Speech Difficulties Research Articles

Giving Voice to People With Dementia and Their Carers: The Impact of Communication Difficulties on Everyday Conversations

People living with dementia are an under-served group, whose voices are often excluded from research studies due to their speech, language and communication difficulties. As part of a larger study into language processing in dementia, we invited five people with dementia and their carers to tell us about how dementia impacts on their everyday conversations. We also wanted to gain insights into their views on communication strategies to circumvent these difficulties. Aware of the limitations of a standard focus group methodology for this population, we adapted this approach to provide people with dementia the opportunity to be active research participants. To amplify their voices and to enable carers to be as open as possible we ran the groups separately. Each was facilitated by a speech and language therapist. Both groups used communication accessible materials, to create an inclusive environment that valued contributions from all participants. The topic guide remained the same for all participants, ensuring equity in posing the same core questions. Focus groups were video recorded and transcribed. Reflexive thematic analysis was selected as the most appropriate method to ensure overarching themes identified were based in the data. In our analysis the main theme was sense-making; participants experienced and tried to make sense of dementia through the lens of interaction. Four subthemes were also identified, 1. It’s a journey, 2. You have to make the most of things, 3. Ask the right questions and it just flows-strategies in conversation, and 4. Dealing with people. Multimodal adaptations to a focus group methodology have given voice to people with dementia as well as their carers. They characterise dementia and identify useful strategies based on observations of what changes for them in everyday conversations.

Schizophrenia and Sexual Behaviour

Schizophrenia is a chronic and severe mental health condition characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking, and speech difficulties. Sexual behaviour in individuals with schizophrenia can be affected by a combination of factors, including the symptoms of the condition, medication side effects, social factors, and personal beliefs and values. Research suggests that individuals with schizophrenia are more likely to have issues with intimacy, experience difficulties with sexual functioning, and engage in risky sexual behaviour. Treatment strategies for these issues may include addressing the underlying causes of sexual dysfunction, developing appropriate communication skills, and providing support to promote healthy sexual relationships. Overall, understanding the complex relationship between schizophrenia and sexual behaviour is important for promoting the overall wellbeing of individuals living with this condition.

Bioenvironmental Predictors of Childhood Reading and Speech Difficulties.

Reading and speech difficulties are common in childhood, yet it is not fully understood how much of their etiology is shared. This partly derives from methodological issues related to overlooking the potential co-occurrence between the two sets of difficulties. This study investigated the effects of five bioenvironmental predictors in a sample assessed for such co-occurrence. A combination of exploratory and confirmatory analyses was performed on longitudinal data from the National Child Development Study. Exploratory latent class analysis was performed on children's reading, speech, and language outcomes at ages 7 and 11 years. Membership in the obtained classes was modeled using a regression with sex and four early-life predictors: gestation period, socioeconomic status, maternal education, and the home reading environment. The model yielded four latent classes that broadly reflected (1) average reading and speech, (2) excellent reading, (3) reading difficulties, and (4) speech difficulties. Early-life factors significantly predicted class membership. Male sex and preterm birth emerged as risk factors for both reading and speech difficulties. Protective effects against reading difficulties were identified for maternal education, and lower (but not higher) levels of socioeconomic status and the home reading environment. Co-occurrence of reading and speech difficulties in the sample was low, and differential patterns of effect of the social environment were supported. Reading outcomes were under stronger malleable influence than speech outcomes.

Activity of a TIE2 inhibitor (rebastinib) in a patient with a life-threatening cervicofacial venous malformation.

Targeted therapy has become the first therapeutic option in many patients with vascular anomalies. A male 28-year-old patient presented a severe cervicofacial venous malformation involving half-lower face, anterior neck, and oral cavity with progression despite multiple previous treatments, with a somatic variant in TEK (endothelial-specific protein receptor tyrosine kinase) (c.2740C>T; p.Leu914Phe). The patient had facial deformity, daily episodes of pain and inflammation needing massive amount of medication, and difficulty in speech and swallowing, so rebastinib (a TIE2 kinase inhibitor) was approved for compassionate use. After 6months of treatment, venous malformation had decreased in size and lightened, as well as improved quality-of-life scores.

Abstract #1406613: Recurrent Thyroiditis in a Patient with Multiple sclerosis on Natalizumab

Thyroiditis, or self-limiting inflammation of the thyroid gland consists of 3 phases: hyperthyroidism, from release of hormone from damaged cells; hypothyroidism, when thyroid stores are depleted and euthyroidism with restoration of thyroid function. Etiology can include infectious, drug-induced or autoimmune causes such as multiple sclerosis (MS). In fact, 20-25% of untreated MS patients have autoimmune thyroiditis [1]. Moreover, drugs used to treat MS such as alemtuzumab and interferon have been reported to cause thyroid disease [2]. A 42-year-old female with MS on natalizumab for 10 years presented with right sided neck pain radiating to her jaw for 3 months and difficulty swallowing. Family history was pertinent for hypothyroidism in her father, and MS in her brother. She was exposed to nuclear radiation at age 3 from the Chernobyl disaster. On presentation, vital signs and physical exam were unremarkable. Thyroid ultrasound noted an ill-defined 4.2X1.3X1.9 cm hypoechoic nodule in the right mid-pole. Fine needle aspiration of the nodule showed subacute granulomatous thyroiditis (SAH). Labs showed TSH 0.02mIU/L [0.4-4.5], FT4 1.5ng/dL [0.8-1.8] and elevated total T3 204ng/dL [76-181]. TSI< 89 [140%]. Naproxen was given for pain control. Repeat labs 1 month later showed TSH 0.83mIU/L, FT4 1.1 ng/dL and total T3 196ng/dL, consistent with resolution of thyroiditis and clinically correlated with resolution of her pain. However, a month later she presented with worsening left sided neck pain and left thyromegaly associated with speech difficulty, diaphoresis, and constipation. Repeat thyroid ultrasound showed decreased size of right thyroid nodule 1.1X1.1X0.9cm and findings consistent with thyroiditis. She was treated with prednisone with complete resolution of symptoms. Labs post treatment showed elevated TSH 6.01mIU/L, total T3 106ng/dL, and FT4 0.8ng/dL consistent with the recovery phase of thyroiditis. Anti-TPO antibody level was < 1 [< 9 IU/mL]. Labs 1 month later showed normal TSH and FT4 levels. Natalizumab, a humanized monoclonal antibody commonly used to treat MS, has rarely been associated with thyroid disease. Alterations in thyroid function are thought to be due to direct toxicity on the thyroid, its blood supply or indirectly mediated by the immune system [2]. Although MS can be associated with thyroiditis, our patient did not present with the typical pattern of thyroiditis. Instead, she reported symptoms consistent with inflammation of one lobe of thyroid followed by resolution, and thereafter developed inflammation and pain of the other lobe, raising suspicion of potential involvement of natalizumab due to her atypical presentation.

Macroglossia in Beckwith-Wiedemann Syndrome: A Narrative Review

Beckwith-Wiedemann syndrome has a wide spectrum of clinical features, namely macroglossia, defects in the abdominal wall and an increased risk of developing embryonal tumors during childhood. Macroglossia can cause several disorders such as airway obstruction, dysphagia, drooling, speech difficulties and other disorders. To determine the etiology and clinical picture and to differentiate macroglossia in BWS from macroglossia in other diseases so as to be able to make a diagnosis and plan the right treatment. Collecting and analyzing relevant references in the form of journals and textbooks accessed through the Google Scholar, Google Books, PubMed and Science Direct databases. Macroglossia in BWS and macroglossia in other diseases can be distinguished if an appropriate diagnosis is made by means of a complete clinical and physical examination so that clinical symptoms and possible etiological factors can be identified.

EARLY INTERVENTION OF SPEECH AND LANGUAGE DEVELOPMENT PROBLEMS IN CHILDREN WITH CLEFT LIP AND PALATE

Children with cleft lip and palate (CLP) can have language and speech difficulties. This happens because of changes in the orofacial anatomical structure, so there are some limitations in articulation abilities. In addition to speech-sound disorders, children with cleft lip and palate often experience problems with language skills due to a limited vocabulary as well as syntactic and morphological abilities. Children with CLP can experience problems with sentence structure and speech speed (words per minute), so children with cleft lip and palate often experience language delays. The research conducted is a systematic research review. This research was conducted by searching for and selecting five types of data from the results of previous studies and from the results of clinical trials conducted on different ethnicities, races, and locations around the world. Research information was retrieved from databases, including PubMed, Wiley, and Google Scholar. The data analysis technique used in this systematic review is the data extraction method. The results showed that the search for articles that matched the searches and explanations about early handling of language development in children with cleft lip and palate, namely. Early intervention with parental assistance. There were five articles on the results of interventions in children with cleft lip and palate, namely, early intervention after the cleft lip and palate fusion process and educational support for parents.

PC29. Surgical, Functional, and Survival Outcomes of Lip Reconstruction after Cancer Resection: A 20-year Experience at MD Anderson Cancer Center

PURPOSE: Lip reconstruction outcomes after head and neck cancer resection have been limited to small series. Herein, we report a 20-year experience with lip reconstruction in this population and delineate the rates and predictors of postoperative outcomes. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent lip reconstruction following cancer resection from January 1994 to January 2015. Patient demographics, surgical characteristics, defect dimensions and flap type were correlated with surgical and functional outcomes using multivariable regression. RESULTS: We identified 244 patients with mean follow-up time of 28.7±37.6 months. Most defects involved the lower lip (44.0%, n=80), without oral commissure resection (67.6%). Lip advancement (21.0%), primary closure (16.2%), Webster-Bernard (11.4%), and folded-fasciocutaneous free flaps (11.4%) were the most common reconstruction techniques. A minority of patients developed surgical complications (25.2%), microstomia (16.7%), food intolerance (14.6%), oral incompetence (11.9%), speech difficulty (3.3%), lip tethering (2.4%), and dysphagia (1.9%). 5-year survival probability was 43.5%. Tobacco use (OR, 3.18; P=.007), diabetes mellitus (OR, 2.29; P=.035), and concurrent mandible reconstruction (OR, 2.31; P=.018) were associated with surgical complications. Recurrent disease (OR, 2.62; P=.043) and oral commissure resection (OR, 2.71; P<0.001) were associated with oral incompetence. Tobacco use (OR, 12.02; P=.023), concurrent upper and lower lip resection (OR, 4.70; P=.028), and larger upper lip resection size (OR, 13.8; P=.028) were associated with microstomia. CONCLUSION: Lip reconstruction after oncological resection may contribute to improved function with relatively low complication rates. Careful consideration of risk factors and preoperative planning is imperative for successful lip reconstruction outcomes.

Intravenous tPA administration in patients with negative diffusion-weighted imaging (DWI) study on the MRI brain (P1-4.006)

<h3>Objective:</h3> To identify and analyze the clinical characteristics of the patients that had stroke-like symptoms (stroke mimics) on presentation and received IV tPA but subsequently were found not to have an ischemic stroke. <h3>Background:</h3> Intravenous tissue plasminogen activator (tPA) administration within 4.5 hours of last known normal to the patients presenting with symptoms of stroke is the standard of care. Stroke mimics are a diverse group that is difficult to identify. They present with acute-onset focal neurological deficits, however further work up including MRI (magnetic resonance imaging) of the brain show no evidence of stroke or TIA. The aim of our study is to identify such patients and understand their clinical characteristics. <h3>Design/Methods:</h3> We retrospectively reviewed the medical records and analyzed all the patients in a span of one year that presented with stroke like symptoms and received IV tPA. <h3>Results:</h3> We identified a total of 107 pts that received tPA in a span of year at our institute. Among them there were 11 patients that showed no changes in the DWI sequence of MRI imaging and did not have stroke as their discharge diagnosis. Overall, we found that stroke mimics compromise 10.2 % of the pts that got administered tPA. The age of this group ranged from 38–73. There were seven women and four men. The NIHSS at the time of presentation ranged from 3–19. We identified three patients with hypertensive crisis, two with cervical radiculopathy, two with suspicion of conversion disorder: one each with normal pressure hydrocephalus, sepsis with neurosyphilis, pulmonary embolism with aortic regurgitation and methamphetamine abuse. Majority of them presented with unilateral weakness along with facial weakness and speech difficulties. <h3>Conclusions:</h3> We conclude that in our patient population, only few patients were found to be stroke mimics. <b>Disclosure:</b> Dr. Badugu has nothing to disclose. Dr. PANDEY has nothing to disclose. Dr. Chappidi has nothing to disclose. Dr. Kelley has nothing to disclose.

Raising Clinical Suspicion for Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS): Recurrent Seizures, Stroke-like Episodes, and Cortical Atrophy in Young Patients (P3-1.007)

<h3>Objective:</h3> Phenotypic variability and lack of familiarity with criteria can make diagnosis of MELAS challenging. Clinicians should be cognizant and consider early MR spectroscopy with genetic screening. <h3>Background:</h3> MELAS is a rare, progressive mitochondrial disorder that can be missed if clinical suspicion is low. <h3>Design/Methods:</h3> A thorough chart review was conducted. <h3>Results:</h3> <h3>Case 1:</h3> A 33-year-old female presented with recurrent right-sided visual scotomas. MRI showed focal DWI changes to the occipital lobe. Continuous video-EEG showed subclinical occipital lobe seizures. The patient had a recurrent episode of right-sided vision changes, speech difficulty and poor comprehension. MRI showed cortical atrophy and DWI abnormalities without ADC mismatch in the left occipital and left posterior temporal lobes. Stroke and infectious workup was unrevealing. Another episode of numbness, hearing loss, and word-finding difficulty prompted MR spectroscopy, screening lactate level, and genetic analysis. The diagnosis of MELAS was established based on the patient’s recurrent seizures, cortical visual loss, acute lesions on MRI, high plasma lactate, and a confirmed, possibly pathogenic mutation in MT-TL1. She suffered from neurological deterioration and passed away 6 months later. <h3>Case 2:</h3> Patient is a 26-year-old male with a long history of migraines with visual disturbances. MRI showed edema in the left occipital lobe. Subsequently, he presented with an intractable headache associated with left-sided peripheral vision loss and left leg weakness. MRI was notable for hyperintense flair signal in the right occipital lobe and marked atrophy. EEG showed frequent seizures and workup for stroke and encephalitis was unrevealing. Lactate levels were elevated and genetic screening was notable for MT-TL1 mutation. <h3>Conclusions:</h3> Patients younger than 40 with stroke-like symptoms, brain atrophy disproportionate to age, and negative infectious and vascular workup should be evaluated for MELAS. MR Spectroscopy, lactate levels, and genetic testing are important non-invasive screening measures. <b>Disclosure:</b> Mr. Tallavajhala has nothing to disclose. Dr. Bochenek has stock in JNJ, Abbott, Moderna, Pfizer. Ms. Dwivedi has nothing to disclose. Ms. Caffio-Learner has nothing to disclose. Miss Suliman has nothing to disclose. Dr. Bashir has nothing to disclose. Dr. Kurukumbi has nothing to disclose.

A Case of Pantothenate Kinase-Associated Neurodegeneration (PKAN) in a Patient with One Known Pathologic Variant and One Variant of Unknown Significance (P11-4.006)

<h3>Objective:</h3> Raise interest in the possibility of an unidentified PANK2 gene mutation in the pathogenesis of PKAN <h3>Background:</h3> Pantothenate kinase-associated neurodegeneration (PKAN), previously known as Hallervorden-Spatz Disease, is a neurodegenerative disorder associated with brain iron deposition. PKAN follows an autosomal recessive inheritance pattern and presents in childhood (classical) or around the second decade of life (atypical). Individuals with PKAN typically present with dysarthria, dystonia, speech difficulties, and extrapyramidal symptoms. PKAN has a characteristic “eye of the tiger” sign on MRI with hypointensity of the globus pallidus surrounded by an area of hyperintensity. Pantothenate kinase 2 (PANK2) gene sequencing changes have been identified as markers of PKAN. <h3>Case Description:</h3> The patient discussed is a 27-year-old woman who presented in 2013 for abnormal posturing and cramping of her hands and feet since she was four. Based on the patient’s physical exam, it was believed she was suffering from young-onset Parkinson’s disease or dystonia. However, a trial of Levodopa resulted in no improvement, genetic testing for dystonia was negative, and her brain MRI was read as normal. Due to worsening symptoms, her MRI was reassessed, and the subtle “eye of the tiger” sign was recognized. Further genetic testing showed she was a carrier for two heterozygous PANK2 mutations, one known pathologic variant and one unknown. The patient elected to join a clinical trial as her symptoms progressed. Nine years since presenting, she has completed two clinical trials and is currently on Deferiprone (an iron chelator), Artane, and Baclofen for symptom management. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> This report discusses a patient with PKAN who has one PANK2 mutation of known significance and one unknown variant. Considering PKAN is an autosomal recessive disease, this report suggests a novel PANK2 pathogenic variant. This study also demonstrates how the diagnosis of PKAN can be easily missed due to subtle MRI changes. <b>Disclosure:</b> Dr. Cevallos has nothing to disclose. Miss Rubin has nothing to disclose. Miss Rhinehart has nothing to disclose. Dr. Houghton has nothing to disclose.

Effects of aging on cortical representations of continuous speech.

Understanding speech in a noisy environment is crucial in day-to-day interactions and yet becomes more challenging with age, even for healthy aging. Age-related changes in the neural mechanisms that enable speech-in-noise listening have been investigated previously; however, the extent to which age affects the timing and fidelity of encoding of target and interfering speech streams is not well understood. Using magnetoencephalography (MEG), we investigated how continuous speech is represented in auditory cortex in the presence of interfering speech in younger and older adults. Cortical representations were obtained from neural responses that time-locked to the speech envelopes with speech envelope reconstruction and temporal response functions (TRFs). TRFs showed three prominent peaks corresponding to auditory cortical processing stages: early (∼50 ms), middle (∼100 ms), and late (∼200 ms). Older adults showed exaggerated speech envelope representations compared with younger adults. Temporal analysis revealed both that the age-related exaggeration starts as early as ∼50 ms and that older adults needed a substantially longer integration time window to achieve their better reconstruction of the speech envelope. As expected, with increased speech masking envelope reconstruction for the attended talker decreased and all three TRF peaks were delayed, with aging contributing additionally to the reduction. Interestingly, for older adults the late peak was delayed, suggesting that this late peak may receive contributions from multiple sources. Together these results suggest that there are several mechanisms at play compensating for age-related temporal processing deficits at several stages but which are not able to fully reestablish unimpaired speech perception.NEW & NOTEWORTHY We observed age-related changes in cortical temporal processing of continuous speech that may be related to older adults' difficulty in understanding speech in noise. These changes occur in both timing and strength of the speech representations at different cortical processing stages and depend on both noise condition and selective attention. Critically, their dependence on noise condition changes dramatically among the early, middle, and late cortical processing stages, underscoring how aging differentially affects these stages.

A Rare Familial Case of MELAS in a 66-Year-Old Female and Her 33-Year-Old Son (P12-5.005)

<h3>Objective:</h3> Mitochondrial encephalopathy, lactic acidosis, and stroke like episodes (MELAS) is a mitochondrial disorder presenting most commonly between 2 to 40 years of age, with 75% of cases before age 20. Rare cases have been reported past age 60. We report on a case of a family presenting with late onset MELAS in the same year. <h3>Background:</h3> A 66-year-old female with a past medical history of sensorineural hearing loss, type 2 diabetes, hypertension and hyperlipidemia presented with word finding difficulty and right sided neglect. MRI demonstrated a DWI lesion in the left temporal lobe consistent with infarct. Vessel imaging, echocardiogram, and cardiac monitor were unremarkable, and she was discharged on clopidogrel. She returned 11 days later with worsening aphasia and MRI revealed extension of her stroke into the left occipital lobe and right cerebellum. It was then discovered her previously healthy 33-year-old son had been diagnosed with MELAS three months prior. The son had presented with subtle speech difficulties and was found to have a right temporal DWI and T2 hyperintense lesion on MRI. CSF and serum studies were unremarkable for infectious and autoimmune causes. He was discharged following improvement of symptoms but returned the following day after having generalized seizure. MRI revealed expansion of the lesion into the right parietal lobe. MR Spectroscopy showed an elevated lactate peak leading to a presumptive diagnosis of MELAS. He was started on L-Arginine and CoQ10. In both cases, genetic testing revealed a pathogenic MT-TL1 m.3243A&gt;G variant consistent with MELAS (9.7% heteroplasmy in mother and 31% heteroplasmy in son). <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> This case demonstrates low heteroplasmy can lead to a later presentation of MELAS requiring MELAS to be on the differential even in people older than 60. <b>Disclosure:</b> Dr. Iordanova has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Cheng has nothing to disclose.

Borno-Net: A Real-Time Bengali Sign-Character Detection and Sentence Generation System Using Quantized Yolov4-Tiny and LSTMs

Sign language is the most commonly used form of communication for persons with disabilities who have hearing or speech difficulties. However, persons without hearing impairment cannot understand these signs in many cases. As a consequence, persons with disabilities experience difficulties while expressing their emotions or needs. Thus, a sign character detection and text generation system is necessary to mitigate this issue. In this paper, we propose an end-to-end system that can detect Bengali sign characters from input images or video frames and generate meaningful sentences. The proposed system consists of two phases. In the first phase, a quantization technique for the YoloV4-Tiny detection model is proposed for detecting 49 different sign characters, including 36 Bengali alphabet characters, 10 numeric characters, and 3 special characters. Here, the detection model localizes hand signs and predicts the corresponding character. The second phase generates text from the predicted characters by a detection model. The Long Short-Term Memory (LSTM) model is utilized to generate meaningful text from the character signs detected in the previous phase. To train the proposed system, the BdSL 49 dataset is used, which has approximately 14,745 images of 49 different classes. The proposed quantized YoloV4-Tiny model achieves a mAP of 99.7%, and the proposed language model achieves an overall accuracy of 99.12%. In addition, performance analysis among YoloV4, YoloV4 Tiny, and YoloV7 models is provided in this research.

Stroke Mortality Among Black and White Adults Aged ≥35 Years Before and During the COVID-19 Pandemic — United States, 2015–2021

Stroke is the fifth leading cause of death and a leading cause of long-term disability in the United States (1). Although stroke death rates have declined since the 1950s, age-adjusted rates remained higher among non-Hispanic Black or African American (Black) adults than among non-Hispanic White (White) adults (1,2). Despite intervention efforts to reduce racial disparities in stroke prevention and treatment through reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to treatment and care for stroke (1,3), Black adults were 45% more likely than were White adults to die from stroke in 2018.* In 2019, age-adjusted stroke death rates (AASDRs) (stroke deaths per 100,000 population) were 101.6 among Black adults and 69.1 among White adults aged ≥35 years. Stroke deaths increased during the early phase of the COVID-19 pandemic (March-August 2020), and minority populations experienced a disproportionate increase (4). The current study examined disparities in stroke mortality between Black and White adults before and during the COVID-19 pandemic. Analysts used National Vital Statistics System (NVSS) mortality data accessed via CDC WONDER† to calculate AASDRs among Black and White adults aged ≥35 years prepandemic (2015-2019) and during the pandemic (2020-2021). Compared with that during the prepandemic period, the absolute difference in AASDR between Black and White adults during the pandemic was 21.7% higher (31.3 per 100,000 versus 38.0). During the pandemic period, an estimated 3,835 excess stroke deaths occurred among Black adults (9.4% more than expected) and 15,125 among White adults (6.9% more than expected). These findings underscore the importance of identifying the major factors contributing to the widened disparities; implementing prevention efforts, including the management and control of hypertension, high blood cholesterol, and diabetes; and developing tailored interventions to reduce disparities and advance health equity in stroke mortality between Black and White adults. Stroke is a serious medical condition that requires emergency care. Warning signs of a stroke include sudden face drooping, arm weakness, and speech difficulty. Immediate notification of Emergency Medical Services by calling 9-1-1 is critical upon recognition of stroke signs and symptoms.

Evaluation of Children’s Perceptions after Frenectomy: Diode Laser vs. Conventional Scalpel Technique

Objective: The presence of abnormal frenum may cause aesthetic or functional problems, which can be prevented by frenectomy operation. Therefore, the aim of this study is to compare children's perceptions of pain, speech and chewing difficulties after conventional scalpel technique and diode laser-assisted frenectomy operations. Material and Methods: Twenty-one patients, aged 10 to 16 years, who were indicated for Frenectomy were assigned to be treated with conventional scalpel technique or diode laser. In the comparison between both techniques, the Wong-Baker FACES Pain Rating Scale was used to evaluate pain immediately after surgery and pain, speech and chewing difficulties at days 1, 3, 7, and 10 following the procedure. Factors such as duration of surgery, use of anaesthetic, and need for analgesics were also recorded. Moreover, Corah's Dental Anxiety Scale was used to evaluate the dental anxiety levels of parents about their children. Results: When compared to the conventional scalpel technique, it was found that the surgery took shorter, and no postoperative analgesic was needed in the group that underwent Diode laser surgery. In addition, as the age of the children increased, the anxiety levels of the parents decreased. When the postoperative perceptions of pain and functional discomforts were evaluated, there was no significant difference between the groups. Conclusion: According to the results of this study, Diode laser provided benefits such as significantly shortening the operation time and not requiring surgical sutures and analgesics in children. It may also allow the use of less infiltrative anaesthetic during the operation.

Teaching Neuro Images : Nonfluent variant primary progressive aphasia

A 66-year-old woman presented with 4 years of progressive speech difficulty. She had nonfluent speech with phonemic errors but intact single-word comprehension and object knowledge. Her grammar was impaired in both speech and writing, and she exhibited orofacial apraxia. A clinico-radiologic (see figure) diagnosis of nonfluent variant primary progressive aphasia was made.

Düşük Kas Tonusu ve Konuşma Bozukluğu Olan 3 Yaşındaki Bir Çocukta Ayres Duyu Bütünleme İçeren Fizyoterapi Programının Etkileri: Tek Vaka Çalışması

This case report describes how a physiotherapy program with Ayres Sensory Integration was associated with changes in a 3 years old child with low muscle tone and speech disorders. To see how the Ayres Sensory Integration Physiotherapy Program affects muscle tone, speech, and the relation between muscle tone and speech, a 24-week physiotherapy program with Ayres Sensory Integration was initiated. Before and after the therapy, Development Screening Test, speech, muscle tone, and Antigravity Test were assessed and recorded. Muscle tone, speech, Development Screening Test and Antigravity Test results have all improved. Children with low muscle tone and speech difficulties can benefit from physiotherapy programs involving Ayres Sensory Integration. In addition to speech therapy, children with speech issues should get sensory integration therapy

73-Year-Old Man With Altered Mental Status and Speech Difficulties

73-Year-Old Man With Altered Mental Status and Speech Difficulties

Symptom Cluster Experiences of Patients Operated for Oral Cancer: A Mixed Methods Study

ObjectiveThis convergent mixed methods study aimed to obtain a comprehensive understanding of symptom cluster experiences in patients with oral cancer. Survey and phenomenological interviews were conducted in parallel to identify distinct patient subgroups based on symptom cluster experiences along with their predictors and explore experiences of living with symptom clusters, respectively. Data SourcesA convenience sample of 300 patients with oral cancer who had completed surgery provided the quantitative data, and a maximum variation purposive subsample of 20 participants, drawn from the survey sample, provided the qualitative data. Agglomerative hierarchical cluster analysis was used to identify subgroups, multivariate analyses were done to identify predictors, and thematic analysis was used for patient narratives. ConclusionAlmost 94% of the survey participants had two or more co-occurring symptoms. The four most severe and prevalent symptoms were dysphagia, problems with teeth or gums, speech difficulty, and dry mouth. A distinct subgroup consisting of 61% of patients reported severe dysphagia and teeth problems, which was associated with age, oral cancer stage and site. Interviews revealed the causes and the context influencing the perception and response to these symptoms. Thus, the quantitative data provided information on severity and patient subgroups based on symptom cluster experiences, while the qualitative data validated these conclusions and additionally provided in-depth details and meaningful insight on perceived causes and contextual influences of their experiences. This comprehensive picture of symptom cluster experiences can aid in the development of patient-centered interventions for people with oral cancer. Implications for Nursing PracticeAn interdisciplinary approach to targeting concurrent symptoms incorporating psychological and physical interventions is necessary. Older patients treated for Stage IV cancers and for buccal mucosa tumors are at high-risk of having severe dysphagia postoperatively, and these patients should be targeted for dysphagia interventions. The contextual factors play an important role in developing patient-centered interventions.