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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, & [...]

Speech intelligibility and its phonetic and acoustic correlates were studied in a group of 10 women with amyotrophic lateral sclerosis (ALS). Intelligibility assessment with a word-identification test indicated that the most disrupted phonetic features pertained to velopharyngeal valving, lingual function for consonant contrasts of place and manner, and syllable shape. An acoustic signature analysis based on trajectories of the first and second formants in selected monosyllabic test words revealed that the mean slope of the second formant ([F.sub.2]) was reduced compared with that of a normal geriatric control group. This [F.sub.2] slope reduction is interpreted to reflect loss of lingual motoneurons. Acoustic measures of phonatory function for sustained vowel prolongaton demonstrated abnormalities in fundamental frequency, perturbations of frequency (jitter) and amplitude (shimmer), and signal-to-noise ratio. The data for women with ALS are compared with data for a normal geriatric control group of women and with data for a group of 25 men with ALS (Kent et al., 1990). Although the overall ranking of errors was similar for males and females with ALS, men were more likely to have impairments of voicing in syllable-initial position.

Narrow phonetic transcriptions and prosodic judgments were made of single-word imitations by apraxic (AOS), conduction aphasic (CA), and ataxic dysarthric (AD) speakers. AOS and AD subjects showed similar vowel error patterns, particularly predominant errors in low, tense, and back vowels, more distortions than other types of vowel errors, and predominant errors in initial position of words and in monosyllabic words. The CA subjects displayed a different vowel error pattern, notably more substitutions than distortions, more errors in polysyllabic than monosyllabic words, and more errors in noninitial than initial positions of words. Analysis of prosodic features identifiable at the single-word level (e.g., syllabic stress, juncture, and struggles to initiate or complete productions) indicated that syllabic stress errors and and more difficulty initiating than completing word production were characteristic of AOS and AD but not CA subjects.

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 ********** [...]

As we age, our speech patterns change. It is often possible to tell that someone is elderly simply by listening. There are probably many reasons why speech changes occur, including hearing loss, changes in the shape of the mouth from aging bone and muscle, and dentures or lack of teeth, as well as the way the nervous system controls muscles. There are marked differences in speech between young adults and older persons up to the age of 80. The variations are even more noticeable when the speech of young adults is compared with the very elderly, i.e. those over age 85. One example of the variability between the young and old is the pronunciation of certain consonants, which may not be formed as completely by the elderly person. Thus, in an older person, the word 'tin' might come out more like 'thin.' Some studies comparing young adults with those up to age 80 have shown that the speech pattern changes in the elderly are similar to those found in people suffering from Parkinson's disease, a neurological disorder that involves the basal ganglia in the brain. It is now suggested that aging may involve processes similar to those seen in neurological disease; that is, the sensory-motor deficits seen in elderly people may reflect neurochemical changes in the basal ganglia of the brain. This is particularly true for very elderly males. (Consumer Summary produced by Reliance Medical Information, Inc.)