Treating dysarthria following traumatic brain injury: Investigating the benefits of commencing treatment during post-traumatic amnesia in two participants

Primary objective: The aims of this preliminary study were to explore the suitability for and benefits of commencing dysarthria treatment for people with traumatic brain injury (TBI) while in post-traumatic amnesia ( PTA). It was hypothesized that behaviours in PTA don't preclude participation and dysarthria characteristics would improve post-treatment. Research design: A series of comprehensive case analyses. Methods and procedures: Two participants with severe TBI received dysarthria treatment focused on motor speech deficits until emergence from PTA. A checklist of neurobehavioural sequelae of TBI was rated during therapy and perceptual and motor speech assessments were administered before and after therapy. Main outcomes and results: Results revealed that certain behaviours affected the quality of therapy but didn't preclude the provision of therapy. Treatment resulted in physiological improvements in some speech sub-systems for both participants, with varying functional speech outcomes. Conclusions: These findings suggest that dysarthria treatment can begin and provide short-term benefits to speech production during the late stages of PTA post-TBI.

Playfulness in children with autistic disorder and their typically developing peers

This study investigated the playfulness of 24 children with autistic disorder (AD) and 34 typically developing children aged 3-7 years, in free (unstructured) and adult-facilitated (structured) play conditions within a clinical play environment. Video recordings of play were rated using the Test of Playfulness (Bundy 2003). The data were analysed using repeated measures ANOVA and ANCOVA and qualitative observations. The children with AD were less playful compared with the typically developing children (F = 49.64, p < 0.001), even when developmental age was accounted for (F = 28.20, p < 0.001). Both groups of children were slightly more playful in a structured environment with adult facilitation (F = 7.72, p = 0.007). Despite statistically significant differences in playfulness between play conditions, considerable overlap in observations for both groups suggests that this may not be as clinically meaningful. When developmental age was accounted for, the play conditions no longer had a significant effect on playfulness (F = 1.54, p = 0.220). The implications of the findings and the limitations of the study are discussed

Environmental factors that influence the community participation of adults with aphasia: The perspective of service industry workers

Background: The loss of language and the inability to communicate effectively as a result of aphasia often affects community participation. Within the World Health Organisation International Classification of Functioning, Disability and Health, disability is recognised as a dynamic interaction between the individual's health condition, such as aphasia, and his or her personal and environmental factors. There has been little research identifying the environmental facilitators and barriers to participation for people with aphasia in the community, and no research focusing on the perspective of service industry workers. Aims: This study aimed to identify barriers and facilitators to community participation for adults with aphasia from the perspective of service industry workers. Methods & Procedures: Eight focus groups were conducted with 24 service industry employees. Transcripts of the focus group discussions were analysed using qualitative content analysis procedures, and barriers to and facilitators for participation of people with aphasia were identified. Outcomes & Results: Results revealed that the participation of people with aphasia in the community can be affected by many environmental factors within three broad categories: (1) people environmental factors, (2) physical environmental factors, and (3) business or organisational environmental factors. Conclusions: Service industry employees were able to identify a range of factors that would act as barriers and facilitators for people with aphasia. Some of the more significant findings include the lack of other people's awareness about aphasia, the willingness of service industry workers at the individual level to accommodate people with aphasia, and the difficulty in making the necessary system, policy, and procedural changes at the organisational level. Speech pathologists are encouraged to assist service industry providers to be more aphasia-friendly through education and training, in addition to assisting people with aphasia to become self-advocates.

An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury

Considerable emphasis has been placed upon cognitive neuropsychological explanations of awareness disorders in brain injury and Alzheimer's disease (AD), with relatively few models acknowledging the role of psychosocial factors. The present paper explores clinical presentations of unawareness in brain injury and AD, reviews the evidence for the influence of psychosocial factors alongside neuropsychological changes, and considers a number of key issues that theoretical models need to address, before going on to discuss some recently-developed models that offer the potential for developing a comprehensive biopsychosocial account. Building on these developments, we present a framework designed to assist clinicians to identify the specific factors contributing to an individual's presentation of unawareness, and illustrate its application with a case example.

An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study

Purpose: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. Method: Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J.M.Bland and D.G.Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. Results: Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. Conclusions: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Characteristics of speech following cervical spinal cord injury

The present study examined 24 individuals with either complete or incomplete injuries to the cervical spinal cord through the use of standardized assessments of dysarthria and a perceptual rating scale. Perceptual assessment revealed predominantly prosodic and phonatory disturbances, while physical impairments were common in the respiratory and laryngeal subsystems of speech production. A reduction in intelligibility and speaking rate resulted in a diminished communicative effectiveness ratio for most participants. Individuals showed a high degree of variation, with no clear relationship between lesion type and impairments present. Further investigation is required to verify the physiological nature of the respiratory and laryngeal impairments found in the present investigation and to determine the relative contributions of these to the overall presentation of speech and voice post cervical spinal cord injury (CSI).

Determinants of stages of smoking uptake among secondary school students

With the uptake of cigarette smoking hypothesised to occur through a series of contemplation and action stages, we sought to investigate what factors are associated with the contemplation of smoking among secondary school students in Queensland, Australia. A series of four cross-sectional surveys were conducted among secondary schools in Queensland in 1993, 1996, 1999 and 2002. Respondents (n = 9993) were asked about the stages of smoking. Nearly half (43%) of secondary school students reported some contemplation of smoking. Increased levels of smoking contemplation were observed among females, earlier survey years, Junior level students, students with average or below average scholastic ability, those prepared to go out with a smoker, those with recent alcohol experience, those who bad influenced other students to smoke or had not discouraged other students smoking. The results of this study provide further information about the factors relevant to stages of smoking uptake among secondary school students and the influence that students may have on their peers. (c) 2005 Elsevier Ltd. All rights reserved.

Dynamic assessment of articulation during lingual fatigue in myasthenia gravis

The present study aimed to investigate how induced lingual fatigue affected lingual strength, articulatory kinematics, and perceptual speech features in CS, a 51-year-old female with active myasthenia gravis (MG), and three age and gender matched control participants, Lingual fatigue was elicited via a series of endurance tasks using a tongue pressure bulb. Following each endurance task, the participants performed a speech task containing the phonemes /k/, /t/, and /j/ that was recorded with an electromagnetic articulograph, followed by a lingual strength assessment using a tongue pressure bulb. Participants repeated this schedule over five phases and kinematic and strength changes during each phase were compared to baseline measurements. All of CSs significant kinematic changes occurred during the final fatigue phase compared to 27.3% of the control group's kinematic changes occurring during this phase, suggesting the kinematic changes associated with fatigue were not accelerated in CS. The endurance tasks also elicited different kinematic effects for CSs anterior and posterior tongue segments. While CS exhibited mostly similar kinematic and perceptual changes to the control group, some of CS's perceptual transcriptions for /k/ and kinematic changes were not replicated, indicating that some different perceptual and physiological consequences to CS's speech were elicited by the endurance tasks.

Effect of different preparation routes on the structure and properties of rigid polyurethane-layered silicate nanocomposites

To identify the effect of reactive preparation on the structure and properties of rigid polyurethane (PU)layered silicate nanocomposite, a range of nanocomposites were prepared by combining the various precursors in different sequences. The morphology of the samples was characterized by XRD and TEM. Tensile properties and dynamic mechanical thermal properties were measured. The reactions between the layered silicates and PU precursors were monitored via FTIR to gain an understanding of the participation of nanofiller in the polymerization reaction, and the impact of this on system stoichiometry. The XRD and TEM results provided evidence that morphology can differ significantly if different synthesis methods are used. However, the mechanical properties are dominated by the stoichiometry imbalance induced by the addition of the layered silicates. (c) 2006 Wiley Periodicals, Inc.