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Purpose: This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task in order to examine the differential effects of each on hyoid motion and associated submental activation in healthy adults, with the overall goal of characterizing task-specific and overload properties of each task. Method: Twenty-five healthy male and female adults (M = 25 years of age) participated in this prospective, experimental study with 1 participant group. Each participant completed all study tasks (including normal swallow, Mendelsohn maneuver swallow, effortful swallow, and EMST task) in random order during concurrent videofluoroscopy and surface electromyography recording. Results: Results revealed significant differences in the trajectory of hyoid motion as measured by overall displacement and angle of elevation of the hyoid bone. As well, timing of hyoid movement and amplitude differences existed between tasks with regard to the activation of the submental musculature. Conclusions: Study results demonstrated differential effects of the 3 experimental tasks on the principles of task specificity and overload. These principles are important in the development of effective rehabilitative programs. Subsequent direction for future research is suggested.

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.

Background and objectives: Whereas injury to the left hemisphere induces aphasia, injury to the right hemisphere's perisylvian region induces an impairment of emotional speech prosody (affective aprosodia). Left-sided medial frontal lesions are associated with reduced verbal fluency with relatively intact comprehension and repetition (transcortical motor aphasia), but persistent affective prosodic defects associated with right medial frontal lesions have not been described. Methods: We assessed the prosody of a man who sustained a right medial frontal cerebral infarction seven years prior. Results: While propositional speech expression was normal including syntactic prosody, the patient was impaired at expressing emotions using prosody. His comprehension and repetition of prosody were also impaired but less so than expression. Conclusions: Right medial frontal lesions can induce an affective aprosodia that primarily impairs expression.

A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report. The study's purpose from which data for this report are drawn was to determine the relationship among signs elicited by a CSE and aspiration on a subsequent videofluoroscopic swallowing examination (VFSE). Sensitivity, specificity; positive and negative predictive values (NPV); likelihood ratios; and post-test probabilities for a variety of signs in isolation and in combinations are reported. These data, if judiciously selected and interpreted contribute to the clinician's knowledge about whether to follow a CSE with a VFSE and about what to expect if the VFSE is completed. Learning outcomes: (1) Clinicians will learn how to use EBM principles in conjunction with clinical assessments of swallowing to enhance patient care. (2) Clinicians will learn how to identify combinations of patient signs during he CSE to predict VFSE performance.

Purpose: In this study, the authors assessed how the addition of intentional left-hand gestures to an intensive treatment for anomia affects 2 types of discourse: picture description and responses to open-ended questions. Method: Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over 3 weeks. Seven subjects also incorporated intentional left-hand gestures into each treatment trial. Results: Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in Western Aphasia Battery--Aphasia Quotient (WAB-AQ; Kertesz, 1982) scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the gesture group produced more words at each assessment, whereas the no gesture group produced fewer words at each assessment. These patterns led to improvements in picture descriptions and minimal declines in question responses in the gesture group. In contrast, the no gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pretreatment levels. Conclusion: The intensive treatment protocol is a successful method for improving picture naming even of untrained items. Further, the authors conclude that the intentional left-hand gesture contributed significantly to the generalization of treatment to discourse. Key Words: aphasia treatment, intention, gesture, discourse, picture description, generalization, Anomia is the most common affliction in persons with aphasia due to stroke or other brain damage (Nickels & Berndt, 2001; Raymer & Gonzalez Rothi, 2001; Wilshire & Coslett, 2000). [...]

Purpose: This article introduces a collection of consensus statements regarding the application of neuroplasticity principles to rehabilitation of dysphagia, dysarthria, apraxia, and aphasia.

Emerging data suggest that aprosodia may be amenable to behavioral treatment. This study investigated the use of acoustic analysis of speech to quantify response to two speech treatments previously judged [...]

Purpose: This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task [...]

Purpose: This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between [...]

The study's purpose was to investigate the item-level psychometric properties of the Communicative Effectiveness Survey (CES) using Rasch analysis, an item response theory model. The CES (8-item 7-category rating scale) [...]

Purpose: Darley, Aronson, and Brown (1969a, 1969b) detailed methods and results of auditory-perceptual assessment for speakers with dysarthrias of varying etiology. They reported adequate listener reliability for use of the [...]

The results of an expiratory muscle strength training (EMST) program is described in the rehabilitation of mixed dysarthria in a patient with Lance-Adams syndrome secondary to a motor vehicle accident [...]

Informal care provision presents many challenges. As the population ages, more people are forced to enter the role of informal caretaker. Despite the increase in the need for caregivers and [...]

Recent research has revealed differences between isolated and sequential swallowing in healthy young adults; however, the influence of normal aging on sequential swallowing has not been studied. Thus, the purpose of this investigation was to examine the effects of normal aging on deglutition during sequential straw drinking. Videofluoroscopic samples of two 10-s straw drinking trials were obtained for 20 healthy young men (age 29 [+ or -] 3 years) and 18 healthy older men (age 69 [+ or -] 7 years). Hyolaryngeal complex (HLC) movement patterns, leading edge of the bolus location at swallow onset, and occurrences of airway invasion were determined. Two HLC patterns were identified: (a) HLC lowering with the epiglottis returned to upright between swallows and (b) partially maintained HLC elevation with the epiglottis inverted between swallows. The bolus was frequently in the hypopharynx at swallow onset. Strong associations were identified between age and HLC pattern, age and leading edge of the bolus location, and HLC pattern and leading edge location. Laryngeal penetration was uncommon overall; however, it occurred more frequently in the older adults than in the young adults. A significant relation was identified between age and the average Penetration-Aspiration Scale score. Laryngeal penetration was associated with both HLC movement patterns and hypopharyngeal bolus location, particularly in older adults. Results indicate that subtle age-related differences are evident in healthy young and older adults with sequential straw drinking. These data suggest that specific inherent swallowing patterns may increase the risk of laryngeal penetration with normal aging. KEY WORDS: deglutition, dysphagia, sequential straw drinking, normal aging, videofluoroscopy, Studies of swallowing in normal aging have identified subtle but important differences between young and older adults. These differences include increased duration of oropharyngeal structural movement (Rademaker, Pauloski, Colangelo, & [...]

Purpose: This article introduces a collection of consensus statements regarding the application of neuroplasticity principles to rehabilitation of dysphagia, dysarthria, apraxia, and aphasia. KEY WORDS: rehabilitation, plasticity, research, recovery ********** [...]

Background: Models of basal ganglia (BG) function suggest that expressive language deficits will likely and consistently present in BG disease. Disparities currently exist between the predictions of models of BG function in expressive language and data from studies of BG disease. Traditional expressive language assessment methodologies that emphasize measures of language form (word and sentence productivity) while not carefully considering how language is used, may only partially account for these disparities. Objective: To use measures of cohesion to examine the use of cohesive markers in narrative discourse. Methods: Twelve individuals with idiopathic Parkinson's disease (PD) were compared to 12 matched neurologically intact controls on measures of discourse performance. Three discourse samples (typical day, memorable vacation and family) were analyzed for measures of narrative productivity, number of cohesive ties and cohesive adequacy. Mixed model analyses were completed for group comparisons. Results: Group differences were not observed on measures of language form as measured by narrative productivity, communication units, and number of cohesive ties produced. In contrast, group differences were observed in cohesive adequacy as individuals with PD produced a higher percentage of incomplete and erroneous cohesive ties relative the control subjects across narratives. Conclusions: These results support the conclusion that the BG in PD may have an executive role in expressive language use that can be disrupted without impacting language form. [ABSTRACT FROM AUTHOR]

This review presents the available evidence for the effects of expiratory muscle strength training (EMST) with the use of a pressure threshold device. The investigators used computerized database searches for studies reporting the outcomes of pressure threshold EMST published after 1994. A total of 24 selected articles presented outcomes related but not limited to respiratory function, such as speech, swallow, voice, and cough function in persons with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in persons with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly. Several studies demonstrated promising outcomes of EMST as a non-task-specific training for airway protection in persons with dysphagia secondary to neuromuscular impairments; however, further research is needed to confirm and generalize the reported findings. [ABSTRACT FROM AUTHOR]

Background: Older adults have difficulty remembering detailed information from what they have read, despite maintaining relatively well preserved gist-level processing. However, an over-reliance on gist can result in vague and errorful encoding. Retrieval-based strategies using testing via free recall have been shown to be more effective for long-term memory retention of text details than additional study, a phenomenon known as the “testing effect”. Retrieval is thought to act as a secondary encoding, thus strengthening memory. Older adults would benefit then, from retrieval-based memory strategies that train efficient encoding of text information. These strategies to enhance memory in older adults can inform evidence-based treatment approaches for adults with acquired neurogenic communication disorders. Aims: The current study’s first aim was to compare the effects of two training techniques in healthy older adults for remembering details of unfamiliar expository texts: (1) Read Attentively, Summarise and Review (RASR), a retrieval-based technique that incorporates recall in the form of summaries at the paragraph level, and (2) Read and Reread Attentively (RARA), a massed-reading technique. We hypothesised that RASR would result in greater retention of details after a 24-hour delay than RARA. Our second aim was to investigate the effects of immediate recall testing after studying compared with no testing after studying. We hypothesised that immediate testing would result in superior retention of details after a 24-hour delay than no testing. Methods & Procedures: A total of 44 healthy older adults met eligibility criteria for the study and were randomly assigned to receive one of the techniques (RASR = 23; RARA = 21). There were three experimental conditions: (1) control-plus-test (passage was read once then tested immediately for recall), (2) study-plus-test (passage was studied using one of the techniques, RASR or RARA, then tested immediately for recall) and (3) study-no-test (passage was studied using RASR or RARA but was not tested until 24 hours later). Outcomes & Results: Results revealed that the RASR group remembered more information immediately and after a 24-hour delay than the massed rereading group RARA. Additionally, the RASR technique combined with an immediate post-study test was the most beneficial method for remembering passage details after a delay. Conclusions: Findings indicate that healthy older adults can improve memory for unfamiliar text details using retrieval-based methods. Incorporating summarisation and retrieval-based strategies into therapies with clinical populations should be considered. [ABSTRACT FROM AUTHOR]

Expiratory muscle strength training (EMST) is efficacious for improving maximum expiratory pressure (MEP), cough function, and swallowing safety in Parkinson disease (PD). However, there are no published reports describing detraining effects following EMST in persons with PD. Moreover, there are no published reports describing detraining effects following any behavioral swallowing intervention. Ten participants with PD underwent 3 mo of detraining following EMST. Measures of MEP and swallowing safety were made prior to beginning EMST (baseline), posttreatment (predetraining), and 3 mo postdetraining. Participants demonstrated, on average, a 19% improvement in MEP from pre- to post-EMST. Following the 3 mo detraining period, MEP declined by 2% yet remained 17% above the baseline value. No statistically significant changes were found in swallowing safety from post-EMST to postdetraining period. Following the 3 mo detraining period, seven participants demonstrated no change in swallowing safety, one worsened, and two had improvements. This preliminary study highlights the need for the design of maintenance programs to sustain function following intensive periods of training. [ABSTRACT FROM AUTHOR]

Background: Language fluency is a common diagnostic marker for discriminating among aphasia subtypes and improving clinical inference about site of lesion. Nevertheless, fluency remains a subjective construct that is vulnerable to a number of potential sources of variability, both between and within raters. Moreover, this variability is compounded by distinct neurological aetiologies that shape the characteristics of a narrative speech sample. Previous research on fluency has focused on characteristics of a particular patient population. Less is known about the ways that raters spontaneously weigh different perceptual cues when listening to narrative speech samples derived from a heterogeneous sample of brain-damaged adults. Aim: We examined the weighted contribution of a series of perceptual predictors that influence listeners' judgements of language fluency among a diverse sample of speakers. Our goal was to sample a range of narrative speech representing most fluent (i.e., healthy controls) to potentially least nonfluent (i.e., left inferior frontal lobe stroke). Methods & Procedures: Three raters blind to patient diagnosis made forced choice judgements of fluency (i.e., fluent or nonfluent) for 61 pseudorandomly presented narrative speech samples elicited by the BDAE Cookie Theft picture. Samples were collected from a range of clinical populations, including patients with frontal and temporal lobe pathologies and non-brain-damaged speakers. We conducted a logistic regression analysis in which the dependent measure was the majority judgement of fluency for each speech sample (i.e., fluent or non-fluent). The statistical model contained five predictors: speech rate, syllable type token ratio, speech productivity, audible struggle, and filler ratio. Outcomes & Results: This statistical model fit the data well, discriminating group membership (i.e., fluent or nonfluent) with 95.1% accuracy. The best step of the regression model included the following predictors: speech rate, speech productivity, and audible struggle. Listeners were sensitive to different weightings of these predictors. Conclusions: A small combination of perceptual variables can strongly discriminate whether a listener will assign a judgement of fluent versus nonfluent. We discuss implications for these findings and identify areas of potential future research towards further specifying the construct of fluency among adults with acquired speech and language disorders. [ABSTRACT FROM AUTHOR]

Speech reaction time (SRT) was measured in a response priming protocol in 12 participants with Parkinson's disease (PD) and hypokinetic dysarthria “on” and “off” left-hemispheric deep brain stimulation (DBS). Speech preparation was measured during speech motor programming in two randomly ordered speech conditions: speech maintenance and switching. Double blind testing was completed in participants with DBS of globus pallidus pars interna (GPi) ( n = 5) or subthalamic nucleus (STN) ( n = 7). SRT was significantly faster in the maintenance vs switch task, regardless of DBS state. SRT was faster in the speech maintenance task “on” stimulation, while there was no difference in speech switching “on” and “off” DBS. These data suggest that left-hemispheric DBS may have differential effects on aspects of speech preparation in PD. It is hypothesized that speech maintenance improvements may result from DBS-induced cortical enhancements, while the lack of difference in switching may be related to inhibition deficits mediated by the right-hemisphere. Alternatively, DBS may have little influence on the higher level motor processes (i.e., motor planning) which it is believed the switch task engaged to a greater extent than the maintenance task. [ABSTRACT FROM AUTHOR]

Purpose: To continue the development of a quantified, standard method to differentiate individuals with stroke and dysphagia from individuals without dysphagia. Method: Videofluoroscopic swallowing studies (VFSS) were completed on a group of participants with acute stroke (n = 42) and healthy age-matched individuals (n = 25). Calibrated liquid volumes of 3, 5, 10, and 20ml were administered during the VFSS. Six measures in 3 domains of bolus flow (timing, direction, and clearance) were measured. Values of these measures obtained from the control group were used to classify dysphagia within the participants. Results: The use of a single measure or single liquid volumes to classify dysphagia did not distinguish between healthy adults and individuals following stroke with and without dysphagia. Abnormality on more than 1 measure across multiple volumes appears to be a more robust method in defining dysphagia for liquids. Conclusions: Our findings indicate that the definition of dysphagia is critical in determining whether persons are classified with disordered swallowing. The definition is dependent on materials and measures evaluated. Each measure provides independent aspects to the evaluation. Determining the level of importance of each depends on the purpose of the evaluation. [ABSTRACT FROM AUTHOR]