Functional Verbal Communication Research Articles

789 Role of Speech Therapy (SLP) in the rehabilitation of a complicated case of glossoparesis (GP)

IntroductionGlossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.MethodsThe patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.ResultsThrough the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.ConclusionsUpon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.

Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence.

Bulbar dysfunction is a common presentation of amyotrophic lateral sclerosis (ALS) and significantly impacts quality of life of people with ALS (PALS). The current paper reviews measurements of dysarthria and dysphagia specific to ALS to identify efficient and valid assessment measures. Using such assessment measures will lead to improved management of bulbar dysfunction in ALS. Measures reviewed for dysarthria in PALS are organized into three categories: acoustic, kinematic, and strength. A set of criteria are used to evaluate the effectiveness of the measures' identification of speech impairments, measurement of functional verbal communication, and clinical applicability. Assessments reviewed for dysphagia in PALS are organized into six categories: patient reported outcomes, dietary intake, pulmonary function and airway defense capacity, bulbar function, dysphagia/aspiration screens, and instrumental evaluations. Measurements that have good potential for clinical use are highlighted in both topic areas. Additionally, areas of improvement for clinical practice and research are identified and discussed. In general, no single speech measure fulfilled all the criteria, although a few measures were identified as potential diagnostic tools. Similarly, few objective measures that were validated and replicated with large sample sizes were found for diagnosis of dysphagia in PALS. Importantly, clinical applicability was found to be limited; thus, a collaborative team focused on implementation science would be helpful to improve the clinical uptake of assessments. Overall, the review highlights the need for further development of clinically viable and efficient measurements that use a multidisciplinary approach.

Prospective cohort study of voice outcomes following secondary tracheoesophageal puncture in gastric pull-up reconstruction after total laryngopharyngoesophagectomy

BackgroundGastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes.MethodsThis was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings (“Rainbow Passage”) randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool.ResultsTen patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214–265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1–68.3) dB. Perceptual analysis (GRBAS) revealed a median ‘moderate’ degree of impairment [grade 2 (IQR 2–3), roughness 2 (IQR 2–3), breathiness 3 (IQR 2–3), asthenia 2 (IQR 1–2), strain 2 (IQR 1–2)] as did median intelligibility scores [median 5 (IQR 4–7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8–35.0)].ConclusionSecondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication.Graphical abstract

A Dental Communication Board as an Oral Care Tool for Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) sometimes display an inability for information sharing through functional verbal communication. This may interfere with professional oral care. These children tend to process visual information more efficiently than auditory information. Picture schedules can briefly suffice as visual cues serving a vital function in helping children with ASD to function in a particular setting such as an oral care environment. A visual communication implement such as a dental communication board was developed in this study to allow for a facilitated communication process between the patient with ASD and the oral care professional. This study entailed two main phases, namely the selection of symbols for theconstruction of adental communication board andthe small scale testing of the board in a clinical setting. This study incorporated a combination of a quantitative non-experimental descriptive survey combined with aconcurrent mixed method survey design which retrieved data for both close-ended and open-ended questions from the same respondent. A quantitative survey questionnaire at a structured dental seminar presentation was employed for the first phase, and a combination of a quantitative and qualitative questionnaire was employed for the second phase of this study. Documented responses were collated and analyzed using frequency and thematic analysis. The most frequently selected symbols were retrieved after a frequency analysis and displayed on a color coded background to distinguish the various categories on the dental communication board. The thematic analysis resulted in the emergence of three main themes, namely the strengths of the board; weakness of the board and suggestions. This study anticipates the incorporation of a dental communication board as a visual mode using graphic symbols to augment expressive and receptive language in an oral care environment to facilitate professional oral care for children with ASD.

Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves

ObjectiveTo investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves. Study designCase series with planned data collection. SettingLarge, urban, tertiary care teaching hospital. Subjects and methodsReferred sample of 30 consecutively enrolled adults requiring a tracheotomy tube and tested with Blom and Passy-Muir valves. Physiologic parameters recorded were oxygen saturation, respiration rate, and heart rate. Voice production abilities included maximum voice intensity in relation to ambient room noise and maximum phonation duration of the vowel/a/. Functional verbal communication was determined from randomized and blinded listener ratings of counting 1–10, saying the days of the week, and reading aloud the sentence, “There is according to legend a boiling pot of gold at one end.” ResultsThere were no significant differences (p>0.05) between the Blom and Passy-Muir valves for the physiologic parameters of oxygen saturation, respiration rate, and heart rate; voice production abilities of both maximum intensity and duration of/a/; and functional verbal communication ratings. Both valves allowed for significantly greater maximum voice intensity over ambient room noise (p<0.001). ConclusionsThe Blom low profile voice inner cannula and Passy-Muir one-way speaking valves exhibited equipoise regarding patient physiologic parameters, voice production abilities, and functional verbal communication ratings.Learning outcomes: Readers will understand the importance of verbal communication for patients who require a tracheotomy tube; will be able to determine the differences between the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves; and will be confident in knowing that both the Blom and Passy-Muir one-way tracheotomy tube speaking valves are equivalent regarding physiological functioning and speech production abilities.

Sensory Response Patterns in Nonverbal Children with ASD

We sought to examine concurrent and longitudinal associations between sensory response patterns (i.e., hyperresponsiveness, hyporesponsiveness, and sensory seeking) and verbal status of young children with autism spectrum disorder (ASD) as a potential factor influencing the development of verbal communication. Seventy-nine children with ASD (verbal, n = 29; nonverbal, n = 50) were assessed using cross-sectional analyses (Study 1), and 14 children with ASD (verbal, n = 6; nonverbal, n = 8) were assessed using prospective longitudinal analyses (Study 2). Data were collected regarding sensory response patterns and verbal ability. Hyporesponsiveness and sensory seeking behaviors were associated with verbal status in both cross-sectional and longitudinal analyses; nonverbal children were more likely to demonstrate higher hyporesponsive and sensory seeking patterns. Hyperresponsiveness did not significantly differ between verbal and nonverbal groups in either design. Sensory hyporesponsiveness and seeking behaviors may be important factors hindering the development of functional verbal communication in children with ASD. Unusual sensory responsiveness can often be observed before the onset of speech and may yield important prognostic capabilities as well as inform early interventions targeting verbal communication or alternative communication options in young children with ASD.

Long-term prognosis of aphasia after stroke

BackgroundThe long-term functional outcome of aphasia after stroke is uncertain, even though this information is needed as early as possible for adequate patient care and support. This observational prospective study...

Employment and social issues in adults with cerebral palsy

Objective: To assess the social and employment status of adults with cerebral palsy.Design: Detailed medical history, physical examination, and functional rating in the PULTIBEC system were performed on all study participants; they also responded to a standardized social adaptation questionnaire.Setting: Outpatient clinic.Subjects: Volunteer participants (n = 101), all with cerebral palsy, between the ages of 27 and 74 years, living independently in the community.Results: More than 80% wished that their physician knew more about cerebral palsy. The majority (84%) felt their parents overprotected them in childhood. More than 90% desired more sexual education. More than half (67%) lived independently, 34% with and 33% without attendant. Of the 53% who were competitively employed, 22% earned an income high enough that advancement wouldcause financial loss through termination of disability benefits. Speech deficits severely compromised functional verbal communication in 50%. Type of employment correlated more with adequate cognition than with physical or communicative impairments.Conclusions: Compared with eather studies, the present study showed more adults with cerebral palsy achieving competitive employment and independent living, despite moderate to severe physical disability. Advances in rehabiliation technology, better home support services, and legal mandates in education and environmental access may have facilitated positive change for persons with cerebral palsy. Further studies are encouraged with emphasis on loggitudinal designs.

Blissymbolics-a nonverbal communication system.

Until recently, speech-language pathologists have shown little interest in seeking alternate forms of communication when functional verbal communication is not attainable. There is a paucity of literature dealing with nonverbal communication systems for people lacking functional verbal communication for reasons other than deafness. Blissymbolics is a logical, visual language that has provided functional communication for nonverbal cerebral-palsied children. The full potential and application of Blissymbolics has only begun to be realized, and there is much need for experimentation and research. This paper describes the system and suggests areas for future application and development.

Medical Instruction at Fever and Small-Pox Hospitals

<h3>Background</h3> The long-term functional outcome of aphasia after stroke is uncertain, even though this information is needed as early as possible for adequate patient care and support. This observational prospective study was aimed at predicting functional outcome at 1 year after stroke. <h3>Methods</h3> We examined linguistic components (ScreeLing) and functional verbal communication (Aphasia Severity Rating Scale, ASRS) in 147 aphasic patients. The ScreeLing was administered at 1, 2 and 6 weeks after stroke; the ASRS at 1 week and 1 year. The relationships between linguistic, demographic and stroke characteristics, and good functional outcome at 1 year (ASRS 4 or 5) were examined with logistic regression analyses. <h3>Results</h3> The baseline linguistic components (ie, semantics, phonology and syntax) were significant predictors (p&lt;0.001) for 1-year outcome in univariable analyses. In multivariable analysis, these variables explained 46.5% of the variance, with phonology being the only significant predictor (p=0.003). Age, Barthel Index score, educational level and haemorrhagic stroke were identified as other significant predictors of outcome. A prognostic model of these five baseline predictors explained 55.7% of the variance. The internally validated area under the receiver operating characteristic curve (AUC) was 0.89, indicating good predictive performance. Adding the degree of phonological recovery between 1 and 6 weeks after stroke to this model increased the explained variance to 65% and the AUC to 0.91. <h3>Conclusions</h3> The outcome of aphasia at 1 year after stroke can be predicted in the first week by the phonology score, the Barthel Index score, age, educational level and stroke subtype, with phonology being the strongest predictor.