Acoustic Investigation of Vocal Quality following Treatment for Childhood Cerebellar Tumour

The aim of the study was firstly to document the acoustic parameters of voice using the Multidimensional Voice Program (MDVP, Kay Elemetrics) in a group of children with dysarthria subsequent to treatment for cerebellar tumour (CT). Then, secondly, compare the acoustic findings to perceptual voice characteristics as described by the GIRBAS (grade, instability, roughness, breathiness, asthenicity, strain). The assessments were performed on 29 voice samples; 9 cerebellar tumour participants with dysarthria, and 20 control participants. None of the control voices were rated as exhibiting any of the six parameters described by the GIRBAS, while 7 of the CT participants were noted to have at least a mild voice disorder. Roughness, instability, breathiness and asthenicity were all identified as voice characteristics in the CT voice samples. Acoustically, the CT voice samples differed significantly from the controls' voices on frequency and amplitude perturbation measures. Our findings confirmed voice dysfunction as a component of dysarthria in children treated for cerebellar tumour, and discussed the links between acoustic and perceptual descriptions. Copyright (C) 2004 S. Karger AG, Basel.

Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task

Study Design. Cross-sectional study. Objective. This study compared neck muscle activation patterns during and after a repetitive upper limb task between patients with idiopathic neck pain, whiplash-associated disorders, and controls. Summary of Background Data. Previous studies have identified altered motor control of the upper trapezius during functional tasks in patients with neck pain. Whether the cervical flexor muscles demonstrate altered motor control during functional activities is unknown. Methods. Electromyographic activity was recorded from the sternocleidomastoid, anterior scalenes, and upper trapezius muscles. Root mean square electromyographic amplitude was calculated during and on completion of a functional task. Results. A general trend was evident to suggest greatest electromyograph amplitude in the sternocleidomastoid, anterior scalenes, and left upper trapezius muscles for the whiplash-associated disorders group, followed by the idiopathic group, with lowest electromyographic amplitude recorded for the control group. A reverse effect was apparent for the right upper trapezius muscle. The level of perceived disability ( Neck Disability Index score) had a significant effect on the electromyographic amplitude recorded between neck pain patients. Conclusions. Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic amplitude of the superficial cervical muscles during performance of the functional task.

Unravelling the complexity of muscle impairment in chronic neck pain

Exercise interventions are deemed essential for the effective management of patients with neck pain. However, there has been a lack of consensus on optimal exercise prescription, which has resulted from a paucity of studies to quantify the precise nature of muscle impairment, in people with neck pain. This masterclass will present recent research from our laboratory, which has utilized surface electromyography to investigate cervical flexor muscle impairment in patients with chronic neck pain. This research has identified deficits in the motor control of the deep and superficial cervical flexor muscles in people with chronic neck pain, characterized by a delay in onset of neck muscle contraction associated with movement of the upper limb. In addition, people with neck pain demonstrate an altered pattern of muscle activation, which is characterized by reduced deep cervical flexor muscle activity during a low load cognitive task and increased activity of the superficial cervical flexor muscles during both cognitive tasks and functional activities. The results have demonstrated the complex, multifaceted nature of cervical muscle impairment, which exists in people with a history of neck pain. In turn, this has considerable implications for the rehabilitation of muscle function in people with neck pain disorders. (C) 2004 Elsevier Ltd. All rights reserved.

Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain

The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid (SCM) and anterior scalene (AS) muscles. While standing, subjects flexed and extended the right arm in response to a visual stimulus. For the control group, activation of DCF, SCM and AS muscles occurred less than 50 ms after the onset of deltoid activity, which is consistent with feedforward control of the neck during arm flexion and extension. When subjects with a history of neck pain flexed the arm, the onsets of DCF and contralateral SCM and AS muscles were significantly delayed (p<0.05). It is concluded that the delay in neck muscle activity associated with movement of the arm in patients with neck pain indicates a significant deficit in the automatic feedforward control of the cervical spine. As the deep cervical muscles are fundamentally important for support of the cervical lordosis and the cervical joints, change in the feedforward response may leave the cervical spine vulnerable to reactive forces from arm movement.

Higher-level language deficits resulting from left primary cerebellar lesions

Background: Contemporary neuropsychological studies suggest that cerebellar lesions may impact upon higher-level cognitive functioning via mechanisms of crossed cerebello-cerebral diaschisis. Accordingly, right cerebellar lesions have been previously associated with linguistic impairments such as reduced word fluency and agrammatic output. Recently, however, neuroimaging investigations have also identified ipsilateral cerebral hypoperfusion as a consequence of cerebellar lesions, implicating a potential role for the left cerebellum in the mediation of language processes. Aims: The purpose of this research was to investigate the effects of left cerebellar lesions of vascular origin, on general as well as high-level language skills. Methods & Procedures: Linguistic profiles were compiled for five individuals with left primary cerebellar lesions utilising a comprehensive language test battery. Individual scores relevant to each subtest were compared to a group of non-neurologically impaired controls. The criterion for anomalous performance was established as greater than or equal to 1.5 SD below the mean of the control group. Outcomes & Results: The findings of this research suggest that higher-level language deficits may result from left primary cerebellar lesions. All participants demonstrated deficits on measures of word fluency, sentence construction within a set context, producing word definitions, and producing multiple definitions for the same word. Deficits were also noted for several participants on measures of understanding figurative language, forming word associations, identifying and correcting semantic absurdities, and producing synonyms and antonyms. Conclusions: The results presented challenge the notion of a lateralised linguistic cerebellum, supporting a potential role for the left as well as right cerebellar hemispheres in the regulation of language processes, presumably via cerebellar-basal ganglia/thalamo-cortical pathways.

Neck flexor muscle fatigue is side specific in patients with unilateral neck pain

Despite the evidence of greater fatigability of the cervical flexor muscles in neck pain patients, the effect of unilaterality of neck pain on muscle fatigue has not been investigated. This study compared myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue between the painful and non-painful sides in patients with chronic unilateral neck pain. Myoelectric signals were recorded from the sternal head of SCM and the AS muscles bilaterally during sub-maximal isometric cervical flexion contractions at 25% and 50% of the maximum voluntary contraction (MVC). The time course of the mean power frequency, average rectified value and conduction velocity of the electromyographic signals were calculated to quantify myoelectric manifestations of muscle fatigue. Results revealed greater estimates of the initial value and slope of the mean frequency for both the SCM and AS muscles on the side of the patient's neck pain at 25% and 50% of MVC. These results indicate greater myoelectric manifestations of muscle fatigue of the superficial cervical flexor muscles ipsilateral to the side of pain. This suggests a specificity of the effect of pain on muscle function and hence the need for specificity of therapeutic exercise in the management of neck pain patients. (C) 2003 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.

Normal values of balance tests in women aged 20-80

OBJECTIVES: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. DESIGN: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. SETTING: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. PARTICIPANTS: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. MEASUREMENTS: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. RESULTS: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. CONCLUSION: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk.

Kick'n'On: Helping young males kick back into life

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Older people with hearing impairment: A literature review of the spouse's perspective

Spouses of older people with hearing impairment frequently urge their hearing impaired partners to seek help for their hearing difficulties. Only a minority of individuals with hearing impairment are self-motivated, with the majority of clients, especially older clients, presenting at audiology clinics under the persuasion or influence of their spouse or significant other. This highlights the important role that spouses play in initiating aural rehabilitation and indicates that spouses of older people with hearing impairment may become so frustrated with their partners' hearing loss that they are often the primary reason why the hearing impaired person presents for audiological services. To date, however, the number of studies addressing the effect of hearing loss on significant others is limited. Those studies that have investigated the effect of hearing impairment on families are commonly focused on the person with the impairment and most commonly, the significant other has merely been used as a proxy to describe the perceived problems of his or her spouse. Further, there has been no systematic indepth investigation of the needs of spouses of older people with hearing impairment, including the effect of retirement and the increase in time spent together, with the majority of studies focusing primarily on younger spouses of workers affected by noise-induced hearing loss. The cumulative effect of experiencing many years of hearing difficulties with a partner may also influence the extent to which older spouses are affected by hearing impairment. The primary purpose of this article is therefore to critically review the existing literature on the effects of hearing impairment on spouses. It will also provide a rationale for the importance of this topic as a clinical issue and suggest some future directions for research in this area.