Current Opinion Paper Research Articles

What's the big IDEA? Incorporating inclusion, diversity, equity, and access (IDEA) in population health nutrition research and practice.

Historically, the constructs of inclusion, diversity, equity, and access (IDEA) have not been sufficiently considered or included in population health nutrition research and practice. Consequently, current nutrition assessment benchmarks and knowledge translation tools may not accurately or adequately reflect diversity in the Canadian population or produce meaningful dietary guidance. The purpose of this current opinion paper is to introduce the population health nutrition research and practice framework and explore the current application of IDEA within this framework. Recommendations are offered to incorporate the constructs of IDEA along the continuum of future nutrition research and services to improve population nutritional health.

The Importance of Assessing Drug Exposure and Medication Adherence in Evaluating Investigational Medications: Ensuring Validity and Reliability of Clinical Trial Results.

The objective of this current opinion paper is to draw global attention to medication adherence, emphasizing its crucial role in drug trials. Frequently, trialists lean on traditional approaches to assess medication adherence, which, while comfortable, may only reveal what trialists desire rather than offering the essential insights needed for informed decision making in drug development. Understanding drug exposure and medication adherence is paramount when evaluating the effectiveness and safety of investigational medications. Without a comprehensive understanding of how patients adhere to their prescribed treatment regimens, the integrity and dependability of clinical trial results can be compromised. This paper emphasizes the need for measures that accurately and reliably assess medication intake behaviors, enabling the differentiation between minor dosing errors and significant deviations that may impact the drug's efficacy and safety. Accurate knowledge of drug exposure empowers researchers to make informed decisions, identify potential confounding factors, and appropriately interpret study outcomes, ultimately ensuring the validity and reliability of the research findings. By prioritizing drug exposure assessment and medication adherence measurement, clinical trials can enhance their scientific rigor, contribute to more accurate evaluations of investigational medications, and ultimately speed up the development process.

Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than ‘wear a mask’, different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

Opportunities in Critical Rare Earth Metal Recycling Value Chains for Economic Growth with Sustainable Technological Innovations

Rare earth elements (REEs) are often referred to as the industrial vitamins and the key drivers of the industry 4.0 revolution. The current global supply chain of REEs for green and high-tech applications with more than 220 metric kilotons per year involves a huge environmental impact (backpack) as well as the piling up of radioactive by-products to about 1.5 times the amount of REEs produced. E-wastes and municipal solid waste streams are attractive secondary resources. The current opinion paper discusses the recycling of rare earth metals along the value chain with the opportunities and challenges associated with it. The way to mitigate the economic constraints has been pointed out in terms of competitive quality and recovery of the REEs when compared with the mineral exploration options in the market. It is also emphasised that the technical complexity, capital expenditures and operating expenses need to fit the economic boundary conditions to make the recycling viable. In future, the appropriate REE-rich feedstocks such as fluorescent lamp e-waste powders and magnets can be potential secondary sources of the critical raw materials necessary for the green transition. The success of the viable recycling approaches and technologies will largely depend on the public–private partnerships based on hybrid financing models and local know-how generation to compete with quasi-monopoly in the REE supply chains. However, to break the monopolies, it will not be sufficient to only recycle the REEs; it will also be relevant to diversify the industries that produce REE-containing goods from recycled waste streams.

Modern Biomarkers for Autism Spectrum Disorder: Future Directions.

Autism spectrum disorder is an increasingly prevalent neurodevelopmental disorder in the world today, with an estimated 2% of the population being affected in the USA. A major complicating factor in diagnosing, treating, and understanding autism spectrum disorder is that defining the disorder is solely based on the observation of behavior. Thus, recent research has focused on identifying specific biological abnormalities in autism spectrum disorder that can provide clues to diagnosis and treatment. Biomarkers are an objective way to identify and measure biological abnormalities for diagnostic purposes as well as to measure changes resulting from treatment. This current opinion paper discusses the state of research of various biomarkers currently in development for autism spectrum disorder. The types of biomarkers identified include prenatal history, genetics, neurological including neuroimaging, neurophysiologic, and visual attention, metabolic including abnormalities in mitochondrial, folate, trans-methylation, and trans-sulfuration pathways, immune including autoantibodies and cytokine dysregulation, autonomic nervous system, and nutritional. Many of these biomarkers have promising preliminary evidence for prenatal and post-natal pre-symptomatic risk assessment, confirmation of diagnosis, subtyping, and treatment response. However, most biomarkers have not undergone validation studies and most studies do not investigate biomarkers with clinically relevant comparison groups. Although the field of biomarker research in autism spectrum disorder is promising, it appears that it is currently in the early stages of development.

Four Aspects Affecting Health Economic Decision Models and Their Validation.

Health care decision makers in many jurisdictions use cost-effectiveness analysis based on health economic decision models for policy decisions regarding coverage and price negotiation for medicines and medical devices. While validation of health economic decision models has always been considered important, many reviews of model-based cost-effectiveness studies report limitations regarding their validation. The current opinion paper discusses four aspects of current health economic decision modeling with relevance for future directions in model validation: increased use of complex models, international cooperation, open-source modeling, and stakeholder involvement. First, new, more complex clinical study designs and treatment strategies may require relatively complex model structures and/or input data analyses. Simultaneously, more widespread technical knowledge along with wider data availability have led to a broader range of model types. This puts extra requirements on model validation and transparency. Second, increased international cooperation of policy makers and, in particular, health technology assessment (HTA) authorities in performing model assessments is discussed in relation to the repeated use of health economic models (multi-use disease models). We argue such coordinated efforts may benefit model validity. Third, open-source modeling is discussed as one possible answer to increased transparency requirements. Finally, involvement of all relevant stakeholders throughout the whole decision process is an ongoing development that necessarily also includes health economic modeling. We argue this implies that model validity should be considered in a broader perspective, with more focus on conceptual modeling, model transparency, accuracy requirements, and choice of relevant model outcomes than previously.

The LC-NE system as a potential target for neuromodulation to ameliorate non-motor symptoms in Parkinson's disease.

Parkinson's disease (PD) is associated with severe motor symptoms but also with several non-motor symptoms (NMS). A substantial reduction of norepinephrine (NE) levels in various brain regions reflecting an extensive loss of innervation from the LC has been assumed as causal for the development of NMS and specifically of attentional impairments in PD. Transcutaneous auricular vagus nerve stimulation (taVNS) is a new, non-invasive neurostimulation method supposed to modulate the LC-NE system in humans. In the current opinion paper, we introduce taVNS as a systemic approach to directly affect NE neurotransmission in healthy as well as clinical populations and discuss its potential as therapeutic option for the treatment of NMS, specifically attentional deficits, in patients with PD. Here, we first describe the LC-NE system and discuss how LC-NE dysfunction might affects cognition in PD before detailing the mode of action of taVNS and proposing its use to modulate cognitive deficits in these patients.

Surgical Application of Human Amniotic Membrane and Amnion-Chorion Membrane in the Oral Cavity and Efficacy Evaluation: Corollary With Ophthalmological and Wound Healing Experiences.

Due to its intrinsic properties, there has been growing interest in human amniotic membrane (hAM) in recent years particularly for the treatment of ocular surface disorders and for wound healing. Herein, we investigate the potential use of hAM and amnion-chorion membrane (ACM) in oral surgery. Based on our analysis of the literature, it appears that their applications are very poorly defined. There are two options: implantation or use as a cover material graft. The oral cavity is submitted to various mechanical and biological stimulations that impair membrane stability and maintenance. Thus, some devices have been combined with the graft to secure its positioning and protect it in this location. This current opinion paper addresses in detail suitable procedures for hAM and ACM utilization in soft and hard tissue reconstruction in the oral cavity. We address their implantation and/or use as a covering, storage format, application side, size and number, multilayer use or folding, suture or use of additional protective covers, re-application and resorption/fate. We gathered evidence on pre- and post-surgical care and evaluation tools. Finally, we integrated ophthalmological and wound healing practices into the collected information. This review aims to help practitioners and researchers better understand the application of hAM and ACM in the oral cavity, a place less easily accessible than ocular or cutaneous surfaces. Additionally, it could be a useful reference in the generation of new ideas for the development of innovative protective covering, suturing or handling devices in this specific indication. Finally, this overview could be considered as a position paper to guide investigators to fulfill all the identified criteria in the future.

How to Get There When You Are There Already? Defining Presence in Virtual Reality and the Importance of Perceived Realism.

The aim of the current opinion paper is to challenge the current definition of presence in the context of virtual reality (VR). Opticians do not only measure visual acuity but also the visual field, stereoscopic vision, and color vision. In the same vein, presence researchers are encouraged to not only measure the experience of “being there” in the sense of attentional allocation to the virtual environment (VE), but also the perceived realism of the VE. Perceived realism is the result of an evaluation of the virtual world regarding (1) the subjective degree of reality of the depicted environment and (2) its overall plausibility and credibility. Thus, the sense of presence in a VE is conceived as a composite of being there and perceived realism. When in VR, a user will inevitably compare the look of virtual objects to real-world objects and judge the level of congruence (Sutcliffe and Gault, 2004). The user evaluates the plausibility and naturalness of the depicted world as well as the ease of interaction within the VE by answering questions such as: is there a shadow cast? Are the proportions of objects correct? Does the environment correspond to my own movements? Does my virtual body match the proportions of my real body? Just like the visual features, a story and its characters are also evaluated in terms of consistency and plausibility (Park et al., 2010; Gorini et al., 2011): are the consequences of actions plausible? Is the story coherent in itself? Does the causal sequence of events make sense? The answers to these questions define the degree of perceived realism. Perceived realism leads to the experience that a user not only feels surrounded by the VE, but rather has a compelling sense of reality and in extreme cases even forgets that he or she is wearing a head-mounted display (HMD). Previous papers on presence are based on the assumption that realism enhances presence (e.g., Heeter, 1992; Welch et al., 1996; Lombard and Ditton, 1997; Bystrom et al., 1999) suggested a conceptualization of presence as the degree to which a medium seems realistic. Interestingly, perceived realism is nevertheless not part of the most widely used presence definitions. It is either a possible trigger of presence or is blended in with the term being there. The conceptualization of presence as the experience of being there in a mediated environment dominates current presence definitions. Being there is strongly associated with attentional allocation and the sensation of being surrounded and absorbed by a mediated world. However, we claim that presence in VR requires much more than just being there. With the widespread use of immersive VR technology, it has become an easy task to absorb users in a VE. Thus, judgments about the realism of the VE become increasingly important. Being there and perceived realism are both important but yet different aspects of presence. They need to be combined in order to (1) adequately describe and define the experience of presence and (2) to obtain an appropriate and more complete assessment of presence in VR. Thus, theories and measures of presence need to be extended and establish perceived realism as an important domain besides being there. Presence in VR as a Two-Dimens

Frontal Transcranial Direct Current Stimulation as a Potential Treatment of Parkinson's Disease-Related Fatigue.

In contrast to motor symptoms, non-motor symptoms in Parkinson’s disease (PD) are often poorly recognized and inadequately treated. Fatigue is one of the most common non-motor symptoms in PD and affects a broad range of everyday activities, causes disability, and substantially reduces the quality of life. It occurs at every stage of PD, and once present, it often persists and worsens over time. PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. However, despite its clinical significance, little progress has been made in understanding the causes of Parkinson’s disease-related fatigue (PDRF) and developing effective treatment options, which argues strongly for a greater effort. Transcranial direct current stimulation (tDCS) is a technique to non-invasively modulate cortical excitability by delivering low electrical currents to the cerebral cortex. In the past, it has been consistently evidenced that tDCS has the ability to induce neuromodulatory changes in the motor, sensory, and cognitive domains. Importantly, recent data present tDCS over the frontal cortex as an effective therapeutic option to treat fatigue in patients suffering from multiple sclerosis (MS). The current opinion paper reviews recent data on PDRF and the application of tDCS for the treatment of fatigue in neuropsychiatric disorders to further develop an idea of using frontal anodal tDCS as a potential therapeutic strategy to alleviate one of the most common and severe non-motor symptoms of PD.

A fascinating but risky case of reverse inference: From measures to emotions!

Inferring emotions based on accessible signals is a tendency that we have both as social individuals and as scientists. Academia and industry have developed methods and devices aimed at detecting specific emotions (e.g., joy, anger or fear) based on physiological or behavioral signals. The current opinion paper argues that this is currently a risky path to be taken in terms of scientific validity. We argue that using measures to test hypotheses concerning emotions is efficient, but that going backward – using measures to infer emotions – is risky. We also argue that ways to circumvent this reverse inference issue include making use of converging evidence across the five components of emotion (cognitive appraisal, action tendency, expression, physiological reaction and feelings), and investing even more in methodological developments.

Do young patients with high clinical suspicion of appendicitis really need cross-sectional imaging? Proceedings from a highly controversial debate among the experts' panel of 2020 WSES Jerusalem guidelines.

The widespread use of cross-sectional imaging in suspected appendicitis is debated. Recent guidelines have demonstrated conflicting views and the debate continues. In April 2020 the World Society of Emergency Surgery (WSES) published the update of the Jerusalem Guidelines on the diagnosis and treatment of acute appendicitis. The role of pre-operative imaging was a particular difficult point to reach a definitive decision, leading to pro-con arguments and an ad hoc Delphi survey with a consensus statement. The systematic review of the literature performed during the guidelines development, which has been summarized in this current opinion paper, demonstrated that the use of AIR and AAS scores as clinical predictors of acute appendicitis is a cost-effective method to reduce the negative appendectomy rate and can stratify patients into high-risk group with specificity of up to 94%. There are currently two principal management strategies for patients with suspected appendicitis: the score-based risk-stratification followed by a diversified management depending on the estimated risk of appendicitis, and the imaging-based strategy advocating routine diagnostic imaging in all patients except those deemed having low probability of appendicitis. In patients younger than 40 years old who have been scored for high probability for acute appendicitis (AIR score 9-12, Alvarado score 9-10, and AAS ≥ 16), CT scan adds little value in the diagnosis. A high-probability score of acute appendicitis may be used to select patients younger than 40 years old in which imaging is not needed.Evidence LevelII (Systematic Reviews and Meta-analyses).

Insights into therapeutic products, preclinical research models, and clinical trials in cardiac regenerative and reparative medicine: where are we now and the way ahead. Current opinion paper of the ESC Working Group on Cardiovascular Regenerative and Reparative Medicine.

Great expectations have been set around the clinical potential of regenerative and reparative medicine in the treatment of cardiovascular diseases [i.e. in particular, heart failure (HF)]. Initial excitement, spurred by encouraging preclinical data, resulted in a rapid translation into clinical research. The sobering outcome of the resulting clinical trials suggests that preclinical testing may have been insufficient to predict clinical outcome. A number of barriers for clinical translation include the inherent variability of the biological products and difficulties to develop potency and quality assays, insufficient rigour of the preclinical research and reproducibility of the results, manufacturing challenges, and scientific irregularities reported in the last years. The failure to achieve clinical success led to an increased scrutiny and scepticism as to the clinical readiness of stem cells and gene therapy products among clinicians, industry stakeholders, and funding bodies. The present impasse has attracted the attention of some of the most active research groups in the field, which were then summoned to analyse the position of the field and tasked to develop a strategy, to re-visit the undoubtedly promising future of cardiovascular regenerative and reparative medicine, based on lessons learned over the past two decades. During the scientific retreat of the ESC Working Group on Cardiovascular Regenerative and Reparative Medicine (CARE) in November 2018, the most relevant and timely research aspects in regenerative and/or reparative medicine were presented and critically discussed, with the aim to lay out a strategy for the future development of the field. We report herein the main ideas and conclusions of that meeting.

Primary, Secondary, and Tertiary Effects of Carbohydrate Ingestion During Exercise

The purpose of this current opinion paper is to describe the journey of ingested carbohydrate from ‘mouth to mitochondria’ culminating in energy production in skeletal muscles during exercise. This journey is conveniently described as primary, secondary, and tertiary events. The primary stage is detection of ingested carbohydrate by receptors in the oral cavity and on the tongue that activate reward and other centers in the brain leading to insulin secretion. After digestion, the secondary stage is the transport of monosaccharides from the small intestine into the systemic circulation. The passage of these monosaccharides is facilitated by the presence of various transport proteins. The intestinal mucosa has carbohydrate sensors that stimulate the release of two ‘incretin’ hormones (GIP and GLP-1) whose actions range from the secretion of insulin to appetite regulation. Most of the ingested carbohydrate is taken up by the liver resulting in a transient inhibition of hepatic glucose release in a dose-dependent manner. Nonetheless, the subsequent increased hepatic glucose (and lactate) output can increase exogenous carbohydrate oxidation rates by 40–50%. The recognition and successful distribution of carbohydrate to the brain and skeletal muscles to maintain carbohydrate oxidation as well as prevent hypoglycaemia underpins the mechanisms to improve exercise performance.

An environmental and health perspective for COVID-19 outbreak: Meteorology and air quality influence, sewage epidemiology indicator, hospitals disinfection, drug therapies and recommendations.

This Opinion Paper wishes to provide a summary of recent findings and solutions for a better understanding of the environmental and health problems associated with COVID-19. The list of topics covered is large: meteorology and air quality factors with correlation number of infections, sewage waters as a way to reveal the scale of COVID-19 outbreak, current hospital disinfection procedures and new eco-friendly technologies and list of drug therapies recommend waiting for the desired vaccine to come. During the last two months we did notice an increase in the scientific literature regarding COVID-19 with a partial vision of this problem. The current Opinion Paper is one of the first attempts, to my understanding, to summarize and integrate environmental and human health aspects related to the monitoring, fate and treatment solutions for COVID-19. That being said I believe that this Opinion Paper can serve as multipurpose document, not only for scientists of different disciplines but for social media and citizens in general.

The trip of a drug inside the body: From a lipid-based nanocarrier to a target cell

To date, enormous investigations have been conducted to enhance medicines' target-oriented delivery to improve their therapeutic index. In this regard, lipid-based carrier system might have been regarded as prime delivery systems that are very close to the naturally cell-derived vesicles used for biomolecular communication among cells from occasionally remote tissues. Upon examination of the literature, we found a chasm between groups of investigations in drug pharmaceutics and thought that maybe holistic research could provide better information with respect to drug delivery inside the body, especially when they are going to be injected directly into the bloodstream for systemic distribution. While a collection of older research in most cases dealt with the determination of drug partition coefficient between the aqueous and cell membrane compartments, the link has been overlooked in newer investigations that were mostly focused on drug formulation optimization and their association with particle biodistribution. This gap in the literature motivated us to present the current opinion paper, in which drug physicochemical properties like drug lipophilicity/hydrophilicity is considered as an important element in designing drug-carrying liposomes or micelles. How a hypothetical high throughput cell-embedded chromatographic technique might help to investigate a nanocarrier tissue distribution and to design ‘multi-epitope grafted lipid-based drug carrier systems’ are discussed. Whenever we would need support for our opinions, we have provided analogy from hydrophobic biomolecules like cholesterol, steroid hormones, and sex hormones and encouraged readers to consider our principle hypothesis: If these molecules could reach their targets far away from the site of production, then a large list of hydrophobic drugs could be delivered to their targets using the same principles.

Amino sugars as specific indices for fungal and bacterial residues in soil

Amino sugars are important indices for the contribution of soil microorganisms to soil organic matter. Consequently, the past decade has seen a great increase in the number of studies measuring amino sugars. However, some uncertainties remain in the interpretation of amino sugar data. The objective of the current opinion paper is to summarize current knowledge on amino sugars in soils, to give some advice for future research objectives, and to make a plea for the correct use of information. The study gives an overview on the origin of muramic acid (MurN), glucosamine (GlcN), galactosamine (GalN), and mannosamine (ManN). Information is also provided on measuring total amino sugars in soil but also on compound-specific δ13C and δ15N determination. Special attention is given to the turnover of microbial cell-wall residues, to the interpretation of the GlcN/GalN ratio, and to the reasons for converting fungal GlcN and MurN to microbial residue C. There is no evidence to suggest that the turnover of fungal residues generally differs from that of bacterial residues. On average, MurN contributes 7% to total amino sugars in soil, GlcN 60%, GalN 30%, and ManN 4%. MurN is highly specific for bacteria, GlcN for fungi if corrected for the contribution of bacterial GlcN, whereas GalN and ManN are unspecific microbial markers.

Variable sensory perception in autism.

Autism is associated with sensory and cognitive abnormalities. Individuals with autism generally show normal or superior early sensory processing abilities compared to healthy controls, but deficits in complex sensory processing. In the current opinion paper, it will be argued that sensory abnormalities impact cognition by limiting the amount of signal that can be used to interpret and interact with environment. There is a growing body of literature showing that individuals with autism exhibit greater trial-to-trial variability in behavioural and cortical sensory responses. If multiple sensory signals that are highly variable are added together to process more complex sensory stimuli, then this might destabilise later perception and impair cognition. Methods to improve sensory processing have shown improvements in more general cognition. Studies that specifically investigate differences in sensory trial-to-trial variability in autism, and the potential changes in variability before and after treatment, could ascertain if trial-to-trial variability is a good mechanism to target for treatment in autism.

Research into the Health Benefits of Sprint Interval Training Should Focus on Protocols with Fewer and Shorter Sprints

Over the past decade, it has been convincingly shown that regularly performing repeated brief supramaximal cycle sprints (sprint interval training [SIT]) is associated with aerobic adaptations and health benefits similar to or greater than with moderate-intensity continuous training (MICT). SIT is often promoted as a time-efficient exercise strategy, but the most commonly studied SIT protocol (4–6 repeated 30-s Wingate sprints with 4 min recovery, here referred to as ‘classic’ SIT) takes up to approximately 30 min per session. Combined with high associated perceived exertion, this makes classic SIT unsuitable as an alternative/adjunct to current exercise recommendations involving MICT. However, there are no indications that the design of the classic SIT protocol has been based on considerations regarding the lowest number or shortest duration of sprints to optimise time efficiency while retaining the associated health benefits. In recent years, studies have shown that novel SIT protocols with both fewer and shorter sprints are efficacious at improving important risk factors of noncommunicable diseases in sedentary individuals, and provide health benefits that are no worse than those associated with classic SIT. These shorter/easier protocols have the potential to remove many of the common barriers to exercise in the general population. Thus, based on the evidence summarised in this current opinion paper, we propose that there is a need for a fundamental change in focus in SIT research in order to move away from further characterising the classic SIT protocol and towards establishing acceptable and effective protocols that involve minimal sprint durations and repetitions.

Tapping into neural resources of communication: formulaic language in aphasia therapy.

Decades of research highlight the importance of formulaic expressions in everyday spoken language (Vihman, 1982; Wray, 2002; Kuiper, 2009). Along with idioms, expletives, and proverbs, this linguistic category includes conversational speech formulas, such as “You've got to be kidding,” “Excuse me?” or “Hang on a minute” (Fillmore, 1979; Pawley and Syder, 1983; Schegloff, 1988). In their modern conception, formulaic expressions differ from newly created, grammatical utterances in that they are fixed in form, often non-literal in meaning with attitudinal nuances, and closely related to communicative-pragmatic context (Van Lancker Sidtis and Rallon, 2004). Although the proportion of formulaic expressions to spoken language varies with type of measure and discourse, these utterances are widely regarded as crucial in determining the success of social interaction in many communicative aspects of daily life (Van Lancker Sidtis, 2010). The unique role of formulaic expressions in spoken language is reflected at the level of their functional neuroanatomy. While left perisylvian areas of the brain support primarily propositional, grammatical utterances, the processing of conversational speech formulas was found to engage, in particular, right-hemisphere cortical areas and the bilateral basal ganglia (Hughlings-Jackson, 1878; Graves and Landis, 1985; Speedie et al., 1993; Van Lancker Sidtis and Postman, 2006; Sidtis et al., 2009; Van Lancker Sidtis et al., 2015). It is worth pointing out that parts of these neural networks are intact in left-hemisphere stroke patients, leading to the intriguing observation that individuals with classical speech and language disorders are often able to communicate comparably well based on a repertoire of formulaic expressions (McElduff and Drummond, 1991; Lum and Ellis, 1994; Stahl et al., 2011). An upper limit of such expressions has not yet been identified, with some estimates reaching into the hundreds of thousands (Jackendoff, 1995). The above literature suggests that formulaic expressions may be viewed as a valuable resource in speech-language therapy. However, surprisingly little is known about their potential impact on the success of popular programs in clinical rehabilitation. The current opinion paper seeks to address this matter by outlining the contribution of formulaic expressions to seminal approaches in recovery from speech and language disorders after stroke.