1/19. Speech and language findings in a chronic hemodialysis patient: a case report.The speech and language findings in one patient who underwent chronic hemodialysis therapy are presented. The patient's degenerating physical status was first signaled by stutteringlike repetitions. The speech diagnosis is mixed dysarthria, apraxia of speech, and aphasia. Clinical implications are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/19. Rhinolalia as a presenting sign of pneumomediastinum complicating post peripheral blood stem cell transplantation bronchiolitis obliterans.A 26-year-old male with graft vs. host disease (GVHD) presented with rhinolalia (a squeaky voice of nasal quality) as a presenting sign for pneumonasopharynx and pneumomediastinum secondary to bronchiolitis obliterans. The patient underwent HLA-identical related peripheral blood stem cells transplantation 8 months before the diagnosis. Three weeks after transplantation he began to suffer from GVHD Grade III that involved the gut, liver, and skin and later on the lungs. Due to severe obstructive bronchiolitis obliterans the patient developed intensive cough evolving into pneumomediastinum and pneumonasopharynx with rhinolalia. The patient was treated conservatively with complete resolution. Although rare, pneumomediastinum and pneumonasopharynx can be a life-threatening event, and one should be aware of the signs and symptoms on physical examination, which may be as subtle as rhinolalia alone.- - - - - - - - - - ranking = 2.6869135245231keywords = physical examination, physical (Clic here for more details about this article) |
3/19. Improved ambulation and speech production in an adolescent post-traumatic brain injury through a therapeutic intervention to increase postural control.PURPOSE: This case study examined the effectiveness of a programme designed to improve anticipatory postural control in an adolescent over years 2 and 3 post-traumatic brain injury (TBI). It was hypothesized that her difficulty in walking and talking simultaneously was caused by excessive co-activation of extremity, trunk, and oral musculature during upright activities. methods: The participant was treated weekly by physical and speech therapy. Treatment focussed on improving anticipatory postural control during gross motor activities in conjunction with oral-motor function. RESULTS: Initially, the participant walked using a walker at a speed of 23 cm s(-1). Two years later, she could walk without a device at 53 cm s(-1). Initial laryngoscopic examination showed minimal movement of the velum or pharyngeal walls; full movement was present after treatment. The measure of intelligibility improved from no single word intelligible utterances to 85% intelligible utterances after 2 years. DISCUSSION: The results suggest that less compensatory rigidification of oral musculature was needed to maintain an upright position against gravity as postural control improved. CONCLUSION: An adolescent 1-year post-TBI was followed as she underwent additional rehabilitation focussed on improving anticipatory postural control. The functional goal of simultaneously talking while walking was achieved through this intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/19. Multidisciplinary management of the airway in a trauma-induced brain injury patient.laryngomalacia occurs in some brain injury patients secondary to global muscle hypotonia. Surgical therapies for epiglottis prolapse have centered around removal or reshaping of the epiglottis. This approach has brought mixed success and frequent complications. We present a case that demonstrates successful nonsurgical treatment of a 33-year-old male brain injury patient with moderate obstructive sleep apnea that is believed to be a consequence of post-brain injury nocturnal epiglottis prolapse. The presence of a tracheostomy performed at the time of emergency surgery had become an emotional and physical barrier to our patient's recovery. The tracheostomy could only be reversed if the obstructive sleep apnea disorder could be managed in an alternative fashion. A titratable mandibular repositioning appliance was prescribed and its effectiveness was demonstrated with nasolaryngoscopy and polysomnography. After initially fitting the oral appliance, a period of accommodation and gradual protrusive adjustments was allowed. Subsequent confirmation polysomnography demonstrated improvement, but not suitable resolution, of disordered breathing events. However, an additional 1.25-mm protrusive titration of the oral appliance during the course of the confirmation polysomnogram led to therapeutic success. The patient's tracheostomy was subsequently reversed with significant quality of life benefits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/19. dysarthria of motor neuron disease: longitudinal measures of segmental durations.motor neuron disease encompasses a group of terminal, demyelinating diseases affecting upper- and lower-motor neurons and producing muscular weakness resulting in a flaccid, spastic, or spastic-flaccid dysarthria of speech. The present study presents measurements of the temporal-acoustic characteristics of dysarthria in three subjects with motor neuron disease over a two-year recording period. Changes seen over the course of the disease varied by type of motor neuron disease, though all types demonstrated some degree of neutralization of the prevocalic VOT, target vowel duration, and postvocalic closure duration. These changes are discussed with relation to physical manifestation and progression of the disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/19. The modified superior based pharyngeal flap. Part III. A retrospective study.A retrospective study of 31 patients who had diagnosed velopharyngeal incompetence and were surgically managed with the modified superior based pharyngeal flap was completed. The following were analyzed: age at time of operation, gender, physical status, diagnostic protocol, length of operation (length of total surgery) and length of superior based pharyngeal flap, length of postoperative hospital stay, length of total hospital stay, length of follow-up, speech results, complications, patient care, and medication. The result showed that the optimal timing for correction of velopharyngeal incompetence was between 3 and 6 years of age. The mean length of total hospital stay was 2.7 days, postoperative complications were minimal, and speech results were generally good.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/19. Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/19. dysarthria in adults: physiologic approach to rehabilitation.A case study is used to illustrate a physical approach to the speech rehabilitation of adults with dysarthria. The approach emphasizes the component-by-component analysis of the peripheral speech mechanism, where the selection and sequencing of treatment procedures follow directly from the physiologic nature and severity of involvement in each component. The selection and sequencing of procedures also are conditioned by the inherent physical interdependencies of these component parts. Several biofeedback procedures of our own are incorporated that have not been reported previously. The case illustration is of a young man injured in an auto accident whose speech intelligibility improves from approximately 5-10% to 95% during the rehabilitation period. Effects of treatment upon individual components of the speech mechanism are illustrated.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/19. teaching nonvocal communication skills to multihandicapped retarded adults.A training program for teaching communication skills to nonvocal retarded adults was evaluated in three experiments. The four subjects were severely disabled physically and had never demonstrated functional speech. Each person was taught to use either a prosthetic head pointer or to point with a hand in using a communication board for expressive language. Following baseline in Experiment I, coordination training was implemented, consisting of instructions, manual guidance, praise, feedback, and practice. Each person demonstrated a higher frequency of accurate pointing to designated areas on the board during coordination training than during baseline. In Experiment II, identification training, consisting of instructions, praise, feedback, and practice was introduced after baseline. Subjects pointed more frequently to specific word-photograph combinations to correspond to descriptive verbal labels after introduction of identification training. Social validation measures in Experiment III indicated that the communication board skills were functional in providing a method of expressing a choice of a leisure activity to people who previously could not understand the subjects' communication attempts. The acquired skills maintained throughout a seven-week followup period.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/19. Microcomputer-based communication augmentation systems for two nonspeaking, physically handicapped persons with severe visual impairment.Two different microcomputer-based communication systems were developed for nonspeaking physically handicapped individuals with severe visual impairment. One subject was 24 years old and had an inoperative optic glioma which impaired motor function as well as vision. The second subject was cortically blind with severe motor limitation secondary to an automobile accident which occurred at 17 years of age. Both communication systems employed speech synthesis as a control feature to compensate for visual impairment. Both subjects have learned to use their communication systems. The second subject has not achieved extended, independent system use due to reduced vigilance and attention span.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
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