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PubMed2000

Cleft palate: modern technology and neuroscience merge.

This is a report of a cleft palate-craniofacial team's experience with 768 patients that have had clefting over 22 years, with a primary focus on function and prevention of communication disorders associated traditionally with cleft palate. The treatment philosophy is based on tenets of child development and the dependency of neuropsychobiological development on the child's inherent competency, and early environmental stimulation and support. The applied treatments include ensuring early and adequate hearing, psychosocial adaptation of the parent and child through training for applications of indirect therapies, and early fistula-free surgical closure of the cleft that produces minimal scarring and a mobile velum. Team members have extensive backgrounds in child development that seem to have helped the majority of families in their complex efforts of daily care and sensory stimulation, and their children have developed early the ability to adapt modified structures to normal functions. Only one of these patients has needed or received secondary palatal surgery for correction of velopalatal insufficiency. Fifty-six children who did not achieve acceptable 2 to 3-year old communication criteria were referred for speech and language evaluation and therapy. These patients were reported to exhibit oral motor deficits described as developmental verbal dyspraxia.

Apraxias↗
PubMed1995

[Children with a presumably isolated speech-language disorder often have medical or cognitive problems as well].

OBJECTIVE: To assess the language problems of children who otherwise appear to develop normally. DESIGN: A clinical inventory. SETTING: University Hospital Groningen. METHOD: The children (n = 319) were examined according to a standard protocol consisting of: ENT examination, audiologic examination, paedogogic observation and logopaedic examination. Further psychological examination was carried out when needed according to the paedagogic observation. RESULTS: 25 per cent of the children had isolated language problems. For these children logopaedic therapy was indicated. In 75 per cent, a clear associated medical factor, or a retarded cognitive and (or) motor development, was found. Forty per cent of these children received medical treatment and 35 per cent specific paedagogic guidance. In some cases additional logopaedic therapy was given. CONCLUSION: It appears advisable to give children with language problems logopaedic therapy only after a diagnostic examination has been carried out according to a standard protocol as described.

Child↗
PubMed2000

[Inner ear in C.H.A.R.G.E. association].

Cochleovestibular dysfunction is one of the major features of C.H.A. R.G.E. association. The inner ear anomalies were studied in a population of 17 children with CHARGE. Temporal bone anomalies were defined with CT scan, hearing loss was evaluated with audiologic procedures appropriate for age, and functional canal and otolith vestibular impairment evaluated with respectively vertical and off vertical axis rotation (OVAR) tests. Temporal bone anomalies appear specific of C.H.A.R.G.E. association. They are characterized by an aplasia of the posterior labyrinth (with an absence of semicircular canals) and a variable degree of anomalies of the anterior labyrinth with sometimes normal cochlea. Hearing loss is variable, often worsened by delayed neurological maturity and frequent association of middle ear effusion. Thus, multiple audiologic evaluations are required at regular intervals. The treatment of middle ear effusion, the association of hearing aid and speech therapy management permit language acquisition in spite of the other multiple sensory handicaps. Vestibular functional evaluation shows a constant canal areflexia but a residual vestibular otolith function (sometimes normal). The deficit of the vestibular function is certainly involved in the delay of posturo-motor development as well as visual deficit and neurological impairment. This can permit an adaption of the physical therapy program for each child to make use of the available sensorial information.

Central Nervous System↗
PubMed1994

Lobular carcinoma of the male breast.

BACKGROUND: A case of lobular carcinoma in a male breast is described. Lobular carcinoma is a very uncommon histopathologic form of male breast cancer because of the absence of lobules in the normal male breast. The cytoarchitecture of the normal male breast can be deranged in conditions such as Klinefelter's syndrome or as a result of estrogen exposure. Lobular carcinoma of the male breast has been described in such instances where cytoarchitectural changes are likely to have occurred. METHODS AND RESULTS: After the pathologic diagnosis was made, a fibroblast karyotype was performed to confirm a male genotype. The patient had received no hormonal therapy. The English language literature was reviewed. CONCLUSIONS: This case represents the first report of lobular carcinoma in a proven genotypic male patient receiving no exogenous estrogens.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Different neural circuits subserve reading before and after therapy for acquired dyslexia.

Rehabilitative measures for stroke are not generally based on basic neurobiological principles, despite evidence from animal models that certain anatomical and pharmacological changes correlate with recovery. In this report, we use functional magnetic resonance imaging (fMRI) to study in vivo human brain reorganization in a right handed patient with an acquired reading disorder from stroke. With phonological dyslexia, her whole-word (lexical) reading approach included inability to read nonwords and poor reading of function words. Following therapy, she was able to read nonwords and function words, and preferred a decompositional (sub-lexical) strategy in general. fMRI was performed during a reading task before and after treatment. Prior to therapy, her main focus of brain activation was in the left angular gyrus (area 39). After therapy, it was instead in the left lingual gyrus (area 18). This result suggests first that it is possible to alter brain physiology with therapy for acquired language disorders, and second, that two reading strategies commonly used in normal reading use distinct neural circuits, possibly reconciling several conflicting neuroimaging studies of reading.

Adult↗
PubMed1994

Stuttering therapy with British-Asian children. II: Speech and language therapists' perceptions of their effectiveness.

This paper tested hypotheses arising from the literature on the treatment of stuttering in British-Asian children and adolescents, using data obtained from a postal questionnaire completed by 87 therapists. The results showed therapists treating lower numbers of Asian clients than expected, but perceiving their therapy to be less effective with their Asian clients than with their British ones. The variables affecting therapists' perceived success were not those expected. Greater experience with Asian clients did not increase perceived success, nor did Asian therapist and client sharing broadly the same cultural background guarantee success. A satisfactory interpreter service did not lead to a higher perceived success rate, nor did postgraduate training or making special changes to usual working practices. On the contrary, therapists in the last two categories were less likely to perceive success with their Asian clients. Therapists identified a very wide range of cultural factors needing special consideration in therapy, but consensus centred around parental attitudes to stuttering and to therapy.

Adolescent↗
PubMed1976

Strategies and risks in psychotherapy with bilingual patients: the phenomenon of language independence.

The presence of two separate languages, each with its own lexical, syntactic, semantic, and ideational components, can complicate psychotherapy with proficient bilingual patients. If only one language is used in therapy, some aspects of the patients emotional experience may be unavailable to treatment; if both languages are used, the patient may use language switching as a form of resistance to affectively charged material. The authors suggest that monolingual therapists should carefully assess the degree of language independence in bilinguals in order to minimize its impact on therapy. They conclude that study of bilingual patients may provide important insights into the nature of the therapeutic process.

Anxiety↗
PubMed2004

Intra-arterial thrombolysis in acute ischemic stroke: a review of pharmacologic approaches.

Ischemic stroke is a major public health problem worldwide. The potential to cure stroke patients with intravenous thrombolytic therapy has evolved to the use of intra-arterial thrombolytic agents. Fewer than 200 patients have been enrolled in randomized trials of intra-arterial therapy. In this article the authors have reviewed the literature listed in MEDLINE and EMBase, and searched relevant articles to examine the role of fibrinolytic agents in acute interventional stroke therapy. Only English language articles reporting five or more patients were included. Outcomes were defined at 90 days. Good outcome was defined on the modified Rankin Scale. Symtpomatic hemorrhage was defined as hemorrhage in the setting of clinical deterioration in the first 24 to 48 h. The search identified 57 studies of which 44 reported usable data. Only three randomized trials were reported. Of a total of 1140 patients, most (73%) were treated open-label with urokinase (Abbokinase, Abbott Laboratories). The best outcomes were reported in case series and slightly worse outcomes were reported in clinical trials. Overall, it was not possible to distinguish whether one agent was superior to the others. There is a paucity of published evidence on intra-arterial therapy for acute ischemic stroke. Alteplase (Activase, Genentech Inc.) is currently the drug of choice simply because it is available and it is the current intravenous standard. Further trials and developments are anticipated.

Brain Ischemia↗
PubMed1979

Toward a dialogue in international consultancy in occupational therapy with Japan as a reference.

The customs and cultural attitudes that determine occupational therapy practice cannot be transferred from one culture to another. However, the technology of occupational therapy can be transferred. The international consultant is responsible for such a technological transfer. The consultee is responsible for assimilating technology and creating a culturally appropriate treatment practice. Technological transfer in industry demonstrates that divergent cultural applications of the same technology are possible, that the autonomy of the consultee is of primary importance, and that government support of the consultation effort is crucial. Current practice and expectation in international occupational therapy consultation is examined. The author concludes that fluency in the language of the host country is a questionable expectation, and that short-term workshops by teams of therapists should supplement the traditional individual long-term consultancy. Japan is used as a reference for discussion.

Culture↗
PubMedDate not supplied

Bronchiolitis management by the Belgian paediatrician: discrepancies between evidence-based medicine and practice.

UNLABELLED: There is no therapy with proven effect on bronchiolitis outcome. This leads to large variations in its management between different countries. In order to evaluate how this disease was managed in our country, a questionnaire was sent to all Belgian paediatricians. With a response rate above 40% of active paediatricians, we found that bronchodilators (74.7% vs. 77.2%), physiotherapy (76.2% vs. 85.6%) and antibiotics (63.8% vs. 74.4%) were still largely prescribed in in- and outpatient settings respectively, corticosteroids (orally or intravenously) being prescribed more often in hospitals (54.3% vs. 17.0%). There were also some variations in admission criteria (minimal age 2 months (75%) to 6 months (8.2%), lower limit for oxygen saturation: 90% (21.5%) to 95% (26.5%)) and 1/3 of the respondents did not use pulse oxymetry to evaluate hypoxaemia in infants with bronchiolitis. Logistic regression analyses allowed us to identify patterns of prescription based on age, type and level of activity and language. CONCLUSION: Many therapies with no proven effect are still used by Belgian paediatricians to treat children with bronchiolitis. Based on these results, we believe that publishing national guidelines will allow a reduction in the cost associated with this disease.

Administration, Inhalation↗
PubMed2006

[Present status and future possibilities of adjuvant pharmacotherapy for aphasia].

Aphasia is one of the most frequent and disabling consequences of stroke. Poor spontaneous recovery and the limited success of conventional speech therapy bring up the question of how current treatment approaches can be improved. Besides increasing training frequency-with daily sessions lasting several hours and high repetition rates of language materials ("massed training")-adjuvant drug therapy may help to increase therapy efficacy. In this article, we illuminate the potential of monoaminergic (bromocriptine, levodopa, d-amphetamine) and cholinergic (donepezil) substances for treating aphasia. For a final evaluation of combined massed training and adjuvant pharmacotherapy, randomized, placebo-controlled (multicenter) clinical trials with sufficient numbers of patients are needed. Furthermore, results of experimental animal studies of functional recovery in brain damage raise hopes that neurotrophic factors or stem cells might find a place in recovery from aphasia in the intermediate future.

Aphasia↗
PubMed2006

Toward a common language for function, disability, and health.

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions. If widely adopted, the ICF framework could provide the rehabilitation field with a common, international language with the potential to facilitate communication and scholarly discourse across disciplines and national boundaries, to stimulate interdisciplinary research, to improve clinical care, and ultimately to better inform health policy and management.

Activities of Daily Living↗
PubMed1987

[Computer-assisted training programs in aphasia therapy].

This article shows how aphasic patients can use computer-aided training programs that enable them to train the language more or less independently apart from speech therapy. The computer offers help or feedback the moment it is asked for. The patient evaluates this as a mature method of therapy.

Aged↗