Basic principles of restorative therapy of speech in aphasia.
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Aphasia↗
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ReQuest-- the challenge of quantifying both esophageal and extra-esophageal manifestations of GERD.
Gastroesophageal reflux disease (GERD) is highly prevalent in Western countries. It is characterized by esophageal and extra-esophageal symptoms (both typical and atypical) as well as by a number of potential complications. As the majority of patients have normal gross endoscopic findings, the assessments of symptom severity and quality of life, as well as the patients' response to treatment have become increasingly important. Self-assessed symptom questionnaires are now key instruments in clinical trials. An ideal GERD symptom questionnaire, suitable as a primary end-point for clinical trials, should: (1) be sensitive in patients with GERD, (2) cover frequency and intensity of typical and atypical GERD symptoms, (3) be multidimensional (cover all symptom dimensions), (4) have proven psychometric properties (validity, reliability and responsiveness), (5) be practical and economical, (6) be self-assessed, (7) use 'word pictures' which are easy to understand for patients, (8) respond rapidly to changes (responsiveness in short-time intervals), (9) be used daily to assess changes during and after therapy, and (10) be valid in different languages for international use. A literature review revealed five evaluative scales that met some of the above characteristics, but none fulfilled all of them. Therefore, a new evaluative tool for the assessment of GERD symptoms and their response to therapy is needed. The Reflux Questionnaire (ReQuest) is a self-assessed questionnaire developed and validated to assess the effect of treatment on the spectrum of GERD-related symptoms. Initially, GERD symptoms were identified on the basis of available literature, knowledge from previous clinical trials, experienced physicians, and patient interviews. An overall of 67 typical and atypical symptom descriptions were grouped into six different dimensions of GERD (acid complaints, upper abdominal/stomach complaints, lower abdominal/digestive complaints, nausea, sleep disturbances, other complaints). To these six dimensions a seventh, general well-being was added. Each dimension was tested by questions for frequency and intensity (except general well-being, for which only the intensity was determined). Thereafter, ReQuest was translated into different languages and tested in mother tongue patient focus groups. ReQuest psychometric properties (test-retest reliability, internal consistency, construct validity, responsiveness) were validated in two clinical trials of erosive GERD and endoscopic negative (en) GERD. In the first open, multicenter study, ReQuest was assessed in 430 patients with erosive GERD grade A-D. Patients with GERD grade A were treated with pantoprazole 20 mg od whereas those with GERD grade B-D received 40 mg od. The second open, multicenter, multinational trial with pantoprazole 20mg od assessed the ReQuest in over 800 patients with endoscopic negative GERD. Furthermore, ReQuest was used to determine the 'normal' ranges of GERD symptoms in individuals without GERD evidence. Over 300 healthy volunteers took part in a 4-day evaluation by completing ReQuest on each of the four study-days, as well as GSRS and PGWB on day 1. Based on the 90% percentiles determined in this study, a 'normal' range was calculated for ReQuest and relative subscales. The study showed that even individuals without GERD evidence can experience mild GERD symptoms. The derived 'normal' ranges within the population can be used for classification of symptom relief. In conclusion, ReQuest proved to be a valid, reliable, and responsive tool for measuring both typical and atypical GERD symptoms, and to be particularly suitable for measuring daily symptom changes and identifying normalization of the clinical picture in therapeutic trials.
Gastroesophageal Reflux↗
Attitudes of speech and language therapists towards stammering: 1985 and 2000.
BACKGROUND: Past research has indicated that speech and language therapists hold some negative attitudes towards people who stammer, their parents and the treatment of stammering. However, studies on attitudes towards stammering have predominantly focussed on therapists in the USA. Recent trends towards earlier intervention suggest that more therapists in the UK will be involved in working with stammering. AIMS: This study aimed to gather current attitudes of therapists in the UK and to compare them with attitudes measured 15 years previously. It also considered the impact of postgraduate training on attitudes and examined the attitudes of therapists trained in the Lidcombe Programme. METHODS & PROCEDURES: The attitudes of 261 speech and language therapists were measured in a postal survey using the Clinician Attitudes Toward Stuttering (CATS) Inventory. OUTCOMES & RESULTS: The survey revealed an increase in positive attitudes towards early intervention and a reduction in negative attitudes towards people who stammer since the CATS inventory was carried out in 1985. An analysis of generalist and specialist attitudes revealed that generalists were unsure about appropriate treatments to use with people who stammer. Therapists trained in the Lidcombe Programme held some different attitudes about early intervention, people who stammer and the treatment of stammering; however, they continued to view parental counselling as a critical factor in the treatment of the preschool child. CONCLUSIONS: The survey indicated that although therapists were more positive about some aspects of stammering, the treatment of stammering remains a complex issue. All therapists working with clients who stammer would therefore benefit from undertaking ongoing professional development in this area such as additional training, liaison with colleagues and joining a special interest group.
Attitude↗
Improving drug dosing in hospitalized patients: automated modeling of pharmacokinetics for individualization of drug dosage regimens.
Many clinical useful drugs have a narrow range of blood concentrations which are both safe and efficacious. Inter-individual and intra-individual variations in drug disposition are important factors causing blood concentrations of drug to fall outside of the therapeutic range. Modeling of the pharmacokinetics of the individual offers an effective approach to the problem of variation in drug disposition. Previous approaches for the modeling of individual pharmacokinetics have required either extensive computations or access to computer software and hardware in the clinical environment, and special expertise to interpret the results. This paper describes a prototype computer program, PK Monitor, which can, when connected with an appropriate interface, automatically monitor drug dosing and recommend changes that may be required to obtain blood concentrations in the therapeutic range. The software can also detect the occurrence of change in drug disposition which will lead to concentrations outside of the therapeutic range, identify potentially erroneous blood concentration measurements, and assess the need for further blood concentration measurements. This program will be an integral part of the MENTOR therapeutic monitoring system of programs. PK Monitor awaits a complete evaluation with the rest of the MENTOR system, but preliminary simulations suggest reasonable sensitivity and specificity in monitoring for unexpected data and change.
Drug Administration Schedule↗
Criteria for facilities and personnel for the administration of parenteral systemic antineoplastic therapy. Adopted on March 3, 2004 by the American Society of Clinical Oncology.
The following American Society of Clinical Oncology (ASCO) position statement represents an update to policy first adopted by the Board in 1997 (J Clin Oncol 15:3416-3417, 1997). The primary change to the statement is the addition of language to section 7, Standards for Antineoplastic Therapy, describing safeguards for preparing and administering chemotherapy drugs. As third-party payors consider and follow through with the establishment of new models for chemotherapy drug procurement, distribution, and delivery, ASCO provides guidance to oncologists to help them ensure the safety and integrity of the drugs they administer. Additionally, section 5, Office Operations, also suggests that oncologists consider measures protecting them from liability associated with drugs obtained from or prepared by outside entities.
Antineoplastic Agents↗
Collaborative consultation: a systemic activity.
In a collaborative consultation model of speech-language service delivery, the treatment system is expanded beyond the traditional client-centered dyad. Further, services are provided in the context of the classroom rather than in the noncontextual environment of a therapy room, and treatment goals relate to aspects of the school, such as curriculum, classroom behavior, and social interactions with peers. The use of the model is illustrated with a child having a cognitive impairment.
Child↗
Student-led exercise sessions yield significant fitness gains for Alzheimer's patients.
At a time when they are losing skills in virtually all arenas of life, persons with Alzheimer's disease can experience significant, esteem-building achievements in physical fitness and mood through supervised participation in an exercise program. The effects of physical exercise plus cognitive and social stimulation on persons with early stage Alzheimer's disease were assessed in a longitudinal study. Twenty-four such individuals, aged 54 to 88 at program entry, participated in 16 to 20 exercise sessions and 10 community activity sessions per semester for two to eight semesters. Half of the weekly exercise sessions included memory and language stimulation activities. Students, supplemented by family caregivers, supervised the sessions. Exercise sessions consisted of flexibility, balance, aerobic, and weight resistance activities. Preparticipation and semiannual post-testing of aerobic fitness and duration and upper and lower body strength was done. Highly significant fitness gains (p < .001) were achieved in the six-minute walk test, upper and lower body strength, and duration of aerobic exercise. Five participants, aged 86 to 91, completed six to eight semesters and were doing 27 to 45 minutes of aerobics per session at program's end. Five participants scored within the normal range for age-matched healthy active adults on the six-minute walk test at baseline. Nine others achieved and three exceeded the normal range during treatment. Cognitive decline was slowed and mood improved. First-year cognitive outcomes have been published elsewhere. An article reporting final cognitive outcomes is in preparation; Outcome data is summarized on the project website: www.u.arizona.edu/ ~sarkin/elderrehab.html. The benefits of physical exercise can be made available at nominal cost to Alzheimer's patients and other elderly persons by using students to provide transportation, supervision, and the motivational support that is key to exercise adherence. Further research is needed to determine the relative contributions of each program component to the positive outcomes.
Affect↗
[Intervention in children with pragmatic language and communication disorders].
AIMS: In this paper we analyse the educational and therapeutic needs of children who present pragmatic disorders in language and communication. DEVELOPMENT: Pragmatic disorders in language and communication stand apart from the other disorders affecting the remaining aspects of language development. Their less specific nature goes beyond the purely linguistic domain and involves wide areas of the patient's affective and social development. CONCLUSIONS: Not only is it necessary to adapt the general model of speech therapy intervention, but also to include it within a set of pedagogical (based on the framework of school itself) and psychological measures (in early care and family guidance services).
Child↗
The implications of bilingualism in the study and treatment of psychiatric disorders: a review.
This review of the data on bilinguals in relation to hypnosis, psychotherapy and psychotic disorders presents evidence for the bilateral representation of language in the cerebral hemispheres of bilinguals, and outlines possible links between the neuropsychology of psychotic disorders and the lateralization of language in these patients. The relationship between affective states and the retrieval of memories and language is also explored.
Aphasia↗
A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability.
OBJECTIVES: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists' perceptual assessment of cleft palate speech. DESIGN: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. SUBJECTS: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. MAIN OUTCOME MEASURES: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. RESULTS: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. CONCLUSIONS: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.
Articulation Disorders↗
[Early detection of hearing disorders. 10 years experience with screening more than 8,000 infants].
Prevention and early detection of deficits of the developing human being demand more and more complex solutions. Screening programmes have been developed to detect deficits and diseases before they cause symptoms. A well-organised and accurately performed screening programme can detect preliminary signs of diseases and may prevent irreversible damage. Early detection of deficits only makes sense if it is followed by consequences. Not only early detection of impairment or of children which are threatened by impairment is a very important medical task, but also the interdisciplinary cooperation in therapy. The most serious impact of hearing deficits in newborn is on the lack of speech-acquisition. It is an indisputable fact that the early detection of hearing impairment in newborn markedly improves the prognosis for further language development if early medical and/or rehabilitative therapy takes place. The following description of 10 years of experience with a newborn hearing screening programme that is effected in cooperation with the maternity ward and the ENT-clinic since 1981, can supply further arguments in favour of the need for early detection, the discussion on reflex audiometry, and to emphasise the need for cooperation of all relevant specialists.
Acoustic Stimulation↗
The role of speech-language pathologists and audiologists in service delivery for persons with mental retardation and developmental disabilities in community settings. Committee on Mental Retardation/Developmental Disabilities. American Speech-Language-Hearing Association.
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Adult↗
Comparison of the effectiveness of the Hanen Parent Programme and traditional clinic therapy.
BACKGROUND: Both direct (clinician to child) and indirect (clinician to carer) approaches are currently used in the management of children with language delay, but there is as yet little evidence about their relative effects or resource implications. AIMS: This research project compared the Hanen Parent Programme (HPP) in terms of its effectiveness and consequent suitability for an inner-city UK population with clinic-based, direct intervention. METHODS & PROCEDURES: Thirty-seven children aged 2;06-3;06 years with a diagnosis of language impairment and their parents took part in the research project. The children were allocated on a geographical basis to receive therapy either as part of an HPP or in a clinic. Nineteen children and their families took part in one of the five Hanen groups that ran successively over 16 months; 18 children and their families received clinic-based intervention. The children's language was assessed using the PLS-3 (UK version) and from an analysis of audio-taped parent and child interaction at three assessment points, one pretherapy and two post-therapy over 12 months. Two parent language measures were also analysed. OUTCOMES & RESULTS: Significant gains in language scores were shown by 71% of the children over 12 months. There were no statistically significant differences in child language scores between the two therapy groups at any assessment point. However, the HPP was twice as intensive (in terms of therapist time) as clinic therapy based on average group size, which has resource implications. CONCLUSIONS. Results suggest that there are parent and child factors that need consideration when choosing an appropriate intervention programme for a child with language impairment. Parental expectations, existing interaction style and the level of child language may be important influencing factors.
Child, Preschool↗
Therapy in cerebrovascular disease: current status and future directions.
OBJECTIVE: To assess the current status and future directions of therapy in cerebrovascular disease. DATA SOURCES: English language literature search using MEDLINE, Index Medicus, reviews, texts and relevant papers. STUDY SELECTION: Information has been drawn from approximately 200 articles. DATA EXTRACTION AND SYNTHESIS: Those articles with most relevance to current practice and future directions in the therapy of cerebrovascular disease have been cited. CONCLUSIONS: Much progress has been made over the last 30 years in the therapy of primary and secondary prevention of cerebrovascular disease. The introduction of antihypertensive agents has been largely responsible for the decline in mortality from stroke and, in some areas, the incidence. Anticoagulants such as warfarin protect against ischaemic stroke in patients with mitral or aortic valve disease and/or atrial fibrillation. Antiplatelet agents are clearly effective in the secondary prevention of ischaemic stroke after transient ischaemic attacks; the risk of stroke or death is reduced, on average, by 22%. In patients with subarachnoid haemorrhage, ischaemic complications caused by vasospasm are reduced by calcium channel blockers. A new wave of therapies is now on the horizon to minimise tissue damage in the early stages of ischaemic stroke ("tissue rescue") with the introduction of thrombolytic agents, calcium channel blockers, NMDA antagonists and haemodilution techniques and many of these are currently being subjected to clinical trial. If they prove to be effective, our current management of acute ischaemic stroke may alter dramatically.
Age Factors↗
Spouses as adjuncts in fluency therapy.
Couples with one partner who stutters completed questionnaires about the fluent partners' awareness of their spouses' stuttering; their general knowledge about stuttering; how fluent spouses had helped their partners; and the nature and benefits of spousal participation in therapy. Findings strongly suggested that spouses may be helpful in therapy. Considerations and suggestions for involving spouses are made on the basis of these findings and those of surveys completed by speech-language pathologists (SLPs) who include spouses in fluency therapy.
Female↗
Specific language impairment in children with velocardiofacial syndrome: four case studies.
OBJECTIVE: To describe specific language impairment in four children with velocardiofacial syndrome (VCFS). DESIGN: A descriptive, retrospective study of four cases. SETTING: University Hospital Groningen, tertiary clinical care. PATIENTS: Of 350 patients with cleft plate, 18 children were diagnosed with VCFS. Four children are described. INTERVENTIONS: In all children, cardiac and plastic surgery was carried out in the first year of life. Afterward, interventions consisted of hearing improvement, pharyngoplasty, and speech therapy. MAIN OUTCOME: Inadequate and uncharacteristic development of articulation and expressive language in four children with VCFS were observed. They differed from the majority in two ways: their nonverbal IQ was in the normal range, and their language skills were below expectations for their IQ. RESULTS: Four of 18 patients with VCFS (22%) showed poor response to therapy and did not develop language in accordance with their normal learning abilities (nonverbal learning capacities and language comprehension). Persistent hypernasal resonance and severe articulation problems remained in all four children. In two children the expressive language profile was also not in agreement with the nonverbal profile: they produced only two- and three-word utterances at the age of 6.0 and 5.3 years. The other two children at the age of 6.8 and 6.4 years produced very long sentences, but they were unintelligible. CONCLUSIONS: The speech and language impairment of the four children may be characterized as a phonological or verbal programming deficit syndrome and as such can be described as a specific language impairment in conjunction with VCFS.
Child↗
Cues-pause-point language training: teaching echolalics functional use of their verbal labeling repertoires.
We evaluated the direct and generalized effects of cues-pause-point language training procedures on immediate echolalia and correct responding in two severely retarded females. Two experiments were conducted with each subject in which the overall goal was to encourage them to remain quiet before, during, and briefly after the presentation of questions and then to verbalize on the basis of environmental cues whose labels represented the correct responses. Multiple baseline designs across question/response pairs (Experiment I) or question/response pairs and settings (Experiment II) demonstrated that echolalia was rapidly replaced by correct responding on the trained stimuli. More importantly, there were clear improvements in subjects' responding to untrained stimuli. Results demonstrated that the cues-pause-point procedures can be effective in teaching severely retarded or echolalic individuals functional use of their verbal labeling repertoires.
Adolescent↗
[Second Consensus of Granada on pharmacotherapy failure. Cross-cultural translation from Spanish to Portuguese (European)].
The cross-cultural translation from spanish to portuguese (european) of the Second Consensus of Granada on Pharmacotherapy failure has the objective to provide clinicians and researchers, working in drug therapy follow-up, with a working tool translated with the accuracy and the reliability that a biomedical document requires. The common origin of the spanish and portuguese languages emphasizes the need to do a cross-cultural translation. Errors of translation or wrong interpretations can be due to falses cognates. The cross-cultural translation followed three steps: translation, back-translation and review of the translation of the original text of the Second Consensus of Granada on Pharmacotherapy failure. The result was the portuguese version of the Second Consensus of Granada on Pharmacotherapy failure, presented in the annex I.
Consensus Statements as Topic↗