA

Inconsistency with the Internal Consistency Test

The article examines the constitutionality of a Maryland tax law focusing on the U.S. Supreme Court case Comptroller of the Treasury of Maryland v. Wynne, and mentions history of state taxation under the dormant Commerce Clause; and use of internal consistency test by the Supreme Courts in Wynne

Alien Registration- Mackenzie, Catherine (Dresden, Lincoln County)

https://digitalmaine.com/alien_docs/13028/thumbnail.jp

Dysarthria in stroke : a narrative review of its description and the outcome of intervention

Dysarthria is a frequent and persisting sequel to stroke and arises from varied lesion locations. Although the presence of dysarthria is well documented, for stroke there are scant data on presentation and intervention outcome. A literature search was undertaken to evaluate a) the features of dysarthria in adult stroke populations relative to the conventional Mayo system for classification, which was developed from diverse pathological groups, and b) the current status of evidence for the effectiveness of intervention in dysarthria caused by stroke. A narrative review of results is presented. The limited data available indicate that regardless of stroke location, imprecise articulation and slow speaking rate are consistent features, and voice disturbances, especially harshness, and reduced prosodic variation are also common. Dysarthria is more prevalent in left than in right hemisphere lesions. There is a need for comprehensive, thorough analysis of dysarthria features, involving larger populations, with stroke and other variables controlled and with appropriate age-referenced control data. There is low level evidence for benefits arising from intervention in stroke related dysarthria. Because studies involve few participants, without external control, and sometimes include stroke with other aetiologies, their results lack the required weight for confident evidence-based practice

Evaluation of job design and its effect on employee engagement in a private outpatient healthcare provider in Kenya: a case of AAR healthcare Kenya

Engagement has been theorized as one of the key positive outcomes of well-designed jobs. Job design determines how the employee interacts with work on a daily basis and significantly influences the behaviour of the employee. The broad objective of this study was to evaluate the effect of job design on employee engagement. Social exchange theory explained the findings of the studies linking job design to employee engagement. Quantitative descriptive cross-sectional research design was used. The target population was 302 employees of private outpatient healthcare provider. Simple random sampling was used and Sample size was determined using Yamane (1967) formula. Data was collected using structured closed-ended questionnaires. The response rate was 63% which was 108 employees out of the sample size of 172. Generally, the study found out that job design affects employee engagement and that both are significantly related. Job design was found to contribute 67% of the variability in the level of engagement amongst the employees. Autonomy was more strongly correlated with employee engaged as compared to the other task characteristics. Characteristics of job design such as autonomy, task variety and task significance should be put into consideration when crafting job descriptions for the employees. This is because they strongly determined the level of employee engagement which has been widely associated with employee high level of performance, job satisfaction and organizational citizenship behaviour