A case study of the resolution of paediatric dysphagia following brainstern injury: clinical and instrumental assessment

The coexistance of a swallowing impairment can severely impact upon the medical condition and recovery of a child with traumatic brain injury [ref.(1): Journal of Head Trauma Rehabilitation 9 (1) (1994) 43]. Limited data exist on the progression or outcome of dysphagia in the paediatric population with brainstem injury. The present prospective study documents the resolution of dysphagia in a 14-year-old female post-brainstem injury using clinical, radiological and endoscopic evaluations of swallowing. The subject presented with a pattern of severe oral-motor and oropharyngeal swallowing impairment post-injury that resolved rapidly for the initial 12 weeks, slowed to gradual progress for weeks 12-20, and then plateaued at 20 weeks post-injury. Whilst a clinically functional swallow was present at 10 months post-injury, radiological examination revealed a number of residual physiological impairments, reduced swallowing efficiency, and reduced independence for feeding, indicating a potential increased risk for aspiration. The data highlight the need for early and continued evaluation and intensive treatment programs, to focus on the underlying physiological swallowing impairment post-brainstem injury, and to help offset any potential deleterious effects of aspiration that may affect patient recovery, such as pneumonia. (C) 2003 Elsevier Ltd. All rights reserved.

Perceptual and instrumental analysis of laryngeal function after traumatic brain injury in childhood

Objective: To investigate laryngeal function and phonatory disturbance in children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. Design and participants: The performance of 16 individuals with moderate to severe TBI acquired in childhood and 16 nonneurologicatly impaired control subjects was compared on a battery of perceptual (Frenchay Dysarthria Assessment, speech sample analysis) and instrumental (Aerophone II, laryngograph) assessments. Results and conclusions: As a group, the children with TBI demonstrated normal, or only minimally impaired laryngeal function, when compared with the control group, which contrasts with the significant laryngeal impairment noted in adults after TBI. Several reasons for the different findings in relation to laryngeal function in adults and children after TBI are postulated: (1) differing types of injury usually incurred by adults and children may result in a relatively decreased degree of neurologic impairment in these children, (2) differences in recovery potential between adults and children, and (3) the pediatric larynx is still developing, hence it may be better able to compensate for any impairment incurred.

Perceptual and instrumental evaluation of voice and tongue function after carotid endarterectomy

Objective: Laryngeal and tongue function was assessed in 28 patients to evaluate the presence, nature, and resolution of superior recurrent laryngeal and hypoglossal nerve damage resulting from standard open primary carotid endarterectomy (CEA). Methods. The laryngeal and tongue function in 28 patients who underwent CEA were examined prospectively with various physiologic (Aerophone II, laryngograph, tongue transducer), acoustic (Multi-Dimensional Voice Program), and perceptual speech assessments. Measures were obtained from all participants preoperatively, and at 2 weeks and at 3 months postoperatively. Results. The perceptual speech assessment indicated that the vocal quality of roughness was significantly more apparent at the 2-week postoperative assessment than preoperatively. However, by the 3-month postoperative assessment these values had returned to near preoperative levels, with no significant difference detected between preoperative and 3-month postoperative levels or between 2-week and 3-month postoperative levels. Both the instrumental assessments of laryngeal function and the acoustic assessment of vocal quality failed to identify any significant difference on any measure across the three assessment periods. Similarly, no significant impairment in tongue strength, endurance, or rate of repetitive tongue movements was detected at instrumental assessment of tongue function. Conclusions: No permanent changes to vocal or tongue function occurred in this group of participants after primary CEA. The lack of any significant long-term laryngeal or tongue dysfunction in this group suggests that the standard open CEA procedure is not associated with high rates of superior recurrent and hypoglossal nerve dysfunction, as previously believed.

Articulatory function following traumatic brain injury in childhood: A perceptual and instrumental analysis

Primary objective: To investigate the articulatory function of a group of children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. Research design: The performance of 24 children with TBI was assessed on a battery of perceptual (Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech and speech sample analysis) and instrumental ( lip and tongue pressure transduction systems) assessments and compared with that of 24 non-neurologically impaired children matched for age and sex. Main outcomes: Perceptual assessment identified consonant and vowel imprecision, increased length of phonemes and overall reduction in speech intelligibility, while instrumental assessment revealed significant impairment in lip and tongue function in the TBI group, with rate and pressure in repetitive lip and tongue tasks particularly impaired. Significant negative correlations were identified between the degree of deviance of perceptual articulatory features and decreased function on many non-speech measures of lip function, as well as maximum tongue pressure and fine force tongue control at 20% of maximum tongue pressure. Additionally, sub-clinical articulatory deficits were identified in the children with TBI who were non-dysarthric. Conclusion: The results of the instrumental assessment of lip and tongue function support the finding of substantial articulatory dysfunction in this group of children following TBI. Hence, remediation of articulatory function should be a therapeutic priority in these children.

Movement Analysis by means of inertial sensors: from bench to bedside

in the everyday clinical practice. Having this in mind, the choice of a simple setup would not be enough because, even if the setup is quick and simple, the instrumental assessment would still be in addition to the daily routine. The will to overcome this limit has led to the idea of instrumenting already existing and widely used functional tests. In this way the sensor based assessment becomes an integral part of the clinical assessment. Reliable and validated signal processing methods have been successfully implemented in Personal Health Systems based on smartphone technology. At the end of this research project there is evidence that such solution can really and easily used in clinical practice in both supervised and unsupervised settings. Smartphone based solution, together or in place of dedicated wearable sensing units, can truly become a pervasive and low-cost means for providing suitable testing solutions for quantitative movement analysis with a clear clinical value, ultimately providing enhanced balance and mobility support to an aging population.

Sensory and instrumental profiling of apples: a new tool for quality assessment

Food suppliers currently measure apple quality considering basic pomological descriptors. Sensory analysis is expensive, does not permit to analyse many samples, and cannot be implemented for measuring quality properties in real time. However, sensory analysis is the best way to precisely describe food eating quality, since it is able to define, measure, and explain what is really perceivable by human senses and using a language that closely reflects the consumers’ perception. On the basis of such observations, we developed a detailed protocol for apple sensory profiling by descriptive sensory analysis and instrumental measurements. The collected sensory data were validated by applying rigorous scientific criteria for sensory analysis. The method was then applied for studying sensory properties of apples and their changes in relation to different pre- and post-harvest factors affecting fruit quality, and demonstrated to be able to discriminate fruit varieties and to highlight differences in terms of sensory properties. The instrumental measurements confirmed such results. Moreover, the correlation between sensory and instrumental data was studied, and a new effective approach was defined for the reliable prediction of sensory properties by instrumental characterisation. It is therefore possible to propose the application of this sensory-instrumental tool to all the stakeholders involved in apple production and marketing, to have a reliable description of apple fruit quality.

Woolliness assessment in peaches. Comparison between human and instrumental procedures and results

Woolliness, a negative attribute of sensory texture, is characterised by the lack of juiciness without variation of the tissue water content an incapacity of ripening although there is external ripe appearance. In this study, peaches cv Springcrest (early and soft flesh peaches) and Miraflores (late and hard flesh peaches) corresponding to three different maturity stages at harvest, stored 0, 1, 2, 3 and 4 weeks at 1 and 5°C have been tested by instrumental and sensory means. A Instrumental classification of woolliness has been compared to the sensory assessment. For Springcrest peaches the sensory results match with those found for the instrumental procedure. In this case , Woolliness appears after 2 weeks of storage at 5°C, changing abruptly from crispy to woolly. Miraflores peaches did not develop woolliness during storage. After comparing with sensory results, it is shown that a common instrumental scale may be appropriate to classify for woolliness all peach varieties.

Storabelity of melon for different ripeness stages at harvest. Selection of instrumental procedures for quality assessment.

The consumption of melon (Cucumis melo L.) has been, until several years ago, regional, seasonal and without commercial interest. Recent commercial changes and world wide transportation have changed this situation. Melons from 3 different ripeness stages at harvest and 7 cold storage periods have been analysed by destructive and non destructive tests. Chemical, physical, mechanical (non destructive impact, compression, skin puncture and Magness- Taylor) and sensory tests were carried out in order to select the best test to assess quality and to determine the optimal ripeness stage at harvest. Analysis of variance and Principal Component Analysis were performed to study the data. The mechanical properties based on non-destructive Impact and Compression can be used to monitor cold storage evolution. They can also be used at harvest to segregate the highest ripeness stage (41 days after anthesis DAA) in relation to less ripe stages (34 and 28 DAA).Only 34 and 41 DAA reach a sensory evaluation above 50 in a scale from 0-100.

Woolliness assessment in peaches (Cv. Springcrest) by sensory and instrumental means.

Mealiness is a negative attribute of sensory texture, characterised by the lack of juiciness without variation of total water content in the tissues. In peaches, mealiness is also known as "woolliness" and "leatheriness". This internal disorder is characterised by the lack of juiciness and flavour. In peaches, it is associated with interna browning near the stone and the incapacity of ripening although there is externa ripe appearance. Woolliness is associated with inadequate cold storage and is considered as a physiological disorder that appears in stone fruits when an unbalanced pectolitic enzyme activity during storage occurs (Kailasapathy and Melton, 1992). Many attempts have been carried out to identify and measure mealiness and woolliness in fruits. The texture of a food product is composed by a wide spectrum of sensory attributes. Consumer defines the texture integrating simultaneously all the sensory attributes. However, an instrument assesses one or several parameters related to a fraction of the texture spectrum (Kramer, 1973). The complexity of sensory analysis by means of trained panels to assess the quality of some producing processes, supports the attempt to estimate texture characteristics by instrumental means. Some studies have been carried out comparing sensory and instrumental methods to assess mealiness and woolliness. The current study is centered on analysis and evaluation of woolliness in peaches and is part of the European project FAIR CT95 0302 "Mealiness in fruits: consumer perception and means for detection". The main objective of this study was to develop procedures to detect woolly peaches by sensory and by instrumental means, as well as to compare both measuring procedures.

Instrumental quality assessment of fresh peaches: Optical and mechanical parameters.

In developing instrumentation for the measurement of fruit quality, there is the need for fast and non-destructive devices, based on sensors, to be installed on-line. In the case of some fruits, like peaches, post-harvest ripeness, which is closely related to high quality for the consumer, is a priority. During ripening, external appearance (colour) and internal mechanical (firmness) and chemical (sugars and acids) quality are main features that evolve rapidly from and unripe to a ripe (high quality) stage. When considering the evolution of fruit quality in this scheme, external colour and firmness are shown to evolve in a parallel pattern, if monitored from the time of harvest to full consumer ripeness ( Rood, 1957; Crisosto et al, 1995; Kader, 1996). The visible (VIS) reflectance spectrum is a fast and easy reference that can be used to estimate quality of peaches, if we could show it to be reliably correlated with peach ripening rate during postharvest (Genard et al. 1994; Moras, 1995; Delwiche and Baumgartner, 1983; Delwiche et al. 1987; Slaughter, 1995; Lleo et al., 1998). Taste, described as an expert acceptance score, improves with ripeness (firmness and colour evolution), when considering the fruits on the tree, and also post-harvest.

Physical activity assessment in the general population; instrumental methods and new technologies.

La medición objetiva del movimiento humano y la cuantificación del gasto energético debido a la actividad física es una necesidad identificada tanto en investigación como en clínica. Los métodos de referencia validados y bien definidos (el agua doblemente marcada, la calorimetría directa, la calorimetría indirecta) son caros y prácticamente se limitan a la investigación en el laboratorio. Por lo tanto, en los últimos años, se han desarrollado diferentes dispositivos de medición objetiva que son apropiados para los estudios de campo y clínicos. No hay ningún estándar de oro entre ellos, ya que todos tienen limitaciones. Los podómetros son ligeros, poco costosos, cuentan los pasos y aportan información sobre la actividad física total, pero no sobre el comportamiento y los patrones de actividad física. Los acelerómetros son caros, aportan información sobre patrón, frecuencia e intensidad de la actividad física, pero no sobre el tipo de actividad física. Los podómetros y acelerómetros únicamente recogen información sobre el movimiento del movimiento corporal, pero la validez en la estimación del gasto energético es limitada. La monitorización de la frecuencia cardíaca relaciona intensidad del ejercicio con gasto de energía, pero no aporta información sobre la actividad física. Los dispositivos GPS son portátiles, relativamente asequibles, no invasivos y recogen distancia, velocidad y elevación con hora y lugar exactos, pero quizás estén limitados para la evaluación de movimientos cortos de alta intensidad y elevado gasto energético. Los dispositivos de última generación combinan acelerometría con la medición de variables fisiológicas, comparten las ventajas de los dispositivos individuales y son más precisos. Para el cálculo del gasto energético se aplican algoritmos específicos de la actividad incluidos en el software del fabricante que pueden afectar a los resultados. La mayoría de los dispositivos estiman con mayor precisión el gasto energético a intensidades ligeras y moderadas, pero subestiman el gasto a intensidades muy ligeras y de mayor intensidad.

Analytical instrumental approaches and strategies to support the sensory assessment of virgin olive oils

At the beginning, this Ph.D. project led to an overview of the most common and emerging types of fraud and possible countermeasures in the olive oil sector. Furthermore, possible weaknesses in the current conformity check system for olive oil were highlighted. Among those, despite the organoleptic assessment is a fundamental tool for establishing the virgin olive oils (VOOs) quality grade, the scientific community has evidenced some drawbacks in it. In particular, the application of instrumental screening methods to support the panel test could reduce the work of sensory panels and the cost of this analysis (e.g. for industries, distributors, public and private control laboratories), permitting the increase in the number and the efficiency of the controls. On this basis, a research line called “Quantitative Panel Test” is one of the main expected outcomes of the OLEUM project that is also partially discussed in this doctoral dissertation. In this framework, analytical activities were carried out, within this PhD project, aimed to develop and validate analytical protocols for the study of the profiles in volatile compounds (VOCs) of the VOOs headspace. Specifically, two chromatographic approaches, one targeted and one semi-targeted, to determine VOCs were investigated in this doctoral thesis. The obtained results, will allow the possible establishment of concentration limits and ranges of selected volatile markers, as related to fruitiness and defects, with the aim to support the panel test in the commercial categorization of VOOs. In parallel, a rapid instrumental screening method based on the analysis of VOCs has been investigated to assist the panel test through a fast pre-classification of VOOs samples based on a known level of probability, thus increasing the efficiency of quality control.

Functional Disability in Alzheimer Disease A Validation Study of the Brazilian Version of the Disability Assessment for Dementia (DAD-Br)

Background: The assessment of activities of daily living (ADL) is important both for the diagnosis and staging of dementia. The objective of this study was to verify the applicability and validity of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). Methods: The DAD was applied to caregivers of 89 patients with probable Alzheimer disease (AD) and to 40 elderly individuals without cognitive impairment (controls). We assessed the construct validity of the scale and its diagnostic accuracy (sensitivity, specificity, and predictive value). In addition, intergroup and intragroup analyses were conducted to characterize patient performance on basic and instrumental ADL and to determine underlying deficits (initiation, planning, or effective execution). Results: AD patients and controls had mean ages of 76.4 +/- 6.9 years and 74.5 +/- 7.3 years (P = 0.08), respectively. Mean Mini-Mental State Examination scores were 17.4 +/- 5.0 and 26.1 +/- 5.1 (P < 0.001) and scores on the DAD were 68.4 +/- 19.0 and 99.8 +/- 0.9 (P < 0.001), for patients and controls, respectively. The DAD scale showed good internal consistency (Cronbach alpha = 0.77) and correlation with the Mini-Mental State Examination (r = 0.44; P < 0.001). The AD group did better on basic ADL than on instrumental ADL (P < 0.001). As expected, controls did not exhibit significant deficits on the items evaluated. Conclusion: The Brazilian version of the DAD is an adequate and reliable tool for assessing functional ability in AD patients.