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PubMed2000

Helping young children with special developmental needs.

BACKGROUND: Many parents worry about their children's abilities and whether their behaviour is normal. The range and complexity of behaviour and skills change rapidly in young children with individual patterns of development varying widely. Normal stages of development may be delayed or the expected sequence varied. This can be associated with neurological or genetic disorders or chronic illness but may sometimes reflect a family pattern. Recognition of vulnerability enables the child's special needs to be supported before a disorder becomes entrenched. Intervention is aimed at understanding and supporting the child, promoting success and approval and encouraging appropriate neurobiological development. OBJECTIVE: This article aims to: clarify the general practitioner role in coordinating appropriate support in collaborative management; describe the relative frequency of various developmental problems; describe the range of assisting services available; emphasise the importance of early recognition and referral; and highlight the interaction between communication disorders and behavioural problems. DISCUSSION: The family doctor may be able to identify problems early and assist parents in coordinating optimum help for their children. Often the GP is the one professional who has known the child from infancy and may know other family members with similar problems as well as understanding the cultural context. This gives the GP a central role in early recognition of developmental vulnerability and in maintaining long term review and modification of supports for the child and family.

Australia↗
PubMed1996

Standardization of the diagnosis of dementia in the Canadian Study of Health and Aging.

Standardization of diagnostic procedures for cognitive impairment in large epidemiologic surveys remains difficult. This paper reports results of diagnostic standardization in a subsample of 2,914 elderly (age 65 years+) Canadians from the Canadian Study of Health and Aging (CSHA; n = 10,263). The objectives were to measure the consistency of the CSHA diagnosis as a test of validity; to assess inter-rater reliability, and to assess the impact of neuropsychological data on the diagnosis of dementia. The CSHA clinical assessment included a nurse's examination, Modified Mini-Mental Status (3MS) exam and Cambridge Mental Disorders Examination, neuropsychological tests, medical history and examination, and laboratory investigations. A final diagnosis was reached in a consensus conference which incorporated preliminary diagnoses from both physicians and neuropsychologists. Computer algorithms, which were developed to check consistency between the clinical observations and the final diagnosis, demonstrated 98% concordance with DSM-III-R criteria for dementia and 92% with NINCDS-ADRADA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for probable Alzheimer's disease. Inter-rater agreement was high: kappa = 0.81 for dementia/no dementia; kappa = 0.74 for normal/cognitive impairment, not dementia/ dementia. Comparisons of diagnoses between raters by clinical specialty revealed few systematic differences. The impact of neuropsychological input on the physician's diagnosis was most marked in the borderline cases between diagnostic categories.

Aged↗
PubMed1991

Neurogenic stuttering as a manifestation of stroke and a mask of dysphonia.

R. L. was a 52-year-old man who was referred for an SLP consultation to determine the nature of his fluency disorder, whether or not treatment would be beneficial, and finally whether resumption of pre-trauma vocational status was feasible. The patient was involved in a motor vehicle accident with no resulting detectable trauma. However, shortly after the accident, R. L. developed a severe dysfluency that was later described as cortical stuttering. We reviewed the medical and rehabilitation work-up that attempted to determine whether the communication disorder was functional or organic in origin. Once the fluency disorder was determined to be caused by a suspected small, focal, hemispheric lesion, a five-month treatment program was undertaken that used a noval prosthetic approach to restore fluency. Once fluency was restored with the use of an artificial larynx, a residual anomia was detected and treated. The case of R. L. illustrates a stuttering that appeared to be caused by a combined neurogenic dyspraxic (vocal control), dysarthric (motor control), and dysnomic (word-finding) dysfluency. The literature on this issue was reviewed and the underlying mechanism of recovery was discussed.

Anomia↗
PubMed1993

Evaluating research for clinical practice. A guide for practitioners.

This has been only a brief treatment of the topic, but one should note that research is an integral part of our clinical practice. If it were not for research our profession would remain static because our understanding of communicative disorders would not change. Instead, there has been a research commitment that has greatly increased our knowledge base. One only need look at the advances in assessment/treatment and the diversity in scope of practice to appreciate research. A profession well grounded in research is a profession that will continue to meet the challenges of the future. We need a strong research base to improve our services to communicatively handicapped persons, and practitioners must be active consumers of this research. The clinician and researcher share a common ground and must communicate with each other (Ringel, 1972). In practice, the speech-language pathologist needs to have a working knowledge of research, since she/he must continually deal with a variety of clinical problems. New tests and measurement procedures, treatments and other critical issues of the profession are subject to experimental scrutiny. It is up to the practitioner to critically examine an issue and then make a rational decision. Moll (1983) has indicated that rational clinical decisions are made on the basis of research and current clinical practice. There is no "cookbook" approach to utilizing research, but there are things that speech/language pathologists can do. First, one must read the literature and interpret the data. If research is to be utilized, make note of its success or lack of success.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed2006

A multi-center blinded prospective study of urine neural thread protein measurements in patients with suspected Alzheimer's disease.

OBJECTIVE: To investigate the utility of a clinical laboratory ELISA format assay that measures neural thread protein (NTP) in urine in the assessment of patients presenting with cognitive symptoms. DESIGN: A prospective blinded multicentered study. SETTING: Eight US specialty clinics for the evaluation of cognitive or memory disorder or dementia, including memory disorder and dementia clinics, neurology clinics, and psychiatry clinics, in 8 states. PARTICIPANTS: Prospectively enrolled consecutive patients who were newly referred to a specialty clinic for assessment of cognitive or memory disorder symptoms or dementia to rule out or rule in Alzheimer's disease (AD). MEASUREMENTS: Participants provided a first morning urine sample for UNTP measurement for testing at a central core laboratory and subsequently went through specialized diagnostic evaluations in accordance with established clinical criteria. Urine NTP measurement was compared to the diagnostic categorization of the patients as probable or possible AD (according to National Institute of Neurological Communicative Disorders and Stroke and the Alzheimer Disease and Related Disorders Association [NINCDS-ADRDA] criteria), mild cognitive impairment (MCI) (according to Quality Standards Subcommittee of the American Academy of Neurology [AAN] criteria) or definite non-AD. Clinical diagnoses were made without reference to UNTP measurement; the testing laboratory was blinded to both patient identity and clinical diagnoses. RESULTS: A total of 168 enrolled and consented patients provided qualifying urine samples and completed specialized diagnostic workups. There were 91.4% of subjects with probable AD, 37.7% of subjects categorized as possible AD, and 48.6% of subjects with MCI who had an elevated NTP measurement (>22 microg/mL). There were 90.7% of subjects diagnosed as definite non-AD who had a normal NTP measurement (< or =22 microg/mL). CONCLUSION: Noninvasive UNTP test results are potentially helpful as part of the workup of dementia for the nonspecialist to help in the decision as to whether referral and/or more detailed investigation is advisable.

Age Distribution↗
PubMed1998

Functional outcome assessment in dysarthria.

Strategies for the functional assessment of communication disorders experienced by persons with dysarthria can be based on the Chronic Disabilities Model described by Nagi (1991), which considers a disorders at five different levels, ranging from pathophysiology at the level of the tissue to the societal levels of dysfunction. Outcomes can be measured at all levels of the model. For example, at the pathophysiologic level, outcomes may indicate events at the tissue level during the course of the disease, whereas, at the level of the disability, outcomes reveal the adequacy of speech production using compensatory strategies in communicative contexts, and at the societal level, they may indicate the overall degree of success a speaker has in specific real-world speaking situations. This article focuses on "functional" assessment of persons with dysarthria. Thus, assessment is viewed from the perspective of how speech and the use of speech can be measured in functional situations over time or as a result of treatment.

Disability Evaluation↗
PubMed2006

[Role of geriatric physicians in the general hospital].

Geriatricians have a major roles to assess and head elderly patients using a team approach. In this paper, the first question is to ask what a geriatrician is, and the second question is to ask the role of a geriatrician. A geriatrician is a coordinator for elderly patients who have physical and mental disorders. We have to take care of not only diseases, but also the patients' lives after discharge from hospital. Geriatrician should coordinates a team approach and maintain contact with care managers. In general hospitals, discharge planning, which supports short and smooth discharge is an important role of geriatrician. We are frequently asked to see elderly patient by specialists because of difficult problems, such as delirium, cognitive dysfunction and communication disorder.

Aged↗
PubMed1998

[Prevention for speech-hearing therapists from the University of Valle in Cali, Colombia].

INTRODUCTION: Preventive activities in communication disorders treated by speech-hearing therapists of the Universidad del Valle in Cali Colombia, between January and April, 1995, are described. METHODOLOGY: Forty-five professionals to whom a self administered questionnaire with 13 questions was applied, were included in the study. RESULTS: For 67% the program of graduation is basic as source of their preventive knowledge. 47% used only one of nine strategic options and 29% report the use of only two of these preventive interventions. For all communication areas, on average nearly 60% of speech-hearing therapists never use preventive actions. CONCLUSION: The alumni of the Universidad del Valle do not exercise the practice of prevention in a systematic way it has been claimed by the curriculum of the school. Some determinants of social context and demand of professional services are suspected to induce a great reduction in the proportion and frequency of preventive practice in the professional role.

Colombia↗
PubMed2004

Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study.

BACKGROUND: Mild cognitive impairment has been regarded as a precursor to dementia of Alzheimer type, but not all patients with mild cognitive impairment develop dementia. OBJECTIVE: To determine whether depression may increase the risk of developing dementia. SETTING: The outpatient clinics of a community general hospital. DESIGN: Prospective cohort study. METHODS: A cohort of 114 patients with amnestic mild cognitive impairment was followed up for a mean period of 3 years. At baseline, the patients underwent memory tests, the Spanish version of the Mini-Mental State Examination, a verbal fluency test, the Geriatric Depression Scale, and the Clinical Dementia Rating Scale for staging purposes. Psychiatric examination for depression was based on structured interview and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria. We also carried out either computed tomography or magnetic resonance imaging of the brain. MAIN OUTCOME MEASURES: We carried out periodic evaluations based on the Mini-Mental State Examination, verbal fluency test, Geriatric Depression Scale, Blessed Dementia Rating Scale, and Clinical Dementia Rating Scale. The end point was the development of probable Alzheimer disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. RESULTS: Depression was observed in 41 patients (36%) at baseline. After a mean period of 3 years, 59 patients (51.7%) developed dementia of Alzheimer type, and 6 died. Of the depressed patients, 35 (85%) developed dementia in comparison with 24 (32%) of the nondepressed patients (relative risk, 2.6; 95% confidence interval, 1.8-3.6). The survival analysis also showed that depressed patients developed dementia earlier than the nondepressed. Most patients with depression at baseline exhibited a poor response to antidepressants. CONCLUSIONS: We conclude that patients with mild cognitive impairment and depression are at more than twice the risk of developing dementia of Alzheimer type as those without depression. Patients with a poor response to antidepressants are at an especially increased risk of developing dementia.

Aged↗
PubMed2005

Speech and language therapy for dysarthria due to non-progressive brain damage.

BACKGROUND: Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population. OBJECTIVES: To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain damage. SEARCH STRATEGY: We searched the trials registers of the following Cochrane Groups: Stroke, Injuries, Movement Disorders and Infectious Diseases. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The trials registers were last searched in September 2004. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to September 2004), EMBASE (1980 to September 2004), CINAHL (1983 to September 2004), PsycINFO (1974 to October 2004), and Linguistics and Language Behavior Abstracts (1983 to December 2004) were searched electronically. We handsearched the International Journal of Language and Communication Disorders (1966 to 2005, Issue 1) and selected conference proceedings, and scanned the reference lists of relevant articles. We approached colleagues and speech and language therapy training institutions to identify other possible published and unpublished studies. SELECTION CRITERIA: Unconfounded randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS: One author assessed trial quality. Two co-authors were available to examine any potential trials for possible inclusion in the review. MAIN RESULTS: No trials of the required standard were identified. AUTHORS' CONCLUSIONS: There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following non-progressive brain damage. Despite the recent commencement of a RCT of optimised speech and language therapy for communication difficulties after stroke, there continues to be an urgent need for good quality research in this area.

Adult↗
PubMed2001

[Employment and communication of hearing disabled patients].

Communicative disorders can remain an uncomfortable, costly, and debilitating factor throughout the lives of millions of children and adults. Deafness is a common problem and no age group is spared. Causes of hearing loss are numerous, and may be multifactorial in an individual. Important causes include trauma, including noise and air pressure changes; genetic hearing loss; infection, including rubella; drug damage, metabolic and neoplasia. Prompt detection and management of hearing loss in children is essential to ensure adequate development of language and associated skills. Untreated hearing loss in adults may cause them to withdraw from social activities. The patient with a hearing loss may represent difficult evaluation and management decisions. While individuals with defective hearing have a wide-ranging choice among absolutely attractive occupations, that choice is likely to be narrowed along with growing severity of the handicap. Hazardous, hearing-related, contact, and noisy occupations are not suitable for them. In handling such persons, due consideration should be given not only to the handicap proper but very much also to psychological aspects.

Adolescent↗
PubMedDate not supplied

Early discovery of hearing impairment: a critical evaluation of the BOEL test.

The BOEL test was originally devised for the early discovery of communication disorders in infants. The sound stimuli employed for hearing testing have been calibrated and standardized and any deviation from normal hearing responses to these stimuli indicate a hearing impairment. Since 1971 the BOEL screening program has been applied experimentally in a number of child health centers in Stockholm. Up to 1975, more than 30 000 infants have been examined and approximately 5% have not responded fully regarding visual or tactile attention, auditory, motor or mental functions or social contact. The results of the audiological follow-up are reported. Application of the BOEL hearing subtest proved very effective. It is pointed out that the BOEL test covers not only hearing defects but also other communication malfunctions and as such it is a more useful technique than simple hearing screening methods.

Child Behavior↗
PubMed2006

Analysis of narratives produced by four children who use augmentative and alternative communication.

UNLABELLED: The ability to narrate a story is fundamental to the development of overall communicative competence and involves the coordination of a variety of knowledge structures and linguistic abilities. In this study, the narrative discourse abilities of four children who use AAC are described in the context of five tasks designed to elicit a spectrum of narrative skills. Assessment was achieved through application of the Narrative Assessment Profile tool [Bliss, L. S., McCabe, A., & Miranda A. E. (1998). Narrative assessment profile: Discourse analysis for school-age children. Journal of Communication Disorders, 31, 347-362.] and analysis of seven major story elements. Our results indicate that most narrative discourse dimensions in our participating children appeared to be compromised and in need of intervention. Discussion includes aspects of narrative intervention and suggested topics for further research. LEARNING OUTCOMES: The reader will be able to: (1) create a list of issues involved in the development of narrative abilities of children who depend on augmentative and alternative communication systems (AAC) and (2) describe the issues involved in assessing the narrative skills of children who use AAC.

Arthrogryposis↗
PubMed1989

[Voice therapy according to Smith. Comments on the accent method of treating voice and speech disorders].

The accent method (A.M.) is based on the myoelastic and aerodynamic phonatory theory. The aim of the respiration exercises is to establish a predominantly abdominal respiration. Following the exercises of accentuated phonatory pulsations, patients work on reading special texts designed to enable them to become aware of the accentuated or unaccentuated sections. The AM is based on a holistic understanding of the voice and of speech. Whilst the exercise of AM is linked to a physiological phenomenon, such as phonatory aerodynamics and muscular function, the method is to be understood as a therapy aimed at producing an overall change in the behaviour related to oral communication disorders. The aim is not so much to eliminate a given particular defect, but rather to condition a subconscious automatism.

Humans↗
PubMed2003

Low serum cholesteryl ester-docosahexaenoic acid levels in Alzheimer's disease: a case-control study.

Low n-3 polyunsaturated fatty acid (PUFA) status may be associated with neuro-degenerative disorders, in particular Alzheimer's disease, which has been associated with poor dietary fish or n-3 PUFA intake, and low docosahexaenoic acid (DHA) status. The present case-control study used an established biomarker of n-3 PUFA intake (serum cholesteryl ester-fatty acid composition) to determine n-3 PUFA status in patients with Alzheimer's disease, who were free-living in the community. All cases fulfilled the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease. Detailed neuropsychological testing and neuroimaging established the diagnosis in all cases. The subjects (119 females and twenty-nine males) aged 76.5 (SD 6.6) years had a clinical dementia rating (CDR) of 1 (SD 0.62) and a mini mental state examination (MMSE) score of 19.5 (SD 4.8). The control subjects (thirty-six females and nine males) aged 70 (SD 6.0) years were not cognitively impaired (defined as MMSE score <24): they had a mean MMSE score of 28.9 (SD 1.1). Serum cholesteryl ester-eicosapentaenoic acid and DHA levels were significantly lower (P<0.05 and P<0.001 respectively) in all MMSE score quartiles of patients with Alzheimer's disease compared with control values. Serum cholesteryl ester-DHA levels were progressively reduced with severity of clinical dementia. DHA levels did not differ in patients with Alzheimer's disease across age quartiles: all were consistently lower than in control subjects. Step-wise multiple regression analysis showed that cholesteryl ester-DHA and total saturated fatty acid levels were the important determinants of MMSE score and CDR. It remains to be determined whether low DHA status in Alzheimer's disease is a casual factor in the pathogenesis and progression of Alzheimer's disease.

Age Factors↗
PubMed1997

Calpain Inhibitors as Neuroprotective Agents in Neurodegenerative Disorders.

It seems plausible to hypothesize that in all forms of neurodegeneration or other forms of tissue degeneration, a common pathway exists which when deciphered could lead to our understanding of a variety of diseases which result in tissue necrosis as well as offer potential for therapeutic intervention. A relatively recent interest has been our preliminary studies on the role of neurodegeneration in hearing loss and tinnitus, particularly that associated with noise. These studies grew out of a collaboration emanating from early discussions with Professor Abraham Shulman of the State University of New York, Health Science Center at Brooklyn, Department of Otolaryngology, and Dr Richard J. Salvi, of the Center for Communication Disorders and Sciences, Hearing Research Laboratories, State University of New York at Buffalo. Further studies in this very promising area of research are continuing for noise induced hearing loss protection and tinnitus control. A brief review of calpain is presented.

Journal Article↗
PubMed1998

Peer group training of pragmatic skills in adolescents with acquired brain injury.

OBJECTIVE: To empirically evaluate a method of treating adolescents with cognitive communication disorders, including pragmatic deficits, secondary to acquired brain injury (ABI) in a group setting by objectively measuring outcomes before treatment and immediately after treatment and at 6 months posttreatment. DESIGN: A before-after trial with follow-up in a consecutive sample, with no control group. SETTING: Inpatient and outpatient pediatric rehabilitation center. SUBJECTS: Adolescents who demonstrated pragmatic deficits and scored a rating of 3 or less on each subdomain of the Rehabilitation Institute of Chicago Rating Scale of Pragmatic Communication Skills (RICE-RSPCS) were eligible for the study. Eight subjects were recruited into the study, and two subjects were lost to follow-up. Thus, six of the eight completed the study. MAIN OUTCOME MEASURES: RICE-RSPCS, Communication Performance Scale (CPS). RESULTS: Clinically relevant and statistically significant (P <.01) changes occurred during the treatment and were maintained at follow-up for the four RICE-RSPCS subscales and the CPS. CONCLUSION: These results suggest that the potential and often typical long-term pragmatic and subsequent social difficulties associated with ABI can possibly be lessened through effective intervention.

Adolescent↗