Betty L. McMicken

Prognostic indicators of functional outcomes in first time documented acute stroke patients following standard dysphagia treatment

Purpose. To explore prognostic factors specific to the speech language pathology scope of practice that may be related to the functional outcome of stroke patients with dysphagia. Method. The prognostic factors analysed for 100 stroke patients with dysphagia included the swallowing portion of the Functional Assessment Measure (SFAM) at discharge as the dependent variable, and age, severity of stroke, cognitive status, length of stay, amount of individual treatment, and the SFAM, Food Texture, and Liquid Consistencies at admission as the independent variables. Correlation analysis, linear regression and descriptive statistics were used to analyse these variables. Results. Variables that had significant influences on the SFAM discharge levels included the admission ratings of the SFAM, Food Texture, Liquid Consistency, Cognitive FIM levels and length of stay. Amount of individual treatment received was also noted to be significant. Subject age, lesion site and lesion type did not reach significance in correlation or regression analysis. Conclusion. Prognostic factors may play an important role in predicting outcome. This data provides speech–language pathologists with knowledge to more effectively communicate the potential outcome of treatment and recovery to patients and families. Additionally, this study stresses the importance of the initial assessment ratings and suggests the need for inter-rater reliability of assessment measures within rehabilitation facilities.

Retrospective ratings of 100 first time-documented stroke patients on the Functional Oral Intake Scale

Purpose. This study investigated whether patients originally evaluated on the swallowing portion of the Functional Assessment Measure (SFAM), an instrument that when used independently of the Functional Assessment Measure (FAM) has questionable reliability and validity, would demonstrate clinically and statistically significant gains if measured on an instrument such as the Functional Oral Intake Scale (FOIS), which is valid and reliable. Second, this study questioned how easily the FOIS could be adopted at Rancho Los Amigos National Rehabilitation Center (RLANRC), a rehabilitation facility currently utilising the Functional Independence Measure and the SFAM. Additionally, this research addressed inter-rater reliability, the relationship between the SFAM and FOIS at admission and at discharge, and the clinical and statistical difference in ratings between the two scales. Method. Treatment was given at RLANRC in Downey, California. Subjects for this study consisted of 100 first time-documented acute stroke patients with swallowing disorders. Inter-item correlation, intraclass correlation coefficients and Spearman Rho Correlations were used to establish inter-rater reliability, and descriptive statistics, Spearman Rho Correlations and the Wilcoxon Signed Ranks Test were used to explore relationships between the two scales. Results. It was found that there was high inter-rater reliability, strong significant relationships between the SFAM and FOIS at admission and discharge, and statistically significant differences and clinical change in scores between admission and discharge on the FOIS. Conclusion. The FOIS is a valid and reliable instrument that is similar in design to the SFAM and requires minimal training for implementation. The transition from the SFAM to the FOIS will provide RLANRC with a reliable and valid assessment protocol.

Functional outcomes of standard dysphagia treatment in first time documented stroke patients

Purpose. This retrospective study investigated whether there were statistically and/or clinically significant changes in functional status for patients between admission and discharge as measured by (1) the assistive/independence levels on the swallowing portion of the functional assessment measure (SFAM), and (2) the food and liquid dietary ratings. Also investigated was the relationship between the assistive/independence levels of the SFAM and the specific dietary ratings. Method. Treatment was given at Rancho Los Amigos National Rehabilitation Centre in Downey, California. Subjects for this study consisted of 100 first-time documented acute stroke patients with swallowing disorders. Descriptive statistics, the Wilcoxon signed ranks test and Spearman rho were used to investigate the proposed questions in this study. Results. There were statistically significant differences in both the dietary ratings and SFAM levels between admission and discharge and a high percentage of these differences were also determined to be clinically significant. In addition, it was found that there was a high level of variability in the dietary ratings at the majority of SFAM levels. Conclusion. These results demonstrate that separate and specific dietary ratings in addition to the SFAM assistive/independence levels are necessary to obtain a comprehensive assessment of the stroke patient with dysphagia.

Acoustic and Perceptual Description of Vowels in a Speaker With Congenital Aglossia

The goals of this study were to (a) compare the vowel space produced by a person with congenital aglossia (PWCA) with a typical vowel space; (b) investigate listeners’ intelligibility for single vowels produced by the PWCA, with and without visual information; and (c) determine whether there is a correlation between scores of speech intelligibility of PWCA speech and the acoustic properties of those speech samples. The main objective of this study was to determine whether a PWCA was able to compensate for the lack of tongue and whether listeners were able to compensate perceptually for the possible atypical acoustics of the PWCA. Cineradiography for this article was limited to observation of gross function of the tongue base and mylohyoid. An audiovisual recording of the PWCA speaker’s output was obtained for a series of isolated vowels, diphthongized vowels, and vowels in monosyllables. Production of vowels was analyzed acoustically and perceptually. Vowels were presented to listeners under two conditions: audiovisual and audio only. Paired differences sample tests revealed no statistical differences in intelligibility for the audio versus audiovisual conditions. Mean intelligibility for vowels was 78.5% overall. Intelligibility was a function of vowel position, with the front vowels revealing the least intelligibility and the back vowels revealing the greatest intelligibility. Quantitative analysis of F1–F2 formant data revealed that the speaker’s front vowels showed greater distances from the back vowels when compared with the F1–F2 means of normative data.

Semantic and Phonemic Listener Confusions in a Case of Isolated Congenital Aglossia.

This article is the second in a series that examines the intelligibility of a person with congenital aglossia (PWCA). Specific factors examined in this study included (a) intelligibility for meaningful words versus nonsense words, (b) intelligibility for consonant-vowel-consonant words (CVCs) as a function of phonemic segment types, and (c) whether there is a correlation between intelligibility for these factors and the acoustic properties of the speech samples. Results revealed greater intelligibility for meaningful versus nonsense CVCs, greater intelligibility for back, low, and high-back versus front vowels embedded in CVCs, and greater intelligibility for productions as a function of phonemic variables, which demonstrated the following hierarchy: initial consonant > consonant vowel > vowel consonant > final consonant. Further results suggest that consonant recognition was consistently affected by “vowel context.” This suggests that movement sequencing appeared to be of importance for speech perception in productions of a PWCA.

Cineradiographic Examination of Articulatory Movement of Pseudo- Tongue, Hyoid, and Mandible in Congenital Aglossia

This research examined cineradiographic films (CRF) of articulatory movements in a person with congenital aglossia (PWCA) during speech production of four phrases. Pearson correlations and a multiple regression model investigated co-variation of independent variables, positions of mandible and hyoid; and pseudo-tongue-dependent variables, positions of mylohyoid and tongue base. Results suggest that backing/fronting of the mandible assisted the mylohyoid/tongue base in making mid-antero-posterior constrictions. Co-linearity findings suggest the best predictor of tongue base movement was mandible for back sounds. Hyoid movement was highly correlated with mandibular movement horizontally, but hyoid acted independently vertically and possibly with greater phonemic specialty in the PWCA. Findings suggest hyoid was a strong determinant of vertically dependent variable movement in all phrases. The extent of hyoid activity was a unique finding and one that may begin to explain relative intelligibility in this PWCA. Observed changes in vocal tract length may have influenced F2 transitional/vowel midpoint values.

Speech Remediation of Long-Term Stuttering

This research article describes the remediation of moderate stuttering in an adult client who experienced speech dysfluency for more than 40 years. Treatment took place at an urban residential rehabilitation mission where the client was court sentenced for a history of felonies and current narcotic sales and use. In conjunction with the operant conditioning instruction of the rehabilitation mission, the Ryan Fluency Program was implemented along with the initial use of pause time in response to the complex needs of the client. The article provides an overview of the assessment (Fluency Interviews, Criterion Tests) and treatment program. At present, 2.5 years post-initiation of treatment, the client has reported and been observed to have achieved smooth, forward-flowing, natural sounding speech throughout his work environment, family interaction, and daily life.

Extrapyramidal Motor Dysfunction and Resultant Orofacial Dystonia Post-Cocaine Abuse: A Clinical Case Study

This case study investigated the consequences of cocaine use and resultant extrapyramidal motor dysfunction. The study focused on a female client, post-long-term drug abuse with concomitant untreated head trauma, experiencing extraneous motor movements of the lips, tongue, jaw, and upper and lower extremities. The goals of this study were to (a) describe the presenting features of extrapyramidal motor dysfunction and resultant orofacial dystonia in this participant, including the presence of extraneous motor movements and the impact of these movements on speech intelligibility and communication effectiveness, and (b) describe the influence of traditional speech exercises and drills on speech characteristics and the presence of extraneous motor movements in this participant. Few studies have addressed extrapyramidal motor dysfunction related to cocaine abuse specific to speech-language pathology assessment and treatment. This study offers speech-language pathologists insight into the diagnosis and treatment of individuals experiencing extrapyramidal motor dysfunction associated with cocaine abuse.

Language Remediation in a Case of Wernickeâs Aphasia Post HerpesSimplex Virus Type 1 Viral Encephalitis

Objective: This report aims to disseminate a successful language remediation in a case of Wernicke’s aphasia following encephalitis caused by herpes simplex virus type 1. Methods: A female patient was referred two months post onset of Herpes Simplex Encephalitis (HSE) with severe Wernicke’s aphasia, confusion, environmental disorientation, and dependence in activities of daily living. Non-standardized portions of the Porch Index of Communicative Ability (PICA) was administered in speech-language assessment. A treatment program following the Context-Based Therapy was applied on an intensive schedule, with emphasis on the auditory system. PICA’s multidimensional scoring system was used to monitor patient’s progress. Results: Sixteen months post onset of Wernicke’s aphasia, patient was able to perform auditory comprehension/ memory tasks with gestural/ visual augmentation and demonstrate no deficits on a non-standardized PICA, other than occasional delays and self-corrections. Patient became independent and functional in activities of daily living. Conclusion: There is no proven method for rehabilitation of the Wernicke’s aphasia. The successful rehabilitation including language remediation in this case suggests that a treatment program following the Context-Based Therapy may be helpful in rehabilitation of Wernicke’s aphasia caused by HSE when administered on an intensive schedule.

Electropalatography in a Case of Congenital Aglossia

Objective: The purpose of this study, the fifth in a series on a Person with Congenital Aglossia (PWCA), was: 1) to determine if there was activation of electrodes in a PWCA during swallow and articulation as detected by the Electropalatography (EPG), 2) to compare the electrode activation patterns in PWCA to those in People without Congenital Aglossia (PWoCA). Methods: EPG was performed using the Complete Speech SmartPalate® software and hardware designed from impressions of the PWCA, a 44-year old Caucasian female. Stimulus materials consisted of 11 vowel-constantvowel combinations were derived from prior research. Results: The PWCA was able to activate electrodes in the anterior and posterior palatal areas, noticeably greater in swallowing than in speech. While PWCA patterns demonstrated significantly fewer electrode activations, patterns were discernibly similar to normal data derived from PWoCA. Conclusion: This study employed EPG to investigate the unique speech production pattern of a 44-year old female PWCA and compared these patterns with those of PWoCA published by Dromey and Sanders. The question remains as to the exact nature of the articulatory compensations and adjustments which allow the PWCA to speak in an intelligible fashion and produce consonants which are perceptually correct and distinguishable from each other.