Georgia A. Malandraki

A fuzzy cognitive map approach to differential diagnosis of specific language impairment

This paper presents a computer-based model for differential diagnosis of specific language impairment (SLI), a language disorder that, in many cases, cannot be easily diagnosed. This difficulty necessitates the development of a methodology to assist the speech therapist in the diagnostic process. The methodology tool is based on fuzzy cognitive maps and constitutes a qualitative and quantitative computer model comprised of the experience and knowledge of specialists. The development of the model was based on knowledge from the literature and then it was successfully tested on four clinical cases. The results obtained point to its final integration in the future and to its valid contribution as a differential diagnosis model of SLI.

Fuzzy cognitive map architectures for medical decision support systems

Medical decision support systems can provide assistance in crucial clinical judgments, particularly for inexperienced medical professionals. Fuzzy cognitive maps (FCMs) is a soft computing technique for modeling complex systems, which follows an approach similar to human reasoning and the human decision-making process. FCMs can successfully represent knowledge and human experience, introducing concepts to represent the essential elements and the cause and effect relationships among the concepts to model the behavior of any system. Medical decision systems are complex systems that can be decomposed to non-related and related subsystems and elements, where many factors have to be taken into consideration that may be complementary, contradictory, and competitive; these factors influence each other and determine the overall clinical decision with a different degree. Thus, FCMs are suitable for medical decision support systems and appropriate FCM architectures are proposed and developed as well as the corresponding examples from two medical disciplines, i.e. speech and language pathology and obstetrics, are described.

Neural activation of swallowing and swallowing-related tasks in healthy young adults: an attempt to separate the components of deglutition.

Understanding the underlying neural pathways that govern the highly complex neuromuscular action of swallowing is considered crucial in the process of correctly identifying and treating swallowing disorders. The aim of the present investigation was to identify the neural activations of the different components of deglutition in healthy young adults using functional magnetic resonance imaging (fMRI). Ten right‐handed young healthy individuals were scanned in a 3‐Tesla Siemens Allegra MRI scanner. Participants were visually cued for both a “Swallow” task and for component/control tasks (“Prepare to swallow”, “Tap your tongue”, and “Clear your throat”) in a randomized order (event‐related design). Behavioral interleaved gradient (BIG) methodology was used to address movement‐related artifacts. Areas activated during each of the three component tasks enabled a partial differentiation of the neural localization for various components of the swallow. Areas that were more activated during throat clearing than other components included the posterior insula and small portions of the post‐ and pre‐central gyri bilaterally. Tongue tapping showed higher activation in portions of the primary sensorimotor and premotor cortices and the parietal lobules. Planning did not show any areas that were more activated than in the other component tasks. When swallowing was compared with all other tasks, there was significantly more activation in the cerebellum, thalamus, cingulate gyrus, and all areas of the primary sensorimotor cortex bilaterally. Hum Brain Mapp 2009.

The Application of PECS in a Deaf Child With Autism A Case Study

A 10-year-old nonverbal Greek boy, C.Z., Who had been diagnosed With both bilateral sensorineural profound hearing loss and autism, Was taught to use the Picture Exchange Communication System (PECS), With some modifications and extensions, over a 4-month intensive intervention period. C.Z.s original communication and behavioral status as Well as the PECS application process are presented, along With the communicative, language, and psychosocial outcomes folloWing the intervention program. FolloW-up data Were collected 6 months post.

Reduced Somatosensory Activations in Swallowing With Age

Understanding the neural functional organization of swallowing in healthy elders is essential in diagnosing and treating older adults with swallowing difficulties. The primary aims of this investigation were to identify the neural activation sites of different components of deglutition in healthy elders using functional Magnetic Resonance Imaging (fMRI) and to investigate age differences in the neural control of swallowing. Ten young (age range 19–25 years of age) and nine older (age range 66–77 years of age) right‐handed healthy individuals were scanned in a 3‐Tesla MRI scanner. Subjects were visually cued for both a “Swallow” task and for component/control tasks (“Prepare to swallow,” “Tap your tongue,” and “Clear your throat”). Behavioral interleaved gradient (BIG) methodology was used to address movement related artifacts. Between‐group comparisons revealed statistically stronger activations in the primary somatosensory cortex of young adults during the motor tasks examined. Both groups showed activations in the major motor areas involved in the initiation and execution of movement; however, areas involved in sensory processing, sensorimotor integration and/or motor coordination and control, showed reduced or limited activity in the elderly. Potential implications of these findings for clinical practice are discussed. Hum Brain Mapp, 2011.

Functional MRI of swallowing: From neurophysiology to neuroplasticity

Swallowing is a complex neurogenic sensorimotor process involving all levels of the neuraxis and a vast number of muscles and anatomic structures. Disruption of any of these anatomic or functional components can lead to swallowing disorders (also known as dysphagia). Understanding the neural pathways that govern swallowing is necessary in diagnosing and treating patients with dysphagia. Functional MRI (fMRI) is a prevalent and effective neuroimaging method that has been used to study the complex neurophysiologic control of swallowing in vivo. This article presents a summary of the research studies that have used fMRI to study the neural control of swallowing in normal subjects and dysphagic patients, and to investigate the effects of swallowing treatments on neuroplasticity. Methodologic challenges and caveats are discussed, and a case study of a pre‐posttreatment paradigm is presented to highlight potential future directions of fMRI applications in swallowing research and clinical practice.

Online Collaboration Environments in Telemedicine Applications of Speech Therapy

The use of telemedicine in speech and language pathology provides patients in rural and remote areas with access to quality rehabilitation services that are sufficient, accessible, and user-friendly leading to new possibilities in comprehensive and long-term, cost-effective diagnosis and therapy. This paper discusses the use of online collaboration environments for various telemedicine applications of speech therapy which include online group speech therapy scenarios, multidisciplinary clinical consulting team, and online mentoring and continuing education

The Effects of Lingual Intervention in a Patient With Inclusion Body Myositis and Sjögren's Syndrome: A Longitudinal Case Study

OBJECTIVE To report the 5-year course of a patients swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program. DESIGN This is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods. SETTING The study was completed in 2 settings-an outpatient swallowing clinic at an acute care hospital and the patients home. PARTICIPANT The subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögrens syndrome. INTERVENTION The patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5). MAIN OUTCOME MEASURES Three outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale. RESULTS Isometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment. CONCLUSIONS We conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögrens syndrome.

A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy

BACKGROUND Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. AIM To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. METHODS AND PROCEDURES Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. OUTCOMES AND RESULTS Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76). CONCLUSIONS AND IMPLICATIONS Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.

Simultaneous dynamic and functional MRI scanning (SimulScan) of natural swallows.

In studies of swallowing, dynamic and functional MRI are increasingly used to observe motor oropharyngeal behaviors and identify associated brain regions. However, monitoring of motor performance during a functional examination requires disruptive monitoring sensors, visual or auditory cued tasks, and strict subject compliance to stimuli. In this work, a simultaneous acquisition (SimulScan) was developed to provide dynamic images to monitor oropharyngeal motions during swallowing (1 mid‐sagittal slice at 14.5 frames per second) simultaneous with functional MRI (24 oblique‐axial slices with a TR of 1.6512 s). Data were acquired while three healthy adult subjects passively viewed a movie during three 15‐min scans with the purpose of covertly studying uncued natural swallows. Dynamic MR images were used to determine timing of swallow onsets for subsequent functional analysis. Resulting functional maps show significant areas of activation that agree with previous functional magnetic resonance imaging studies of cued water swallows, except for regions associated with processing the task stimulus. SimulScan may prove a useful tool in developing new techniques for studying swallowing and associated neuromuscular disorders. Magn Reson Med, 2011.