Biomedical subjects

J C Rosenbek

Publications and source records attributed to J C Rosenbek.

At least 19 recordsLinked to original sources

PubMed2005

Utility of clinical swallowing examination measures for detecting aspiration post-stroke.

The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that investigation as well as with other research on CSEs. The results suggest that clinicians can make an accurate judgment of the occurrence of aspiration in most post-stroke patients. However, ruling out aspiration when it is absent appears more problematic. More work needs to be done if data collected from non-instrumented examinations are to be strongly predictive of the presence and absence of aspiration on VFSE. At present, there are no data to suggest that CSEs can be used to quantify aspiration or make adequate recommendations regarding patient care.

Adult↗

PubMed2001

Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures.

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Adult↗

PubMed2000

Inter- and intrajudge reliability of a clinical examination of swallowing in adults.

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

Adult↗

PubMed2000

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development.

In the past two decades, noteworthy advances have been made in measuring the physiologic outcomes of dysphagia, including measurement of duration of structure and bolus movements, stasis, and penetration-aspiration. However, there is a paucity of data on health outcomes from the patients' perspective, such as quality of life and patient satisfaction. A patient-based, dysphagia-specific outcomes tool is needed to enhance information on treatment variations and treatment effectiveness. We present the conceptual foundation and item generation process for the SWAL-QOL, a quality of life and quality of care outcomes tool under development for dysphagia researchers and clinicians.

Aged↗

PubMed2000

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling.

The SWAL-QOL outcomes tool was constructed for use in clinical research for patients with oropharyngeal dysphagia. The SWAL-QOL was constructed a priori to enable preliminary psychometric analyses of items and scales before its final validation. This article describes data analysis from a pretest of the SWAL-QOL. We evaluated the different domains of the SWAL-QOL for respondent burden, data quality, item variability, item convergent validity, internal consistency reliability as measured by Cronbach's alpha, and range and skewness of scale scores upon aggregation and floor and ceiling effects. The item reduction techniques outlined reduced the SWAL-QOL from 185 to 93 items. The pretest of the SWAL-QOL afforded us the opportunity to select items for the ongoing validation study which optimally met our a priori psychometric criteria of high data quality, normal item distributions, and robust evidence of item convergent validity.

Aged↗

PubMed1998

Comparing treatment intensities of tactile-thermal application.

The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.

Aged↗

PubMed1998

Functional outcome assessment of adults with oropharyngeal dysphagia.

Neurologic and mechanical abnormalities of the oropharynx often result in oropharyngeal dysphagia. Assessment of dysphagia and its treatment has been limited largely to measurement of the biomechanical aspects of bolus flow. This article reviews the measurement tools in current use and in development for assessing oropharyngeal dysphagia in terms of the "value compass" for health services. A number of measurement needs for this clinical population are identified and discussed.

Adult↗

PubMed1997

A speaking task analysis of the dysarthria in cerebellar disease.

Cerebellar disease affects a number of skilled movements, including those in speech. Ataxic dysarthria, the speech disorder that typically accompanies cerebellar disease, was studied by acoustic methods. Control subjects and subjects with ataxic dysarthria were recorded while performing a number of speaking tasks, including sustained vowel phonation, syllable repetition, monosyllabic word production (intelligibility test), sentence recitation, and conversation. Acoustic data derived from the speech samples confirmed the hypothesis that temporal dysregulation is a primary component of the speech disorder. The data also show that the nature of the disorder varies with the speaking task. This result agrees with observations on other motor systems in subjects with cerebellar disease and may be evidence of a dissociation of impairments. Suggestions are offered on the selection of measures for a given task and on the role of the cerebellum in the regulation of speaking.

Adult↗

PubMed1996

Thermal application reduces the duration of stage transition in dysphagia after stroke.

The present study had two purposes. The first was to provide variability data on objectively measured durational parameters of swallowing as accomplished by dysphagic patients secondary to stroke. The second was to examine the short-term effects of thermal application on these same durational measures. The study employed a cross-over design with each dysphagic stroke subject swallowing 10 times in both untreated and treated conditions. Two findings emerged: (1) swallowing durations in the 22 dysphagic stroke subjects were highly variable within and across subjects and have distributions that were nonnormal with nonhomogeneous variances; (2) thermal application reduced duration of stage transition (DST) and total swallow duration (TSD). Implications of these findings are discussed.

Aged↗

PubMed1996

A penetration-aspiration scale.

The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.

Deglutition↗

PubMed1995

Efficacy in dysphagia.

Data demonstrating the efficacy of behavioral methods for treating dysphagia are in short supply. This paper defines efficacy and distinguishes it from efficiency. It highlights the attitudes, measures, decisions, and data essential to the design of clinical trials. The need for additional outcome measures and for establishing appropriate treatment intensities are emphasized.

Behavior Therapy↗

PubMed1993

Swallowing after unilateral stroke of the cerebral cortex.

We report differential patterns of swallowing in 40 patients with their first ischemic middle cerebral artery (MCA) stroke and compare these to 20 nonstroke controls. Stroke patients were divided a priori, into groups by right or left and, post hoc, primarily anterior or posterior MCA territory lesions. The left hemisphere subgroup was differentiated from controls by longer pharyngeal transit durations and from the right hemisphere group by shorter pharyngeal response durations. The right hemisphere subgroup was characterized by longer pharyngeal stage durations and higher incidences of laryngeal penetration and aspiration of liquid. Anterior lesion subjects demonstrated significantly longer swallowing durations on most variables compared to both normal and posterior lesion subjects. Changes in the consistency of foods and other modifications for safe nutrition should be considered during the first month of recovery for unilateral stroke patients with swallowing difficulty.

Adult↗

PubMed1992

Quantitative description of the dysarthria in women with amyotrophic lateral sclerosis.

Speech intelligibility and its phonetic and acoustic correlates were studied in a group of 10 women with amyotrophic lateral sclerosis (ALS). Intelligibility assessment with a word-identification test indicated that the most disrupted phonetic features pertained to velopharyngeal valving, lingual function for consonant contrasts of place and manner, and syllable shape. An acoustic signature analysis based on trajectories of the first and second formants in selected monosyllabic test words revealed that the mean slope of the second formant (F2) was reduced compared with that of a normal geriatric control group. This F2 slope reduction is interpreted to reflect loss of lingual motoneurons. Acoustic measures of phonatory function for sustained vowel prolongation demonstrated abnormalities in fundamental frequency, perturbations of frequency (jitter) and amplitude (shimmer), and signal-to-noise ratio. The data for women with ALS are compared with data for a normal geriatric control group of women and with data for a group of 25 men with ALS (Kent et al., 1990). Although the overall ranking of errors was similar for males and females with ALS, men were more likely to have impairments of voicing in syllable-initial position.

Adult↗

PubMed1991

Image processing in swallowing and speech research.

An image processing system for application to studies of the temporal and spatial parameters of movement during swallowing and speech is described. Image sequences from videotape are digitized for computerized manipulation and analysis in an attempt to improve on conventional visual inspection. The system is "interactive" or "event-driven": after executing a function, the computer waits for guidance from the user who controls the program through keyboard and mouse input, selecting options from menus and responding to prompts. The analyst alters image clarity by the application of filters and heightens contrast through video enhancement. A technique called "remapping" reduces head motion and provides uniform spatial scaling. Animated sequences of images are used, as opposed to frame-by-frame analysis, to preserve temporal context and increase efficiency of measurement. Low cost off-the-shelf personal computer hardware is used along with original software tailored to the application.

Deglutition↗

PubMed1991

Perceptual characteristics of vowel and prosody production in apraxic, aphasic, and dysarthric speakers.

Narrow phonetic transcriptions and prosodic judgments were made of single-word imitations by apraxic (AOS), conduction aphasic (CA), and ataxic dysarthric (AD) speakers. AOS and AD subjects showed similar vowel error patterns, particularly predominant errors in low, tense, and back vowels, more distortions than other types of vowel errors, and predominant errors in initial position of words and in monosyllabic words. The CA subjects displayed a different vowel error pattern, notably more substitutions than distortions, more errors in polysyllabic than monosyllabic words, and more errors in noninitial than initial positions of words. Analysis of prosodic features identifiable at the single-word level (e.g., syllabic stress, juncture, and struggles to initiate or complete productions) indicated that syllabic stress errors and more difficulty initiating than completing word production were characteristic of AOS and AD but not CA subjects.

Adult↗

PubMed1991

Effects of thermal application on dysphagia after stroke.

The influence of thermal application on dysphagia for liquid boluses after multiple cerebrovascular accidents was measured. A month-long trial of thermal application organized according to the guidelines of a single-subject withdrawal or ABAB design was replicated across 7 male subjects. After baseline testing, 6 subjects were randomly assigned to begin the study with a week-long period of thermal application (B stage), and 1 subject was randomly assigned to begin the study with a week-long period of no thermal application (A stage). Subsequent week-long A and B stages were then alternated until each subject had completed the 4-week interval of this study. Progress testing occurred at the end of each stage and at follow-up testing 1 month after the study's completion. The influence of thermal application on eight duration and four descriptive measures was determined by three judges using visual inspection of data displays. Two of three judges agreed that 2 of the subjects demonstrated decreased Duration of Stage Transition in the absence of any change in the occurrence of aspiration or penetration. Overall, this study failed to reveal strong evidence that 2 weeks of thermal application alternating with 2 weeks of no thermal application improves dysphagia following multiple strokes. Further replications are needed.

Aged↗

PubMed1991

Speech deterioration in amyotrophic lateral sclerosis: a case study.

Few detailed reports have been published on the nature of speech and voice changes during the course of amyotrophic lateral sclerosis (ALS). The subject of this case study is a woman who was diagnosed as having ALS with bulbar signs at the age of 53. Speech intelligibility, pulmonary function, and selected speech and voice functions were tested during an approximately 2-year course of her disease. Over this period, her speech intelligibility, as measured by a multiple-choice word identification test, declined from 98% to 48%. Phonetic features that were most affected during the intelligibility decline included voicing contrast for syllable-initial and syllable-final consonants, place of articulation contrasts for lingual consonants, manner of articulation for lingual consonants, stop versus nasal manner of production, features related to the liquid consonants, and various features related to syllable shape. An acoustic measure, average slope of the second-formant frequency, declined in association with the intelligibility reduction and is thought to reflect the loss of lingual motoneurons. Her pulmonary function also declined over the observation interval, with particularly severe reduction in measures of air flow. Oral diadochokinesis and measures of vocal function (including jitter, shimmer, and signal-to-noise ratio) were highly variable across test sessions. These results are discussed in terms of the challenges they present to sensitive assessment of change and to management of the communication disability in ALS.

Amyotrophic Lateral Sclerosis↗

PubMed1990

Perceptual characteristics of consonant production by apraxic speakers.

Single-word repetitions by 4 brain-damaged adults with apraxia of speech (AOS) but without concomitant aphasia were transcribed using a standard narrow phonetic transcription system. Analysis of consonant productions yielded a profile of AOS slightly different from the traditionally accepted one. Among the results was the atypical finding that consonant distortions exceeded all other error types including sound substitutions. In addition, errors predominated in the medial position of words, and monosyllabic words had approximately the same error rate per number of consonants as did multisyllabic words. Results are discussed with reference to previous perceptual descriptions of AOS and in relationship to Broca's aphasia. Results are also interpreted relative to linguistic and motoric components of speech production models.

Aged↗