Deanna Britton

Endoscopic assessment of vocal fold movements during cough

Objectives: Little is known about the function of the true vocal folds (TVFs) during cough. The objective of this study was to determine the reliability of measuring TVF movements during cough and to obtain preliminary normative data for these measures. Methods: Sequential glottal angles associated with TVF adduction and abduction across the phases of cough were analyzed from laryngeal videoendoscopy records of 38 young healthy individuals. Results: The intraobserver and interobserver reliability of 3 experienced measurers was high (intraclass correlation of at least 0.97) for measuring sequential and maximum glottal angles. The TVF abduction velocity during expulsion was significantly higher than the precompression adduction velocity (p = 0.002), but there were no significant differences in maximum angle. No statistically significant differences were seen in maximum TVF angle and velocity when they were compared between the sexes and between the levels of cough strength. True vocal fold closure following expulsion occurred in 42% of soft coughs and in 57% of moderate to hard coughs. Conclusions: The TVF abduction angles during cough can be reliably measured from laryngeal videoendoscopy in young healthy individuals. The TVF movements are faster for expulsion abduction than for precompression adduction, but the extents of abduction are similar. To validly determine the cough phase duration, simultaneous measures of airflow are needed.

Feasibility of game-based electromyographic biofeedback for dysphagia rehabilitation

Dysphagia (abnormal swallowing) is widely prevalent in the neurologically impaired and can result from both motor weakness and degraded sensory feedback. We present a system to pair augmentative sensory feedback through surface electromyography biofeedback with video game play for dysphagia rehabilitation. This system was employed with an individual with dysphagia as a result of brainstem stroke and compared against 6 unimpaired individuals. Initial results indicate high usability of the system and identify two objective measures with potential for differentiating control participants from the individual with dysphagia. Both gaming performance and the neck intermuscular beta coherence were decreased for the individual with dysphagia relative to control participants. Performance during gameplay is an estimate of the ability to voluntarily modulate neck muscle activity, whereas intermuscular coherence in the beta band may be representative of transmission from the primary motor cortex to muscle.

Baclofen pump intervention for spasticity affecting pulmonary function.

Abstract Introduction: Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonaryfunction. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support. Methods: Case presentation. Results: Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapidweaning from the ventilator occurred within 3 weeks of baclofen pump placement. Conclusions: Randomized clinical trials among SCI patients with significant spasticity are needed todetermine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.

The use of speaking valves with ventilator-dependent and tracheostomy patients

As speaking valve designs are modified and improved, researchers continue to analyze and compare specific performance variables between them, and challenge the validity of advertised claims. Recent research suggests that use of a speaking valve with tracheostomy or ventilator-dependent patients may improve verbal communication, some biomechanical features of swallowing, and the ability to clear secretions. The potential for the speaking valve to reduce or eliminate aspiration has been variable between and within studies, and there is no current evidence clearly demonstrating usefulness of the speaking valve as an aid to ventilator weaning. The speaking valve has, however, been introduced as a means of facilitating functional use of breathing strategies for patients with high-level respiratory muscle paralysis. Transition to a cuffless tracheostomy tube before prolonged speaking valve use is recommended.

Beyond Tracheostomy: Noninvasive Ventilation and Potential Positive Implications for Speaking and Swallowing.

For more than a decade, there has been a trend toward increased use of noninvasive positive pressure ventilation (NPPV) via mask or mouthpiece as a means to provide ventilatory support without the need for tracheostomy. All indications are that use of NPPV will continue to increase over the next decade and beyond. In this article, we review NPPV, describe two common forms of NPPV, and discuss the potential benefits and challenges of NPPV for speaking and swallowing based on the available literature, our collective clinical experience, and interviews with NPPV users. We also speculate on how future research may inform clinical practice on how to best maximize speaking and swallowing abilities in NPPV users over the next decade.

Dysarthria of Spinal Cord Injury and Its Management

&NA; The dysarthria associated with spinal cord injury (SCI) is characterized by speech impairments that reflect respiratory dysfunction and its downstream effects on phonation, articulation, and prosody. The exact nature of the dysarthria is determined in large part by the level of SCI and whether or not diaphragm function is spared. Individuals with insufficient diaphragm strength to breathe on their own must rely on ventilator support, which may help or hinder speech, depending on a variety of ventilator‐related variables. This article provides a conceptual review of the underlying pathophysiology and effects of respiratory muscle weakness on speech produced with and without mechanical ventilation. Selected multidisciplinary interventions for the dysarthria of SCI are also reviewed.

Swallowing and Secretion Management in Neuromuscular Disease

Neuromuscular disease frequently leads to dysphagia and difficulty managing secretions. Dysphagia may lead to medical complications, such as malnutrition, dehydration, aspiration pneumonia, and other pulmonary complications, as well as social isolation and reduced overall quality of life. This review provides an overview of dysphagia associated with neuromuscular disease in adults, along with a concise review of swallowing assessment and intervention options.

Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson's Disease

&NA; Although understanding patient perspectives on treatment is a major component of patient‐centered care, little is known about patient perspectives related to dysarthria treatment in Parkinsons disease (PD). This article attempts to explore the perspective of patients with dysarthria associated with PD by interviewing them before and after treatment. Treatment expectations and experiences are summarized along with a discussion of how patients are using the tools they learned once treatment was completed. Comments about treatment were generally positive and suggested increased awareness and improved speech loudness. However, areas for improvement were also identified including: (1) treatment was not addressing some communication problems that were of concern to patients; (2) therapy programs were not enjoyable; and (3) it was difficult to maintain gains after therapy ended. Principles of self‐management are reviewed to address some of the shortcomings of current treatment approaches.