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PubMed2005

Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early-stage breast carcinoma.

BACKGROUND: Evidence suggests that women diagnosed with early-stage breast carcinoma may experience cognitive problems as a consequence of adjuvant chemotherapy treatment. The present study was conducted to examine whether there are differences in cognitive performance and cognitive complaints between women treated with and without chemotherapy for TNM Stage 0 to II breast carcinoma. METHODS: As part of a larger study on quality of life, women were recruited with newly diagnosed Stage 0 to II breast carcinoma scheduled to be treated with chemotherapy plus radiotherapy (n = 60) or radiotherapy only (n = 83). Six months after the completion of treatment, participants were administered a standard neuropsychologic battery to assess cognitive performance and a self-report measure to assess perceived cognitive problems. RESULTS: There were no statistically significant differences between women who received chemotherapy and those who did not with regard to their average performance on tests of episodic memory, attention, complex cognition, motor performance, or language. Likewise, there were no significant differences between the treatment groups in the prevalence of impairment in each of these cognitive domains. Women who underwent chemotherapy also did not report significantly more problems with cognitive functioning than women treated without chemotherapy. CONCLUSIONS: The findings failed to confirm previous reports suggesting adjuvant chemotherapy is associated with problems in cognitive functioning among women who receive treatment for Stage 0 to II breast carcinoma. Future research should use prospective longitudinal research designs incorporating appropriate comparison groups to further explore this issue.

Analysis of Variance↗
PubMed1991

An adapted language training strategy in the treatment of an electively mute male child.

The present study investigated the usefulness of an Adapted Language Training Program in the treatment of an electively mute seven-year-old male. Training utilized a multiple baseline across behaviors single subject design. Four phases of treatment focused on non-verbal attending, verbal imitative responding, and functional language responding. Systematic attempts at promoting generalization of verbal responses across situations and persons were employed throughout the language program. A 90% appropriate response criterion was reached for all measures. Non-verbal attending and imitative verbal responding remained above criterion at the termination of treatment, but functional language responding regressed to below criterion. Generalization of verbal responses was noted outside of the training sessions.

Attention↗
PubMed1992

Language intervention and disruptive behavior in preschool children with autism.

Disruptive behaviors are often exhibited by children with severe disabilities during difficult teaching tasks. Because learning verbal communication can be a difficult task for nonverbal children with autism, disruptive behaviors are common during such interventions. The purpose of this experiment was to assess whether the incorporation of parameters of natural language interactions and motivational techniques might reduce disruptive behavior during language teaching tasks. Within a repeated reversals design with order of conditions and number of sessions varied within and across children, treatment was conducted for two language teaching conditions. During one condition trials were presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. The other condition incorporated parameters of natural language interactions and motivational techniques, such that stimulus items were functional and varied; natural reinforcers were employed; communicative attempts were reinforced; and trials were conducted within a natural interchange. Results showed that greater improvements in responding and considerably less (often negligible) disruptive behavior occurred during the natural language teaching conditions. Results are discussed with respect to their implications for improving language interventions, and with respect to reducing disruptive behavior without the need for specialized or severe interventions focused specifically on the disruptive behavior.

Autistic Disorder↗
PubMed1999

Acquisition of adaptive skills: psychotherapeutic change in cognitive and dynamic therapies.

We argue that there are important areas of overlap in the types of patient change processes that occur in cognitive therapy and dynamic therapy. These common processes of patient change have been obscured by differences in language and theoretical constructs between the two traditions. We suggest that the acquisition of adaptive skills describes patient change processes that are common to both therapies. More specifically, we propose that the concept of adaptive skills encompasses both the compensatory skills model of cognitive therapy (Barber & DeRubeis, 1989) and some of the patient changes that occur in dynamic therapies. In clarifying these areas of overlap between cognitive and dynamic therapies encompassed by the adaptive skills acquired in both, the present article highlights the fact that the two therapeutic traditions employ radically different techniques to achieve some of the same outcomes. Recognizing the overlap between change processes in the two types of therapy, and adopting a common language for them, allows for further theoretical and empirical investigation of therapy process and outcome.

Adaptation, Psychological↗
PubMed2002

Iatrogenic symptoms in psychotherapy. A theoretical exploration of the potential impact of labels, language, and belief systems.

Although the mental health professions are effective in ameliorating personal distress, treatment can sometimes have negative consequences. The authors explore causal mechanisms for iatrogenic symptoms in therapy by discussing the processes by which clients may be socialized into therapy and the potential impact that psychiatric labels and language may have in influencing clients' self-perceptions. The authors review research that has examined possible negative effects of psychiatric labels and then examine other forms of language, categorization, and conceptualizations that may contribute to negative effects in therapy. Iatrogenic symptoms may originate through the over-reliance on a belief system within which therapists interpret, reinterpret, or label clients' characteristics or distress as pathological. Therapeutic communication that emphasizes pejorative language may introduce clients to this belief system. Iatrogenic symptoms may also provide clients and therapists with secondary gains. Possible approaches for minimizing iatrogenic symptoms are explored.

Culture↗
PubMed2002

Neural substrates of spoken language rehabilitation in an aphasic patient: an fMRI study.

Little is known about the neural counterparts of speech therapy in aphasic patients. An fMRI experiment was performed before and after a specific and intensive speech output therapy in RC, a patient with long-lasting speech output deficit following a left-sided ischemic lesion. Overt picture naming and picture/word rhyming were used as activation tasks in RC and 6 control subjects. The naming task concerned the output lexicon deficit to be rehabilitated while rhyming referred to preserved levels of processing and was used to control for repetition effect. The speech therapy program improved naming performance. By comparison to the pattern observed before therapy, the naming task after therapy induced a pattern of activation close to that observed in control subjects, involving left-sided language areas surrounding the lesion. Speech therapy effect was associated with activations in Broca's area and the left supra-marginal gyrus, which might reflect a therapy-induced phonological compensatory strategy for naming.

Adult↗
PubMed2005

Management of Landau-Kleffner syndrome.

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia disorder in which children, usually 3-8 years of age who have developed age-appropriate speech, experience language regression with verbal auditory agnosia, abnormal epileptiform activity, behavioral disturbances, and sometimes overt seizures. There are no controlled clinical trials investigating the therapeutic options for LKS. Only open-label data are available. Early diagnosis and initiation of prompt medical treatment appear to be important to achieving better long-term prognosis.Several antiepileptic drugs have been reported to be beneficial in treating this syndrome. These include valproic acid (valproate sodium), diazepam, ethosuximide, clobazam, and clonazepam. Reports on the efficacy of lamotrigine, sultiame, felbamate, nicardipine, vigabatrin, levetiracetam, vagal nerve stimulation, and a ketogenic diet are few and more experience is needed. Carbamazepine and possibly phenobarbital and phenytoin have been reported to occasionally exacerbate the syndrome. As initial therapy, valproic acid or diazepam is often empirically chosen. Subsequently, other antiepileptic drugs, corticosteroids, or intravenous immunoglobulin (IVIG) therapy are often used. Corticosteroid therapy should probably not be delayed more than 1-2 months after the initial diagnosis. Various corticosteroid regimens including oral prednisone and, recently, high doses of intravenous pulse corticosteroids, as well as corticotropin (adrenocorticotropic hormone) have been reported to be effective in LKS. Oral corticosteroids are used more often and usually need to be maintained for a long period of time to prevent relapses. The use of IVIG has been associated with an initial dramatic response in only a few patients. In our experience, a long-term worthwhile improvement has been noted in only 2 of 11 patients. These two patients had an immediate response to IVIG initially and after relapses before eventually achieving a long-term sustained remission. Surgical treatment by multiple subpial transection, which is reserved for patients who have not responded to multiple medical therapies, has been followed in selected cases by a marked improvement in language skills and behavior. However, a widely accepted consensus about suitable candidates for this surgery and about its efficacy is still lacking. Speech therapy, including sign language, and a number of classroom and behavioral interventions are helpful in managing LKS, and should be used in all patients.

Adrenocorticotropic Hormone↗
PubMed1994

[Greenlanders in hospital. An interview study of communication between patients and therapists, satisfaction and therapeutic preferences].

In four hospitals in Greenland, 50 Greenlandic patients and their Danish therapist (18 doctors, 26 nurses and six other staff) have been interviewed about the same topics. The interviews were semistructured with open ended questions on the following subjects: Language difficulties, perception of diagnosis and therapy, patients' satisfaction and points of criticism. Several of the patients had not understood the most important medical information about diagnosis and treatment. But most of the patients did not consider the information problem to be serious and patients were satisfied with most of the consultations. Language difficulties and insufficient communications do not correspond to patients' satisfaction but have to be analysed in the wider cultural context. There was a tendency towards the elder patients being more satisfied than the younger.

Adult↗
PubMed1995

Sedation for the critically ill neurologic patient.

OBJECTIVE: To review the scientific basis for sedation of critically ill neurologic patients by summarizing the distinct neurophysiologic disturbances present in this population and presenting the central nervous system effects of sedative agents to permit optimal drug therapy. DATA SOURCES: Review of the English language clinical and scientific literature using MEDline data search. STUDY SELECTION: Literature references were selected through a key word search of sedative therapy, drugs used for sedation, and specific neurologic disorders and processes to provide an in-depth overview of sedative drug mechanisms of action, effects on neurophysiology and intracranial dynamics, pharmacokinetics, and toxicity profile. Special emphasis was placed on neurologic side effects. DATA EXTRACTION: Clinical and scientific literature was reviewed and data relevant to neurophysiologic effects of sedative drug therapy were summarized. Recommendations for institution of sedative therapy and of particular agents were made as a result of analysis of all pooled data. DATA SYNTHESIS: Critically ill patients with neurologic pathology present as a unique subset of individuals cared for in an acute care setting. Because monitoring of neurologic patients requires frequent assessment of the neurologic examination, the goal of sedative therapy should be to enhance, or to minimally perturb elicitation of the examination. Neurophysiologic disturbances introduce distinct risks for sedation and require their identification and understanding before the initiation of any sedative therapy. Sedative drugs, in particular, act to disturb central nervous system function and their effects may result in diagnostic confusion and further neurologic deterioration. The pharmacokinetic and neurophysiologic actions of the common classes of sedative agents, such as benzodiazepines, opioids, barbiturates, and neuroleptics, as well as ketamine, propofol, and clonidine are discussed. Recommendations are presented based on the specific type of sedation required and the underlying neurologic disturbance. Several specific examples, including head trauma, neuromuscular disease, and alcohol withdrawal, are provided. CONCLUSIONS: Preservation of the neurologic examination is paramount in documenting clinical improvement or deterioration in the critically ill neurologic patient. Pharmacologic sedation in this unique population of acute care patients requires careful consideration of the underlying neurophysiologic disturbances and potential adverse effects introduced by sedative drugs.

Critical Illness↗
PubMed1980

[Psycholinguistic aspects of aphasia diagnosis and therapy].

A central goal of psycholinguistic research on the diagnosis and therapy of aphasic patients consists of the construction of a series of language tasks which a. can provide guidelines for the development of systematic therapy programs and b. are suited to the evaluation of the recovery process in aphasia, in particular the effectiveness of speech therapy. Since current aphasia tests fall short on both points, a number of requirements are discussed which an aphasia test should minimally meet in order to satisfy the above objectives. Some of these requirements are illustrated in the light of the preliminary results of the Amsterdam Aphasia Test (AAT).

Aphasia↗
PubMed2004

Patterns of therapy activities across length of stay and impairment levels: peering inside the "black box" of inpatient stroke rehabilitation.

OBJECTIVES: To classify therapy activities and to describe the type and pattern of activities provided during inpatient rehabilitation to persons with stroke. DESIGN: Descriptive study. SETTING: Eight acute and 5 subacute rehabilitation facilities across the United States. PARTICIPANTS: Persons with stroke (N=177) who received rehabilitation services and had lengths of stay (LOSs) between 2 and 5 weeks. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Weekly and total therapy units aggregated by discipline and activity type for each of 4 (2-wk, 3-wk, 4-wk, 5-wk) LOS groups. RESULTS: Across LOS groups, significant differences in total therapy units were found by week of rehabilitation, discipline, and therapy activity type. Patterns in and significant interactions of time and activity type by discipline were also found. The amount of therapy provided by occupational and physical therapists was significantly more than that provided by speech-language pathologists. CONCLUSIONS: Patterns of time spent in therapy are similar for all LOS groups, but type of therapy received reflects a complex interaction of patient severity, rehabilitation discipline, and LOS.

Aged↗
PubMed2006

Efficacy of very high dose steroid treatment in a case of Landau-Kleffner syndrome.

Landau-Kleffner syndrome (LKS) is an acquired childhood aphasia associated with paroxysmal bitemporal electroencephalogram (EEG) abnormalities and, sometimes, clinical seizures. We report the case of a female aged 5 years 6 months who presented clinically with apparent hearing loss, deterioration in speech, and seizure activity over 12 days. The female had previous detailed speech/language assessments at 3 to 4 years of age due to articulation delay. LKS was diagnosed on EEG with bitemporal spike and wave activity during sleep. The patient was treated with high dose prednisolone 3mg/kg/day, intensive speech/language therapy, and followed a modified educational program. We recorded a marked regression in receptive and expressive language skills, as well as her speech, language, and cognitive profiles before and during treatment with prednisolone, during an 18-month follow-up period. The patient demonstrated an excellent clinical response highlighting the importance of a multidisciplinary approach to management of LKS.

Child↗
PubMed1989

OVERSEER: a prototype expert system for monitoring drug treatment in the psychiatric clinic.

This paper describes the development of OVERSEER: a prototype knowledge-based system that monitors the drug treatment of psychiatric patients in real time. Using treatment protocols developed by the expert clinician, OVERSEER monitors the drug treatment process and issues alerts when standard clinical practices are not followed or when laboratory results are abnormal. Written in Prolog, OVERSEER is designed to interface directly with the hospital's database, and, thereby, utilizes all available pharmacy and laboratory data. Moreover, unlike the interactive expert systems developed for the psychiatric clinic, OVERSEER does not require extensive data entry by the clinician. Consequently, the chief benefit of OVERSEER's monitoring approach is the unobtrusive manner in which it evaluates psychopharmacological treatment and provides information regarding patient management to the hospital.

Drug Therapy, Computer-Assisted↗
PubMed2005

[Music therapy and child care].

Music therapy was shown many years ago to have positive effects in various age groups of patients in the Western world. Music can produce physiological and psychological effects, including changes in the vital signs, reductions in anxiety, improvements in the immune system, decreases in cortisol levels, the reduction of stress and the promotion of well-being. Music therapy is an inexpensive and effective intervention for nurses to apply to patients. The application of such therapy to children, however, is different from that to adults due to their limited cognitive and language development. In Taiwan, nurses' knowledge of music therapy is limited, and it is rarely used in child care. This article introduces music therapy and its effects in child care, such as in premature infants, children in emergency care, handicapped children, and children receiving surgery. Music therapy is often used as an assisted intervention for patient care in clinical settings. Health care professionals can perform some of the music therapy activities for patients appropriately even if they have not been trained in music. This article aims to improve nurses' knowledge of music therapy and to provide a useful reference for those involved in child care.

Child↗
PubMed1989

[Muscle function therapy of the orofacial area].

Many disabilities, motorial disorders, tics, behaviour disturbances, habits, greater or smaller dysfunctions in the oral system and speech and voice damages concern the paediatrician in his daily practice. Very often these problems appear in combination or together with other pathologies, sometimes within difficult complex diseases. Different symptoms are mentioned helpful to the paediatrician. Often must be used diagnosis and therapy of different branches in a connected team-work. The demonstrated conception of the myofunctional therapy in the oro-facial system developed by the two authors, has to be seen in this respect. This conception has been tested on patients with dysgnathias, dyslalias and the two oro-facial dysfunctions deviate swallowing and habitual mouthbreathing. Characteristic features of this conception, its sources, its elements, its course, its methodical principles and its position in a paediatric complex therapy are demonstrated.

Child↗