Speech Impairment Research Articles

Development of a Real-Time Wearable Humming Detector Device

This study focuses on the development of a wearable real-time Humming Detector Device (HDD) aimed at enhancing the control of assistive devices through humming. As the need for portable user-friendly tools in assistive technology grows, the HDD offers a non-invasive solution to detect vocal cord vibrations. Vibrations, detected thanks to an accelerometer worn on the neck, are processed in real time using a Fast Fourier Transform (FFT) to identify specific humming frequencies, which are then translated into commands for controlling assistive devices via Bluetooth Low Energy (BLE) transmission. The device was tested with 13 healthy subjects to validate its potential and determine the optimal number of distinct commands that users can achieve. The HDD’s portability and precision make it a promising alternative to traditional voice recognition systems, particularly for individuals with speech impairments.

Progression of Motor Speech Function in Speakers With Primary Progressive Apraxia of Speech.

Speakers with primary progressive apraxia of speech (PPAOS) have an insidious onset of motor speech planning/programming difficulties. As the disease progresses, the apraxia of speech (AOS) becomes more severe and a co-occurring dysarthria often emerges. Here, longitudinal data from speakers with phonetic- and prosodic-predominant PPAOS are used to characterize the progression of their motor speech impairment, including the development of dysarthria and mutism. Data are presented from 52 speakers who had PPAOS at enrollment (i.e., progressive AOS in the absence of aphasia, cognitive, or other neurologic symptoms). Twenty-one had predominantly phonetic features, whereas 31 had primarily prosodic features. All participants underwent a comprehensive motor speech evaluation at their enrollment visit and each annual return visit, with a median of three visits per participant. Almost 25% of the speakers with PPAOS presented with dysarthria at their enrollment visit (median disease duration of 3.65 years), whereas more than 70% of them had developed dysarthria by their last visit (median disease duration of 6.85 years). Neither the likelihood to develop dysarthria nor the disease duration at which it was detected differed significantly between the phonetic and prosodic groups. However, muteness emerged sooner for speakers with phonetic-predominant PPAOS; the median disease duration at which they became mute was 1.5 years shorter than for their prosodic counterparts. Clinically, these results facilitate more accurate prognostication of motor speech symptoms in speakers with PPAOS, allowing for timely introduction of alternative means of communication. The results also support the differentiation between progressive AOS and dysarthria as distinct motor speech disorders that often co-occur in these individuals.

Missense variant Met119Val in ACTB in a patient with Baraitser-Winter syndrome type 1 and mild intellectual disability.

Here we report on a Brazilian female patient with striking dysmorphic craniofacial features of the Baraitser-Winter syndrome (BRWS), including coarse face with prominent metopic ridge, highly arched eyebrows, ocular hypertelorism, ptosis, long palpebral fissures, broad nasal tip, long philtrum, full cheeks, cleft lip and palate, and low-set ears with abnormal lobe. Other clinical signs included partial agenesis of the corpus callosum, asymptomatic pineal cyst, oligodontia, cervical cystic hygroma, pterygium colli, axillary pterygium, duplicated left hallux and seizures. Sanger sequencing of the ACTB gene showed a heterozygous missense variation NM_001101.5 (ACTB):c.355A>G (p.Met119Val). This variant is located very close to the ACTB variant Thr120Ile, which results in the severe BRWS phenotype with severe intellectual disability and absence of speech, firstly described as Fryns-Aftimos syndrome. Despite this, our patient had mild developmental delay, without impairment of speech, and with moderated learning difficulties.

Assistive Technology Integration for Students with Speech and Language Impairments: A Mixed Methods Study

This study examines a large urban public school (UPS) district in the Midwest USA that has faced bankruptcy, state takeover of public education, and financial scams. As a result, UPS's capacity to integrate assistive technologies (AT) has been limited and is declining. This study investigates the UPS teachers' technological pedagogical content knowledge (TPACK) and how the UPS teachers integrate AT for students with speech and language impairments (SLI). This article details the UPS special education and general education teachers' TPACK across grade levels, content, and classroom settings. This article reports the UPS teachers' current integration of AT, instructional practices, implementation, and experiences integrating AT in the classroom for students with SLI. 94 UPS teachers participated in the online survey. The study found no significant differences in the UPS teachers' TPACK across classroom settings or grade levels. Results show no significant differences between the UPS teachers' TPACK in mathematics, social studies, science, or literacy content knowledge. The study revealed that UPS teachers utilize various AT tools, from basic tools like [calculators, audio/video recording devices, and voice amplifiers] to more advanced tools like [iPads, SmartBoards, and computers], for diagnostic, formative, and summative assessments. Results indicate that the UPS teachers utilize similar instructional methods across content and express mostly positive experiences integrating AT for SLI students.

QOL-04. THE UNDER-UTILIZATION OF PALLIATIVE CARE SERVICES BY PATIENTS WITH GLIOBLASTOMA HIGHLIGHTS THE IMPORTANCE OF DISCUSSIONS AROUND PALLIATIVE CARE: A CROSS-SECTIONAL STUDY WITH CARE PARTNERS OF PATIENTS WITH GBM RECRUITED FROM FACEBOOK SUPPORT GROUPS

Abstract Glioblastoma (GBM) is a terminal brain cancer that has a rapid onset and results in symptoms such as headaches, vomiting, seizures, anxiety, depression, agitation, speech impairment, memory impairment, infections, brain bleeds, mobility changes, changes in sleep patterns, and cognitive changes. Palliative care helps patients diagnosed with an incurable or chronic disease manage physical, social, and psychological symptoms and has been shown to increase survival for patients with cancer. Previous data of former care partners of patients with GBM indicated only 30% of patients used palliative care whereas 90% used hospice. To better understand the reasons for underutilization of palliative care patients with GBM, 38-question survey about the use of palliative care, type of medical center where treatment occurred, and discussions with care team members about palliative care was given to current care partners recruited from Facebook support groups in February 2024. Inclusion criteria: current primary care partner of a patient with GBM, over the age of 18, and willing to participate (IRB exempt; H24-0393). The care partner was excluded if their patient was no longer living. Of the 77 current care partners, 56 reported they did not use palliative care as part of their care team. The use of palliative care was similar among care facilities (community hospital, major medical center, university hospital, brain tumor center). When care team members discussed palliative care with patients and their care partners (n=21), 71% of the dyads used palliative care. When care team members did not discuss palliative care (n=56), the use of palliative care was much lower at 7%. Interestingly, 55% of respondents reported they would benefit from knowing more about ways to increase physical and emotional support. This data suggests discussions around palliative care increase the use of palliative care services among patients with GBM and their care partners.

“The illuminating quiet”: a metaphor analysis of autobiographical descriptions of inner speech in aphasia

ABSTRACT Background Inner speech in aphasia is a rapidly expanding research area, but can be defined in numerous ways. Unlike behaviourally observable language processes such as overt word-production, inner speech is only directly available to introspection. Subjective experience thus grounds our understanding of inner speech and is a necessary starting point for investigating its definition. Descriptions of inner speech written by people with aphasia can make an important contribution to conceptual clarity in the literature. This important data source has not been systematically analysed. Our research addresses this gap. Aims This research aims to understand the subjective experience of impaired and preserved inner speech in aphasia, through analysis of the metaphors used in autobiographical accounts, and to interpret the findings in relation to the inner speech literature. Methods & Procedures This study carries out a metaphor-led discourse analysis of descriptions of inner speech in four autobiographical accounts of aphasia. Metaphorical expressions describing language processing were identified and coded, then systematic metaphors (i.e. the related concepts which are used consistently to describe a particular topic) were described. The metaphors used to describe inner speech were then analysed, with attention to patterns of use and contextual information. Results & Discussion 338 expressions made use of the main systematic metaphors which were used to describe inner speech. Two types of inner speech- Phonological Inner Speech and Dialogic Inner Speech – were described as distinct and dissociable experiences, and were described using different metaphors. Phonological Inner Speech, the internal activation of phonological representations, as used in mental repetition of a word or phrase, was described by two authors using the metaphors WORDS AS OBJECTS, MIND AS CONTAINER and INNER SPEECH AS HEARING WORDS. Dialogic Inner Speech, the use or awareness of linguistic inner reasoning or dialogue, was described by two different authors using the metaphors INNER SPEECH AS INNER VOICES/PERSONS/MONOLOGUE/DIALOGUE and APHASIA AS SILENCE/FLUID/SPIRITUAL EXPERIENCE. A double dissociation of these different definitions of inner speech is seen across two of the accounts. Different impacts on language processing and cognition were also described. Conclusions This research demonstrates that subjective accounts of inner speech can help clarify theoretical discussions and clinical implications. Although recent research within aphasiology has focused mainly on Phonological Inner Speech, we show that in these accounts the impairment of Dialogic Inner Speech was described as more salient and more explicitly as a “lack of inner voices”.

Transient biopsy-proven progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) in an elderly woman without known immunodeficiency: a case report

BackgroundProgressive multifocal leukoencephalopathy (PML) is a severe opportunistic brain disease caused by lytic JC polyomavirus (JCPyV) replication in oligodendrocytes. Although JCPyV infection is common in the general population, PML almost exclusively occurs in patients immunocompromised due to untreated HIV/AIDS, haematological malignancies, primary immunodeficiencies, solid organ transplantation, or immunomodulatory treatment of autoimmune diseases. There is no effective antiviral treatment, and recovery depends on immune reconstitution. Paradoxically, initiation of antiretroviral therapy for HIV/AIDS or interruption of immunomodulating treatment can worsen the clinical manifestations due to immune reconstitution inflammatory syndrome (IRIS). Here, we report an unusual case of spontaneous IRIS in a 76-year-old immunocompetent woman, unmasking PML and leading to unexpected recovery.Case presentationThe patient was admitted to the hospital due to psychosis, speech impairment, and behavioral changes over the last three months. She had previously been healthy, except for a cerebellar stroke secondary to paroxysmal atrial fibrillation. Magnetic resonance imaging (MRI) revealed multiple contrast-enhancing white matter lesions suspicious of cancer metastases. Due to suspicion of edema, dexamethasone was administered, and the patient was released while waiting for a stereotactic brain biopsy. Eight days later, she suffered tonic seizures and was readmitted. Intravenous levetiracetam gave rapid effect, but the patient was paranoid and non-cooperative, and dexamethasone was unintentionally discontinued. Ten days later, the brain biopsy revealed demyelination, abundant perivascular T cells, macrophages, and scattered JCPyV-infected oligodendrocytes, rendering the diagnosis of PML-IRIS. The cerebrospinal fluid contained low amounts of JCPyV-DNA, and plasma contained high levels of anti-JCPyV immunoglobulin G. Despite extensive immunological testing, no evidence of immunodeficiency was found. The patient gradually recovered clinically and radiologically. More than 19 months after diagnosis, the patient has only a slight impairment in language and behavior.ConclusionsAn apparently immunocompetent elderly person developed clinically symptomatic PML, which spontaneously resolved with symptoms and signs of IRIS. The atypical MRI lesions with contrast enhancement and the lack of known immunological risk factors for PML delayed the diagnosis, eventually proved by biopsy. PML and PML-IRIS should be considered in the differential diagnosis of patients presenting CNS symptoms and focal lesions with contrast enhancement on MRI.

Use of Augmentative and Alternative Communication Technology to Retrain Attention and Enhance Functional Communication Following Severe Traumatic Brain Injury: A Clinical Case Report

Purpose: This case report outlines the use of high-tech assistive technology in the form of an augmentative and alternative communication device to assess and treat a veteran with severe speech, language, and cognitive impairments status post severe blast injury. Method: The patient is a right-handed male Veteran of the United States Marine Corps who sustained catastrophic injury after stepping on a dismounted improvised explosive device. He presented to the outpatient clinic 4 years status post injury for continued speech, language, and cognitive interventions. Based on assessments and observations, the patient was diagnosed with spastic anarthria, probable apraxia of speech, aphasia, and attentional impairments. His functional communication was restricted to limited facial expression and eye movements interpreted by those who knew him well. This case reviews the detailed informal and novel assessment techniques and training methods used to implement high-tech assistive technologies as part of the rehabilitation plan designed to enhance functional communication. Results: Through systematic instruction and retraining visual and sustained attention, the patient was able to engage meaningfully with a high-tech device to increase functional personal choice when supported by a partner. Conclusion: This case demonstrates the role high-tech assistive technologies can play in the rehabilitation and functional communication efforts for persons with severe traumatic brain injury and cerebrovascular accidents.

Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder.

Inhalants are often used for their psychoactive effects, producing feelings of euphoria. Inhalant and solvent use is a serious public health concern, yet little is known about their effects on perinatal, fetal, and child outcomes. The aim of our review is to evaluate the impact of inhalant use by pregnant people on maternal, fetal, neonatal, and early childhood outcomes. A systematic review was conducted on March 1, 2023, in 6 databases using relevant keywords. Bias assessment was performed using JBI Critical Appraisal Tools. Studies were included if they described a prenatal exposure to an inhalant; focused on maternal, fetal, neonatal, or early childhood outcomes; and were published as peer-reviewed reports in English. The search yielded 1101 unique references with 22 studies meeting eligibility criteria and representing 205 pregnancies and 171 infants.The most common symptom of inhalant use reported in pregnant people was altered mentation, followed by renal tubular acidosis (RTA) reported with toluene use. Most common fetal outcomes included fetal growth restriction and preterm delivery (<37 weeks), while neonatal outcomes were withdrawal symptoms, such as jitteriness, trouble feeding, and dystonia. Child outcomes included developmental delays, including cognitive and speech impairments, and postnatal growth restriction, including microcephaly. Perinatal, fetal, and child outcomes associated with inhalant use among pregnant individuals are largely based on case reports and series. Prospective studies are needed to better characterize these outcomes, reduce stigma, increase equitable access to treatment, and identify potential interventions to reduce use and potential harm.

Amyotrophic lateral sclerosis represents corticomotoneuronal system failure.

Several decades have passed since the anterograde corticomotoneuronal hypothesis for amyotrophic lateral sclerosis (ALS) was proposed. The intervening years have witnessed its emergent support based on anatomical, pathological, physiological, neuroimaging, and molecular biological studies. The evolution of an extensive corticomotoneuronal system appears restricted to the human species, with ALS representing a uniquely human disease. While some, very select non-human primates have limited corticomotoneuronal projections, these tend to be absent in all other animals. From a general perspective, the early clinical features of ALS may be considered to reflect failure of the corticomotoneuronal system. The characteristic loss of skilled motor dexterity involving the limbs, and speech impairment through progressive bulbar dysfunction specifically involve those motor units having the strongest corticomotoneuronal projections. A similar explanation likely underlies the unique "split phenotypes" that have now been well characterized in ALS. Large Betz cells and other pyramidal corticomotoneuronal projecting neurons, with their extensive dendritic arborization, are particularly vulnerable to the elements of the ALS exposome such as aging, environmental stress and lifestyle changes. Progressive failure of the proteosome impairs nucleocytoplasmic shuffling and induces toxic but soluble TDP-43 to aggregate in corticomotoneurons. Betz cell failure is further accentuated through dysfunction of its profuse dendritic arborizations. Clarification of system specific genomes and neural networks will likely promote the initiation of precision medicine approaches directed to support the key structure that underlies the neurological manifestations of ALS, the corticomotoneuronal system.

Five-year long-term functional and quality of life outcomes in total glossectomy survivors.

Total glossectomy is proven to be a superior treatment option for advanced tongue cancer. Despite its efficacy, the procedure is associated with profound morbidity, notably impacting Speech, swallowing, and overall quality of life. Limited therapeutic benefits and the potential for considerable morbidity render total glossectomy a subject of controversy. We performed a multidimensional quality of life evaluation of long-term (more than 5 yrs.) total glossectomy survivors. In this study, we evaluated 25 total glossectomy survivors with comprehensive functional and quality of life outcomes using objective measures (London Speech Evaluation Scale, FOIS, 100ml Water Challenge, FEES) and Patient-reported outcomes (SHI, PSS HN, EORTC QLQ 30 & HN35). EORTC QLQ 30 showed overall good global health status (M = 80 ± 20) and functional scale mean scores ranging from 87 to 91, despite issues in pain (M = 31.6 ± 31), swallowing (M = 23.3 ± 24), and Speech (26.1 ± 1). Speech outcomes revealed 80% with moderate to severe intelligibility impairment. Swallowing outcomes showed 84% requiring special food preparation, 24% exhibiting aspiration, and 72% having pharyngeal residue. Speech outcomes showed 88% having moderate-severe speech impairment, and Patient-reported speech outcomes indicated a mean SHI score of (M = 47.2 ± 42). Patients undergoing total glossectomy report favourable long-term outcomes in global health-related quality of life despite moderate to severe impairments in objective speech and swallowing evaluations. These positive patient-reported outcomes support the consideration of total glossectomy as a viable treatment option if and when required, underscoring the importance of evaluating treatment outcomes through the patient-perceived quality of life.

Please Understand My Disability: An Analysis of YouTubers' Discourse on Disability Challenges

Video-sharing platforms offer a unique avenue for people with disabilities (PWDs) to highlight their experiences, including the challenges and accessibility barriers they face. While creators with disabilities effectively use these platforms to share their life struggles and advocate for societal changes, the scope of research exploring the nature of the discourse activities related to disability challenges remains limited. Our study addresses this gap by conducting a comprehensive qualitative content analysis of 468 videos posted by YouTubers with a range of disabilities, including vision, speech, mobility, hearing, and cognitive and neural impairments. Our findings reveal a predominant discussion on stigma and lack of support. YouTube is also used to share difficulties related to communication and systemic problems. Creators with disabilities also share experiences with technologies and public and private environments, through which they discuss accessibility issues and solutions. Building on our analysis, we propose future research directions aimed at enhancing the experience and support for disability communities on video-sharing platforms.

Expanding the Molecular and Clinical Phenotype of Patients With De Novo Variants in KIF5C: A Six Patient Case Series.

Heterozygous de novo loss of function variants in the motor domain of KIF5C are associated with a neurodevelopmental disorder characterized by infantile-onset epilepsy, frontal cortical dysplasia, and developmental delays including motor and speech impairments. Previously, only three missense variants in KIF5C were known to be pathogenic. We identified an additional six patients with significant developmental delays with heterozygous de novo variants in the KIF5C gene (Glu237Val, Thr93Ile, Thr93Asn, Ser90del, Lys92Arg, and Glu237Lys), of which four variants have not been reported before. Functional assessment was performed on fluorescently-tagged KIF5C variants expressed in isolated hippocampal neurons. The pathogenic de novo variants displayed significantly reduced motor function compared to the wild-type KIF5C. We conclude that the pathogenic de novo variants presented have decreased motor domain activity and that is likely to be the etiology of the patients' symptoms given the gene's constraint in the population. By adding these patients to the seven patients previously reported, we are able to expand the phenotypic spectrum associated with pathogenic KIF5C variants. Evaluation of the neurodevelopmental phenotype of additional individuals with loss of function variants in KIF5C is indicated to further characterize the spectrum of associated phenotypes.

Nonnormative Communication and Metaphors of Silencing in Two Postcolonial Texts

Brian Friel’s Translations and Aminatta Forna’s Ancestor Stones both use a character with a speech impairment as a metaphorical representation of silencing and its limits under colonialism. When read purely as metaphors, as in the extensive body of criticism on Friel’s play, these characters offer competing visions of what is lost and what is not when precolonial cultures and languages are suppressed. However, a purely metaphorical reading reinforces both the broad tendency to use disability to represent other forms of oppression and the specific tendency to use communication disabilities to represent the supposed silencing of marginalized people, both of which reaffirm ableist conceptions of disability as deficiency and pull our attention away from the individuality of the disabled characters. A closer reading of each text shows the flaws in a strictly metaphorical reading, as both characters complicate the idea that their inability to vocalize is a form of silence, as they demonstrate that people with communication disabilities can have much to tell people and many ways of doing so. This poses a challenge to the overreliance on voice and voicelessness as metaphors in discussions of marginalization.

Advanced Grad-CAM Extensions for Interpretable Aphasia Speech Keyword Classification: Bridging the Gap in Impaired Speech with XAI

Advanced Grad-CAM Extensions for Interpretable Aphasia Speech Keyword Classification: Bridging the Gap in Impaired Speech with XAI

Adapting to Individual Differences: An Experimental Study of Language Evolution in Heterogeneous Populations.

Variations in language abilities, use, and production style are ubiquitous within any given population. While research on language evolution has traditionally overlooked the potential importance of such individual differences, these can have an important impact on the trajectory of language evolution and ongoing change. To address this gap, we use a group communication game for studying this mechanism in the lab, in which micro-societies of interacting participants develop and use artificial languages to successfully communicate with each other. Importantly, one participant in the group is assigned a keyboard with a limited inventory of letters (simulating a speech impairment that individuals may encounter in real life), forcing them to communicate differently than the rest. We test how languages evolve in such heterogeneous groups and whether they adapt to accommodate the unique characteristics of individuals with language idiosyncrasies. Our results suggest that language evolves differently in groups where some individuals have distinct language abilities, eliciting more innovative elements at the cost of reduced communicative success and convergence. Furthermore, we observed strong partner-specific accommodation to the minority individual, which carried over to the group level. Importantly, the degree of group-wide adaptation was not uniform and depended on participants' attachment to established language forms. Our findings provide compelling evidence that individual differences can permeate and accumulate within a linguistic community, ultimately driving changes in languages over time. They also underscore the importance of integrating individual differences into future research on language evolution.

Sign language recognition using modified deep learning network and hybrid optimization: a hybrid optimizer (HO) based optimized CNNSa-LSTM approach.

Speech impairment limits a person's capacity for oral and auditory communication. Improvements in communication between the deaf and the general public can be progressed by a real-time sign language detector. Recent studies have contributed to make progress in motion and gesture identification processes using Deep Learning (DL) methods and computer vision. But the development of static and dynamic sign language recognition (SLR) models is still a challenging area of research. The difficulty is in obtaining an appropriate model that addresses the challenges of continuous signs that are independent of the signer. Different signers' speeds, durations, and many other factors make it challenging to create a model with high accuracy and continuity. This study mainly focused on SLR using a modified DL and hybrid optimization approach. Notably, spatial and geometric-based features are extracted via the Visual Geometry Group 16 (VGG16), and motion features are extracted using the optical flow approach. A new DL model, CNNSa-LSTM, is a combination of a Convolutional Neural Network (CNN), Self-Attention (SA), and Long-Short-Term Memory (LSTM) to identify sign language. This model is developed for feature extraction by combining CNNs for spatial analysis with SA mechanisms for focusing on relevant features, while LSTM effectively models temporal dependencies. The proposed CNNSa-LSTM model enhances performance in tasks involving complex, sequential data, such as sign language processing. Besides, a Hybrid Optimizer (HO) is proposed using the Hippopotamus Optimization Algorithm (HOA) and the Pathfinder Algorithm (PFA). The proposed model has been implemented in Python, and it has been evaluated over the existing models in terms of accuracy (98.7%), sensitivity (98.2%), precision (98.5%), Word Error Rate (WER) (0.131), Sign Error Rate (SER) (0.114), and Normalized Discounted Cumulative Gain (NDCG) (98%) as well. The proposed model has recorded the highest accuracy of 98.7%.

Predictors of school attendance among children with cerebral palsy in Bangladesh.

To determine school attendance and its predictors among children with cerebral palsy (CP) in Bangladesh using population-based data. This study utilized data from the Bangladesh Cerebral Palsy Register (BCPR), a population-based register of children with CP aged less than 18 years in Bangladesh. Sociodemographic, clinical, and educational data were documented, and descriptive statistics and multivariate regression analyses were used to identify potential predictors of school attendance. Between January 2015 and January 2019, 2725 children with CP were registered into BCPR of which 1582 were school-aged children (i.e. aged 6-18 years). The majority of those children had not attended school (73.9%); 50% (n = 239) children in Gross Motor Function Classification System (GMFCS) levels I to II did not attend schools. Adjusted odds ratios (OR) showed significantly higher odds of school attendance among children whose mothers had completed secondary education or higher (adjusted OR: 2.2; 95% confidence interval [CI]: 1.2-4.0) and received rehabilitation (adjusted OR: 2.1; 95% CI: 1.4-3.1). Conversely, lower odds of school attendance were observed among children aged 15 to 18 years (adjusted OR: 0.4; 95% CI: 0.2-0.8), those with bilateral CP (adjusted OR: 0.5; 95% CI: 0.3-0.8), GMFCS levels III to V (adjusted OR: 0.3; 95% CI: 0.2-0.5), Manual Ability Classification System levels III to V (adjusted OR: 0.5; 95% CI: 0.4-0.8), and speech impairment (adjusted OR: 0.3; 95% CI: 0.2-0.6). A large number of children with CP in Bangladesh, including half of those with milder forms, do not attend schools. These findings underscore a deficiency in awareness and support, encompassing the provision of resources and trained teachers, highlighting the necessity for policy-level changes. Sociodemographic and clinical predictors should be taken into account when devising educational programmes to enhance school attendance for children with CP in Bangladesh.

Surgical Considerations in Treating Central Nervous System Lymphomas: A Case Series of 11 Patients

In this retrospective unicentric study, we analyzed the medical records of 11 patients who were surgically treated for CNS lymphoma, both primary and secondary, between 2009 and 2024. Given the rarity of CNS lymphomas and their diverse signs and symptoms based on tumoral location, our aim was to describe key aspects, such as clinical presentations and surgical management. A possible relationship between obesity and CNS lymphoma progression was investigated through an analysis of previous study findings. The literature suggests a wide spectrum of manifestations, from nausea and headaches to loss of equilibrium and speech impairment. A predominance of unsystematized balance disorders and epileptic seizures were affirmed. Notably, as emerged from our study, aphasia was a particularly interesting neurological symptom due to its rarity in the clinical features of CNSL. Other significant factors, such as tumor localization and perioperative phases, were thoroughly investigated, with the latter highlighted by an illustrative case report. Additionally, a literature review was included, comprising nine recent retrospective studies on the efficacy of surgical resection for patients diagnosed with PCNSL.

Clinical characteristics and prognosis of brain metastasis in locally advanced rectal cancer

Objective: To investigate the clinical characteristics of brain metastases after radical surgery for locally advanced rectal cancer (LARC). Methods: The clinical characteristics of LARC with brain metastases treated in the Department of General Surgery, Peking Union Medical College Hospital from 2013 to 2023 were retrospectively analyzed. The inclusion criteria were rectal adenocarcinoma within 15 cm of the anal verge and having undergone radical surgery, and the exclusion criterion was primary malignant tumor of the brain. The main outcomes were overall survival (OS), disease-free survival (DFS), and disease-specific overall survival (determined as the interval between occurrence of brain metastasis to death from any causes). The Kaplan-Meier method was used for survival analysis. Results: We identified 4500 patients with LARC, 20 (0.4%) of whom had brain metastases. The mean age of patients with brain metastases was 63.8±9.3 years. They comprised five women and 15 men. The brain was the first site of metastasis in four patients (20%) whereas 18 patients had heterochronous extracranial metastases before brain metastasis. Two patients also had multi-organ metastases. The most common manifestations of brain metastases were dizziness and headache (five patients, 25%), sudden onset of limb weakness (four, 20%), sudden speech impairment (two, 10%), and polyopia (two, 10%). The metastases were diagnosed during follow-up in three patients (15%). Four of the patients were asymptomatic (20%). Treatment approaches included surgical resection (six patients, 30%), chemoradiotherapy (nine, 45%), and palliative (five, 25%). The median follow-up time was 45.5 (4-112) months until October 2023. 1y-OS, 3y-OS, and 5y-OS were 95.0%, 62.9%, and 43.3%, respectively. 1y-DFS, 3y-DFS, and 5y-DFS were 55.0%, 25.0%, and 5.0%, respectively. With brain metastasis as the starting point, the median duration of survival was 16 (10.2-21.8) months. Conclusion: The incidence of brain metastasis is relatively low in patients with LARC, who often have multiple synchronous extracranial metastases. Brain metastases lack specific manifestations and more often occur in male patients. Surgical intervention or combined radiotherapy and chemotherapy may improve disease-specific survival to a certain extent. However, the overall prognosis remains poor.