Anita S. Halper

Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients

This study examined the effects of bolus volume and viscosity and the variability of repeated swallows in ten stroke patients and ten age-matched nonstroke subjects. The ten stroke patients demonstrated single unilateral cortical (three subjects), subcortical (six subjects), or brainstem (one subject) infarcts on computed tomography or magnetic resonance imaging scans at three weeks post-ictus. All subjects underwent videofluoroscopic swallow studies in which seven temporal pharyngeal swallow measures were examined. Despite the dissimilarity in lesion locations, the swallow physiology in the stroke patients was relatively homogeneous, ie, no swallowing disorders severe enough to prevent oral intake. As bolus volume increased, pharyngeal delay time diminished in stroke patients, but not in nonstroke subjects. Increasing bolus volume affected three other pharyngeal swallow measures similarly in nonstroke and stroke subjects: laryngeal closure durations and cricopharyngeal (CP) opening durations increased and duration of tongue base contact to posterior pharyngeal wall decreased. On viscosity comparisons (liquid vs paste), both subject groups displayed longer duration of base of tongue contact to posterior pharyngeal wall. On paste swallows, nonstroke subjects had longer CP opening and lower swallow efficiency, whereas stroke patients did not. This study found no statistically significant learning/repetition effect for repeated swallows in either subject group, or both groups combined.

Oropharyngeal swallowing after stroke in the left basal ganglion/internal capsule.

One of the foci of Martin Donners work was the neural control of swallowing. This present investigation continues that work by examining oropharyngeal swallowing in 8 patients identified with a single, small, left-basal ganglion/internal capsule infarction and 8 age-matched normal subjects. Stroke patients were assessed with a bedside clinical and radiographic swallowing assessment, and normal subjects received only the radiographic study. Results revealed disagreement between the bedside and radiographic assessments in one of the 8 stroke patients. Stroke and normal subjects differed significantly on some swallow measures on various bolus viscosities, but behaved the same as normal subjects on a number of measures. Differences in swallowing in the stroke subjects were not enough to prevent them from eating orally. The significant differences seen in the basal ganglia/intemal capsule stroke subjects may result from damage to the sensorimotor pathways between the cortex and brainstem. These differences emphasize the importance of cortical input to the brainstem swallowing center in maintaining the systematic modulations characteristic of normal swallowing physiology.

Patient-Reported Changes in Communication After Computer-Based Script Training for Aphasia

OBJECTIVE To evaluate changes in patient-reported communication difficulty after a home-based, computer-delivered intervention designed to improve conversational skills in adults with aphasia. DESIGN Delayed treatment design with baseline, preintervention, postintervention, and follow-up observations. SETTING Outpatient rehabilitation. PARTICIPANTS Twenty subjects with chronic aphasia. INTERVENTIONS Sessions with the speech-language pathologist to develop personally relevant conversational scripts, followed by 9 weeks of intensive home practice using a computer program loaded on a laptop, and weekly monitoring visits with the speech-language pathologist. MAIN OUTCOME MEASURE Communication Difficulty (CD) subscale of the Burden of Stroke Scale (BOSS). RESULTS The intervention resulted in a statistically and clinically significant decrease of 6.79 points (P=.038) in the CD subscale of the BOSS during the intervention, maintained during the follow-up period. CONCLUSIONS The findings of this study provide positive albeit preliminary and limited support for the use of a home-based, computer-delivered language intervention program for improving patient-reported communication outcomes in adults with chronic aphasia. Additional research will be required to examine the efficacy and effectiveness of this intervention.

Dysphagia after head trauma: the effect of cognitive-communicative impairments on functional outcomes.

This article discusses the impact of cognitive-communicative and behavior problems on oral intake. Data on the swallowing outcomes of a group of patients in an acute rehabilitation facility are presented. These data illustrate the relationships among severity of dysphagia, admission and discharge Functional Independence Measure (FIM) scores, admission and discharge cognitive FIM scores and length of stay. Two case studies that describe the effect of cognitive-communicative disorders on dysphagia are provided.

Unilateral visual neglect in right-hemisphere stroke: a longitudinal study

Unilateral visual neglect occurs frequently after right-hemisphere stroke. This longitudinal study assessed the performance pattern of 54 individuals with unilateral right-hemisphere stroke on the Behavioural Inattention Test (BIT), a measure of unilateral neglect. Eighteen subjects returned for retesting between 6-26 months post-onset. Results confirmed the frequent occurrence of unilateral visual neglect in patients with right-hemisphere damage. A high correlation was found between the Conventional and Behavioural Subtests of the BIT, indicating that the shorter subtest may be sufficient to identify neglect. Longitudinal data revealed two subgroups, those with transient neglect that resolved within 6 months and those with neglect that persisted over time. No differences in aetiology and lesion location distinguished patients with and without neglect or patients with transient or persistent neglect. Further research is needed to confirm these results and identify other characteristics that would predict the nature of the neglect.

Novel Technology for Treating Individuals with Aphasia and Concomitant Cognitive Deficits

Abstract Purpose: This article describes three individuals with aphasia and concomitant cognitive deficits who used state-of-theart computer software for training conversational scripts. Method: Participants were assessed before and after 9 weeks of a computer script training program. For each participant, three individualized scripts were developed, recorded on the software, and practiced sequentially at home. Weekly meetings with the speech-language pathologist occurred to monitor practice and assess progress. Baseline and posttreatment scripts were audiotaped, transcribed, and compared to the target scripts for content, grammatical productivity, and rate of production of script-related words. Interviews were conducted at the conclusion of treatment. Results: There was great variability in improvements across scripts, with two participants improving on two of their three scripts in measures of content, grammatical productivity, and rate of production of scriptrelated words. One participant gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from exit interviews: increased verbal communication, improvements in other modalities and situations, communication changes noticed by others, increased confidence, and satisfaction with the software. Conclusion: Computer-based script training potentially may be an effective intervention for persons with chronic aphasia and concomitant cognitive deficits.

Computer-Based Script Training for Aphasia: Emerging Themes from Post-Treatment Interviews.

This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded comments that were categorized into ten themes. Five of the themes related to the communication behaviors of the participant, whereas the other five related to the computer program and study procedures. Examples of each theme are presented. The themes provide qualitative evidence of change and generalization, supporting the use of this computer-based script training program.

Sex, age, and aphasia type

Data from the Rehabilitation Institute of Chicago was used to contrast a sample of 358 aphasics with data from a Boston aphasia and aging study (L. Obler, M. Albert, H. Goodglass, and F. Benson, Brain and Language, 6, 318–322, 1978). Unlike the females, Chicago males showed remarkable similarity to the Boston male sample for the Broca, Wernicke, and Global groups with ratios of approximately four Brocas to every two Wernickes and Global aphasics. Similar to the Boston Sample, Wernickes aphasics were 11.6 years older (p < .001) than Brocas aphasics.

Two approaches to treating unilateral neglect after right hemisphere stroke: A preliminary investigation

Abstract Purpose: This preliminary study assessed the efficacy of two treatment methods for persistent unilateral or hemispatial neglect following right hemisphere stroke. Method: Two patients received an intervention focusing on the underlying impairment of attention during visual scanning. Two other participants received an intervention that provided repetitive practice during a functional task of oral reading. Standardized tests of attention and neglect were administered before and after treatment. Performance on a functional task assessing generalization of treatment was probed at every session. Results: Results indicate no clear conclusions regarding the efficacy of either approach. Factors contributing to these equivocal findings are addressed.

Informational content and unilateral neglect: A longitudinal investigation of five subjects with right hemisphere damage

The relationship between unilateral visual neglect and production of narrative discourse in bye patients with right hemisphere damage (RHD) was examined longitudinally. Initially, all subjects demonstrated a left unilateral neglect on the Behavioural Inattention Test (Wilson et al. 1987a). During subsequent testing at 6-8 months and 12-16 months post-onset, subjects with a persistent unilateral neglect produced less concise discourse with reductions in the percentage of meaningful content units as compared to a group of control subjects. Subjects with a transient unilateral neglect produced informational content that was comparable to the normal subjects. Results support the notion that the presence and persistence of a unilateral visual neglect might assist in delineating more homogeneous groups of RHD subjects.