Acute Stroke Phase Voluntary Cough and Correlation with Maximum Phonation Time

Here is an interesting article:

Acute Stroke Phase Voluntary Cough and Correlation with Maximum Phonation Time American Journal of Physical Medicine & Rehabilitation – June 2012, Volume 91, Issue 6, pp 494-500

Objective: This study aimed to assess cough effectiveness after a stroke and to propose a bedside screening test.

Design: Patients who had ischemic hemispheric stroke were recruited and followed up for 2 mos. Maximum phonation time (MPT) was assessed during the first 10 days. Aspiration was evaluated on days 2 and 10 after stroke. Lung function testing was performed on day 10. Peak cough flow less than 160 liters/min was defined as the criterion for cough ineffectiveness. Correlation between peak cough flow and MPT was determined, and the optimal cutoff value relating MPT to effective cough was determined using receiver operating characteristic analysis when referring to peak cough flow.

Results: Of the 70 patients, 6 developed pneumonia (mean time, 1.7 ± 2.4 days). Lung function assessment in 32 cases revealed general reduced cough effectiveness. MPT was correlated with peak cough flow (r = 0.413, P = 0.025), and an MPT cutoff of 10 secs was identified. Forty-seven patients were able to perform MPT on day 2; 49 were able to perform on day 10. Patients with MPT of 10 secs or longer had less frequent aspiration on both day 2 (5.9% vs. 36.7%, P = 0.034) and day 10 (2.9% vs. 26.6%, P = 0.026).

Conclusions: Cough effectiveness was reduced at the time of greatest risk for pneumonia. MPT provides a reliable bedside screening test of cough effectiveness.

The Impact of Moving to Stroke Rehabilitation Best Practices in Ontario

Hi SLP network: When you click onto the site below, you may have to download “Microsoft Silverlight” as directed but that takes only a few moments. Matthew Meyer’s presentation is about an hour in length. He explains the preliminary findings for revising stroke rehabilitation in Ontario. Very interesting.

Mathhew’s presentation from Feb 23 is titled “The Impact of Moving to Stroke Rehabilitation Best Practices in Ontario”.

Here is the link

 

AAC Conference

A conference revolving around AAC is coming up soon.  Take a look here.

UHN and TIMS DICOM Dysphagia Interest Group

On April the 19th, UHN and TIMS Dysphagia Interest Group will host Dr. Catriona Steele for a presentation via videoconference entitled “Thickening liquids for dysphagia management: Challenges and opportunities”. In this session, Dr. Steele will share recent results from research exploring the smallest differences in viscosity that have clinical utility.  Additionally, she will discuss simple instrumental methods for measuring viscosity during production in health care facilities.

Dr. Catriona M. Steele is the Director of the Swallowing Rehabilitation Research Laboratory at the Toronto Rehabilitation Institute. She teaches in the Department of Speech-Language Pathology at the University of Toronto. Prior to completing her Ph.D., Dr. Steele worked as a medical speech-language pathologist for 10 years. Dr. Steele is known for her commitment to pursuing theoretically driven research that will underpin clinical interventions with sound empirical evidence. She has received particular recognition for her work on tongue function in swallowing. Dr. Steele holds research funding from the National Institutes of Health (USA), a Canadian Institutes of Health Research New Investigator Award and has more than 50 peer-reviewed publications.

Please see attached the flyer and Handout:

UHN and TIMS DIG 19 April 2012

Dysphagia Interest Group Q1 2012-2013

Steele Dysphagia Rounds 2012 Handout

Dysphagia Therapy and iDevices

Here is a list of a few new apps that you may be interested in using as a part of your dysphagia therapy:

Dysphagia2Go is the new Dysphagia evaluation app that lets you use your iPad during your Clinical Dysphagia Evaluation to write a report with all of your findings. If you already have a computerized version of your report, you can email the results to yourself and copy and paste your findings. This app is available through SmartyEars and will have some exciting new updates soon!

iSwallow is available for Apple devices. iSwallow is a free app that allows you to show videos of each exercise for your patient and allows your patient to track their exercises and lets the therapist see how many times each exercise was completed at home.

Lingraphica offers 2 apps for dysphagia. One is a communication aid for the iPhone/iPod Touch that can also be used on the iPad. It allows a patient with dysphagia to communicate regarding their dysphagia, for example, “I need my dentures” or “I need to be sitting up to eat”. This would be helpful if you have an aphasic patient with dysphagia that would be able and/or willing to communicate these items with others. Lingraphica also has an oral motor app which has videos of each exercise being completed.

There are also several apps which show the structures, from a scope view. You can use iLarynx, LUMA ENT and URVL to look at the structures, or to use for patient education. They are also fun to play and see if you can “insert” the scope appropriately.

Lab Tests is a relatively inexpensive app, I think it’s $1.99 that describes the lab values and has normative data for lab values. This is nice if you work in an acute care hospital, where they typically draw daily labs to interpret what the lab values indicate.

Pill Identifier lets you search medications by shape, color or score. Telling you what the pill is, what the indications are, how it is available OTC or prescription. You can view images of the pill or look at information of each pill via Drugs.com.

3D Brain is a wonderful view of the brain to educate patients on lesions and where their lesions are located. It’s also a fun app to play with giving you views of the brain and descriptions of the areas of the brain.

Dysphagia by Northern Speech Services this app features custom-designed, state-of-the-art MBSImP animations depicting adult swallow physiology. Includes normal swallow physiology and also examples of varying physiologic impairments of the swallow. Video controls allow for slow motion, pause, and frame-by-frame forward and reverse. A great visual tool to aid professionals with patient and family education.

This information was found on ASHAsphere

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Aphasia- 1924

 

Here is a news article from 1924 that describes aphasia and some remedies.  Things have changed quite a bit!

Tube Feeding in Patients with Advanced Dementia

Speech-language pathologists are often called on to evaluate eating difficulties in patients with dementia. This article looks at various factors associated with SLPs’ knowledge and recommendations about feeding tubes in patients with advanced dementia.

SLP knowledge re tube feeding and dementia (2)

 

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Brain’s Speech Processing Center Broader than Realized

This was previously discussed on the blog here, but more information is also below.

March 8, 2012 – The brain’s speech processing center is much larger than previously reported, a new study shows.

The newly identified zone spans beyond Wernicke area and is closer to the front of the brain.

Scientists have long believed human speech is processed toward the back of the brain’s cerebral cortex, behind the auditory cortex where sounds are received. This region is known as the Wernicke area. However, mounting evidence suggests that this zone may be much larger.

New results, published in the February 21 Proceedings of the National Academy of Sciences, may prompt textbook rewrites on the location of the brain’s speech processing center, the researchers say.

It is a controversial issue spurred on by other researchers as well, who are questioning the location of the Wernicke area.

“This study provides a definitive, irrefutable answer,” senior investigator Josef Rauschecker, PhD, from Georgetown University Medical Center in Washington, DC, said in a news release.

Dr. Rauschecker’s team analyzed more than 100 imaging studies from several laboratories and identified an area about 3 cm closer to the front of the brain and on the other side of auditory cortex – miles away from the Wernicke area in terms of brain architecture and function.

“Functional magnetic resonance imaging and positron emission tomography brain imaging implicate a much broader portion of the superior temporal gyrus and sulcus in speech comprehension than has been previously appreciated,” Iain DeWitt, a PhD candidate at Georgetown, told Medscape Medical News. He pointed out that the region near the anteriolateral aspect of the Heschl gyrus is robustly activated in auditory word processing experiments.

The investigators suspect greater similarity in organization between the visual and auditory cortices than was previously appreciated.

“Clinically, it suggests we may have been missing something in analysis of lesion data, both from temporal lobe resections and from stroke,” DeWitt said. “Our work suggests we ought to take a closer look at the effect of anterior superior temporal gyrus and sulcus lesions on auditory comprehension.”

The prevailing sentiment in the field was that word recognition occurred in the posterior superior temporal gyrus and sulcus or Wernicke area, DeWitt said. “Therefore, it was an open question about just where the totality of the evidence from functional imaging stood on the matter of anterior superior temporal gyrus involvement in word recognition. When I began a systematic review of the literature, the surprising thing was just how many papers actually found anterior superior temporal gyrus activation in auditory word processing, but made little notice of the result. Many papers even went out of their way not to see what was clearly in the data.”

These new findings support the anterior-directed hierarchical account of word recognition by Binder and colleagues ( Cereb Cortex. 2000;10:512-528). They also back the Cohen et al hypothesis of an auditory word-form area in the left anterior superior temporal gyrus (( Neuroimage. 2004;23:1256-1270).

“If you Google ‘language organization’ in the brain,” DeWitt said, “probably every cartoon illustration out there is wrong.”

A lot of evidence from brain imaging and primate electrophysiology and neuroanatomy support their conclusions, DeWitt pointed out.

“The evidence from lesion studies is sparser and, perhaps, more equivocal. We really just don’t have high-resolution, well-controlled studies using modern methods, like lesion symptom mapping, to estimate acute auditory comprehension deficits following anterior superior temporal gyrus and sulcus lesions,” he noted.

“There is probably 1 study of high quality that I am aware of and it appears to support our findings,” he concludes. “Critics and myself alike will want to see more work done in this particular area to show consistency between neurological data and functional imaging data.”

The researchers have disclosed no relevant financial relationships.

Proc Natl Acad Sci. 2012;109:E505-E514. Abstract

Conference

The Windsor – Essex County Community Link is pleased to bring you:

Accuracy of Assessment in Dysphagia

And

Dysphagia Management in the Frail Elder

Please have a look at the brochure for further information.

adult 2012 murray brochure

online registration link

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Stroke Strategy

 

Here is a comprehensive article on stroke rehabilitation in the USA.

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care for the Stroke Patient.

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