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A project with several strands was carried out with a local Volunteer Stroke Scheme (VSS) which evaluated current practice; identified gaps in practice on which a training programme was based: and then evaluated the outcome of this training in subsequent activities.
This paper presents an argument in support of clinic based research. The role that the clinic-based speech and language therapist has in advancing our knowledge of communication disorders and their treatment is emphasised. The value of single-case research within the field of speech and language therapy is discussed and the arguments are presented with respect to stammering. A single case study of pre-school dysfluency is used to illustrate the potential for conducting research using this methodology in a clinical environment.
The principal symptom of subjects suffering from King-Kopetzky syndrome is a perceived difficulty in recognizing and understanding speech in noisy backgrounds. For some patients, minor disturbances in auditory function, e.g. a deteriorated signal-to-noise ratio for speech, can be demonstrated; for others, all measurements of hearing are normal. A conceptual framework developed for the analysis of communication disorders is applied to King-Kopetzky syndrome in the present article. The usefulness of the framework is evaluated, and an extended system for the analysis of King-Kopetzky syndrome patients is suggested. It is emphasized that changes in demands resulting from external conditions and altered perception and evaluation of the conditions may generate the symptoms. A change in the subjects' desired self-image (preferendum) and a change in social role, new, unfamiliar vocabulary, as well as minor dysfunctions in peripheral and central auditory processing, might generate the characteristic features of the syndrome. The framework is related to the current literature, and arguments for the usefulness of the framework in the planning of support and rehabilitation are presented. Several new questions are generated for further analysis of King-Kopetzky syndrome.
Evidence-based practice (EBP) has been widely embraced in many health-care fields as a way of maintaining currency of knowledge and state-of-the-art treatment recommendations in an age of information abundance and rapid scientific progress. Although the principles of EBP are slowly entering the specialties of communication disorders, they are not well known or extensively employed as yet. In this article, the rationale for EBP is presented and differences between EBP and traditional practice are highlighted. The five-step process of EBP is described: defining the problem, searching for evidence, critically appraising the evidence, formulating a recommendation, and assessing the outcome. Critical appraisal calls for determination of the validity, clinical significance, and applicability of evidence. Each of these topics is explored with emphasis placed on the application of EBP to hearing rehabilitation. Finally some suggestions are offered for researchers and practitioners to facilitate a transition to EBP in amplification provision.
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Three patients with referred otalgia and/or oropharyngeal pain due to ectopic facial hair found in either the external auditory canal or oropharynx were treated at the Cleveland Clinic Foundation, Department of Otolaryngology and Communicative Disorders. In each of these patients, annoying symptoms were relieved by simple removal of the misplaced facial hair. Sensory nerve innervation of the external ear and oropharynx and their interrelationship in referred pain are described in detail following the case reports.
PURPOSE: This study was conducted to identify health problems and support received from the health and welfare service using MDS-HC(Minimum Data Set for Home Care) in the aged living at home. METHOD: Eighty-one elderly persons were selected from those listed in community-welfare service centers in Seoul and Kyunggi Province between December 2002 and January 2003. RESULT: Eleven health problems per elderly person on average were identified, and the frequent care needs were in order: preventive health measure, health promotion, visual function, depression & anxiety, communication disorders, social function, pain, environmental assessment, oral health, cognition and falls. The number of health problems by the level of ADL was 'ADL 1(Independence)' 9.87, 'ADL 2(Partial independence)' 12.78, 'ADL 3(Dependence)' 13.73. Utilization of formal health & welfare services among the elderly was 'meals on wheels' 40.7%, 'home helper' 38.2%, 'visiting of social welfare worker' 21.0%, 'physical therapy' 19.6%, 'day care center' 12.3%, 'volunteer's service' 9.9%, 'home visiting care' 3.7%, 'occupational therapy' 3.7%, and 'speech therapy' 2.5%. CONCLUSION: The results suggest that using the MDS-HC 2.0 is applicable to help decide criteria for both health and welfare service supplied to the elderly.
BACKGROUND: This open-label study examined the effects of the reversible cholinesterase inhibitor donepezil on emotional/behavioral symptoms in Alzheimer's disease (AD) patients. METHOD: Patients were diagnosed as having probable/possible AD by National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria. This study used the CERAD Behavior Rating Scale for Dementia (CBRSD) and its subscales to evaluate a group of 25 AD patients treated with donepezil. Dosage was increased at 4 months for most patients from 5 to 10 mg q.h.s. Analysis of variance was used to compare scores over a period of 12 months. These patients were also compared, using t tests, to a reference group that had received no donepezil or other anticholinesterase. RESULTS: Donepezil administration was associated with improvement in Mini-Mental State Examination (MMSE) and CBRSD total scores at 3-month evaluation (p< or =.05). CBRSD depression and behavioral dysregulation scores improved transiently at 4 months (p< or =.05). MMSE, CBRSD total, CBRSD depression, and CBRSD behavioral dysregulation scores returned to baseline levels at 12 months, in contrast to the reference group, whose MMSE and CBRSD total scores worsened minimally over the 12 months. CONCLUSION: Donepezil has a mildly positive effect on emotional/behavioral symptoms in AD in addition to its effect on cognitive function.
BACKGROUND: Vagus nerve stimulation (VNS) is an established treatment method for therapy-refractory epilepsy and, in Europe, for treatment-resistant depression also. Clinical and experimental investigations have also shown positive effects of VNS on cognition in epilepsy and depression. The purpose of the present pilot study was to investigate the effect of VNS on cognition in patients with Alzheimer's disease. METHOD: All the included patients (N = 10) met the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria for the diagnosis of Alzheimer's disease. Before the implantation of the vagus stimulator (NeuroCybernetic Prosthesis), the patients underwent neuropsychological tests (e.g., Alzheimer's Disease Assessment Scale-cognitive subscale [ADAS-cog] and Mini-Mental State Examination [MMSE]), computerized tomography of the brain, medical/neurologic and psychological examinations (status evaluation), and lumbar puncture with investigation of the cerebrospinal fluid. The presence of depressive symptoms was rated using the Montgomery-Asberg Depression Rating Scale. The VNS was initiated 2 weeks after the implantation, and the patients were followed up with regular investigations and tests over 6 months. Response was defined as improvement or absence of impairment in ADAS-cog and MMSE scores after 3 and 6 months. RESULTS: After 3 months of treatment, 7 of 10 patients were responders according to the ADAS-cog (median improvement of 3.0 points), and 9 of 10 patients were responders according to the MMSE (median improvement of 1.5 points). After 6 months of treatment, 7 patients were responders on the ADAS-cog (median improvement of 2.5 points), and 7 patients were responders on the MMSE (median improvement of 2.5 points). VNS was well tolerated, and its side effects were mild and transient. CONCLUSION: The results of this open-label pilot study suggest a positive effect of VNS on cognition in patients with Alzheimer's disease. Further studies are warranted.
BACKGROUND: Cognitive-enhancing effects of vagus nerve stimulation (VNS) have been reported during 6 months of treatment in a pilot study of patients with Alzheimer's disease (AD). Data through 1 year of VNS (collected from June 2000 to September 2003) are now reported. METHOD: All patients (N = 17) met the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD. Responder rates for the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Mini-Mental State Examination (MMSE) were measured as improvement or absence of decline from baseline. Global change, depressive symptoms, and quality of life were also assessed. Cerebrospinal fluid (CSF) levels for total tau, tau phosphorylated at Thr181 (phosphotau), and Abeta42 were measured by standardized enzyme-linked immunosorbent assay (ELISA). RESULTS: VNS was well tolerated. After 1 year, 7 (41.2%) of 17 patients and 12 (70.6%) of 17 patients improved or did not decline from baseline on the ADAS-cog and MMSE, respectively. Twelve of 17 patients were rated as having no change or some improvement from baseline on the Clinician Interview-Based Impression of Change (CIBIC+). No significant decline in mood, behavior, or quality of life occurred during 1 year of treatment. The median change in CSF tau at 1 year was a reduction of 4.8% (p = .057), with a 5.0% increase in phosphotau (p = .040; N = 14). CONCLUSION: The results of this study support long-term tolerability of VNS among patients with AD and warrant further investigation.
CONTEXT: Several abnormalities have been described in red blood cells of patients with Alzheimer disease (AD), but to date none of these has been confirmed by a second, independent study. Erythrocyte anion exchange has been reported to be abnormal in AD; we have developed a new technique for measuring anion exchange. OBJECTIVES: To confirm the abnormality of erythrocyte anion exchange in AD and to determine whether the phenomenon has potential for clinical utility. DESIGN: Comparison of patients with probable AD to age-matched controls. SETTING: University hospital and ambulatory clinic. METHODS: Chloride-bicarbonate exchange was measured in erythrocyte ghosts resealed with a fluorescent probe of chloride concentration. RESULTS: Erythrocyte anion exchange is abnormal in AD. This difference appears in citrate but not EDTA anticoagulant. Mahalanobis's generalized distance between the 2 populations is 1.7, and a discriminant function derived from our technique classifies 82% of the study population in accordance with the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Receiver operating characteristic analysis demonstrates the possibility of choosing cutoffs with high sensitivity and specificity. CONCLUSIONS: Measurement of red blood cell anion exchange may be useful in classifying patients with AD. The dependence of this phenomenon on anticoagulant suggests the involvement of platelet activation or complement fixation.
The Northern Outreach Program (NOP) in Ontario, Canada was initiated in 1980 by the Health Sciences Faculties at The University of Western Ontario and the Ontario Ministry of Health. Objectives of the NOP are to contribute to development of health services and health manpower in Northern Ontario and to develop supportive research programs. NOP Coordinators are appointed to their respective faculties from each of the following disciplines: Communicative Disorders, Library Science, Nursing, Occupational Therapy, and Physical Therapy (PT). PT coordinators identify needs and opportunities for development of PT service and manpower in the North, collaborating with District Health Councils and health professionals. Programs are developed considering the areas of service, manpower, education, and research. Programs include workshops, consultations, student clinical placements, and access to library resources. An external evaluation of the NOP was carried out and ongoing evaluation of the PT program is based on feedback from program participants. The NOP has been effective in supporting development of PT services in Northern Ontario, decreasing professional isolation and also serves as a model for other programs. Alternatives for recruitment and retention of manpower and research opportunities must continue to be developed to ensure optimal delivery of health care to underserviced areas.
Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the elderly, are related to progressive neurodegenerative or vascular disorders with dementia. The aim of the study was to assess the prevalence and the intensity of higher cerebral dysfunctions in the population over 65 years and to investigate the association between these disorders and the presence of other neurological abnormalities, i.e. extrapyramidal signs, primitive reflexes as well as cognitive impairment assessed by Mini-Mental State Examination (MMSE). There were 92 women and 90 men, aged from 65-78 years included in the study. All patients were interviewed for the presence of vascular risk factors. The battery of 21 detailed test of higher cerebral functions testing speech, calculation, reading, writing, praxia and gnosia were performed in each person. Extra-pyramidal signs and primitive reflexes were also examined. Among the disorders of higher cortical functions, slight dyspraxia was the most frequent (33.7%). Finger dysgnosia, dyscalculia and dysgraphia were found less frequently. 25.4% of studied group abnormally performed at least two tests assessing higher cortical functions and when compared with normal persons, they presented significantly more frequent the extrapyramidal signs (63.9% vs. 46.9%, respectively) and had significantly frequent impaired cognitive functions (p < 0.05). Patients with higher cortical dysfunction, when compared with other persons, had more frequent primitive reflexes (p < 0.05). The results of the study showed that slight disorders of higher cortical functions were found in about 25% of studied population; they were more frequent in people with cognitive impairment, primitive reflexes and extrapyramidal signs.
The need for culturally appropriate language tests served as motivation for this study. The aim of the study was to evaluate the suitability and adaptability of the Afrikaanse Reseptiewe Woordeskattoets (ARW) (Buitendag, 1994) for a group of seven and ten year old non-standard Afrikaans speaking children from the coloured community in Gauteng, North West, Mpumalanga and Northern Province. In order to achieve this goal the ARW (Buitendag, 1994), and a questionnaire regarding socio-economic deprivation, were administered to a proportionally stratified randomized sample of 960 children. Test bias was evaluated by comparing the psychometric characteristics of the test for the research group to those of the normative group. Various test adaptation procedures were considered, namely adaptations to the rank order of item difficulty, test starting points and test procedures. The results indicated the same degree of confidence in the test results of the two groups. It demonstrated that the original rank order of item difficulty does not need to be changed and that corresponding increase in ARW scores is evident with an increase in age in both groups. The findings imply that the test measures the same ability in the two groups. Although comparison of the psychometric characteristics of the test for the research group to those for the normative group failed to identify test bias, intra-group comparison indicated that the test may be linguistically biased against the socio-economically deprived sub-group. Significant differences in individual ARW scores occurred when a shift in the child's basal or ceiling item occurred as a result of the biased items. The test's cultural validity for the group may be increased by lowering the test starting points, in order to prevent reversed testing. Culturally appropriate responses should be accepted as correct, in order to award equal credit to standard and non-standard language responses and to take intra-group differences into consideration. This research is an important contribution towards the expansion of the speech-language therapist's skills and resources, vitally needed to provide culturally relevant services in South Africa to all individuals with communication disorders.
OBJECTIVE: The purpose of this study was to evaluate symptoms associated with impaired insight in patients with Alzheimer disease (AD). BACKGROUND: Although unawareness of deficits is common in AD, the relation of awareness to psychiatric and behavioral disturbances has not been extensively studied. METHOD: We conducted a cross-sectional investigation of 91 patients with probable AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Awareness of cognitive and functional deficits was measured with the Inaccurate Insight item from the Neurobehavioral Rating Scale. Psychiatric and behavioral symptoms were measured using factor scores and individual items from the Neurobehavioral Rating Scale. Global cognitive deficits were measured using the Mini-Mental State Examination (MMSE). RESULTS: Stepwise regression analysis showed that insight was associated with MMSE score, depression/anxiety factor score, and agitation/disinhibition factor score. Variables not associated with awareness of deficits included patient age, behavioral retardation factor score, verbal output disturbance factor score, and psychosis factor score. Post hoc analyses showed a positive relation (i.e., greater insight, more symptomatology) between deficit awareness and symptoms of depressed mood and anxiety. There was a negative relation (i.e., greater insight, less symptomatology) between insight and symptoms of hostility, agitation, inattention, and tension. In a follow-up stepwise regression analysis, increased deficit awareness was associated with a higher MMSE score, greater depressed mood, and decreased agitation. CONCLUSIONS: These findings suggest that patients with AD may experience symptoms of depressed mood in relation to increased awareness of decrements in functioning. The data also indicate that patients with poor insight demonstrate greater agitated behavior. Consistent with previous research, impaired insight was higher in the later stages of the illness.
The National Library of Medicine, in partnership with the National Institute for Dental and Craniofacial Research, the National Eye Institute, the National Science Foundation, the National Institute for Deafness and Other Communication Disorders, and the National Cancer Institute, has founded a software consortium to support the creation of a public resource in high-dimension data processing tools. The initial emphasis of this effort is to provide public software tools in 3D segmentation and deformable and rigid registration, capable of analyzing the head-and-neck anatomy of the Visible Human Project data. The eventual goal is for the consortium to provide the cornerstone of a self-sustaining software community in 3D, 4D and higher dimensional data analysis. The consortium is committed to open-source code, public software including open interfaces supporting connections to a broad range of visualization and graphic user interface platforms.
OBJECTIVE: To analyze the factors which affect the burden and quality of life in carers of patients with Alzheimer's disease. MATERIAL AND METHODS: From a sample of 234 carers of patients in the Unit for Assessment of Memory and Dementia with a diagnosis of probable Alzheimer's disease, according to the scale of National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA), and of minimal or slight severity, according to the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) criteria, we obtained sociodemographic variables and administered the following questionnaires: Neuropsychiatric Inventory (NPI), Rapid Disability Rating Scale (RDRS-2), Quality of Life Questionnaire (QLQ) and Burden Interview (BI). RESULTS: The sex of the carers, the hours of attention to the basic activities of daily life (BADL) and the Cambridge Cognitive Examination (CAMCOQ), Minimental State Examination (MMSE), QLQ, NPI and RDRS-2 scores were related to the BI score. Multiple regression accepted the scoring for NPI, RDRS-2 and QLQ in the model. The QLQ score was associated with male sex of the patient, the age of the carer, employment status, whether or not he lived with the patient, with the family relationship, the hours of attention to the BADL and the scores on CAMCOG, MMSE, RDRS-2, NPI and BI. The multiple regression model included the age of the carer, the BI score and the hours of attention to the BADL. CONCLUSION: The non-cognitive symptoms, functional disability and poor perception of quality of life are factors affecting the burden and age of the carer, the hours of attention to the BADL and the burden affecting quality of life.