Lucia Iracema Zanotto de Mendonça

Descriptive study of 192 adults with speech and language disturbances

CONTEXT Aphasia is a very disabling condition caused by neurological diseases. In Brazil, we have little data on the profile of aphasics treated in rehabilitation centers. OBJECTIVE To present a descriptive study of 192 patients, providing a reference sample of speech and language disturbances among Brazilians. DESIGN Retrospective study. SETTING Speech Pathology Unit linked to the Neurology Division of the Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo. SAMPLE All patients (192) referred to our Speech Pathology service from 1995 to 2000. PROCEDURES We collected data relating to demographic variables, etiology, language evaluation (functional evaluation, Boston Diagnostic Aphasia Examination, Boston Naming and Token Test), and neuroimaging studies. MAIN MEASUREMENTS The results obtained in language tests and the clinical and neuroimaging data were organized and classified. Seventy aphasics were chosen for constructing a profile. Fourteen subjects with left single-lobe dysfunction were analyzed in detail. Seventeen aphasics were compared with 17 normal subjects, all performing the Token Test. RESULTS One hundred subjects (52%) were men and 92 (48%) women. Their education varied from 0 to 16 years (average: 6.5; standard deviation: 4.53). We identified the lesion sites in 104 patients: 89% in the left hemisphere and 58% due to stroke. The incidence of aphasia was 70%; dysarthria and apraxia, 6%; functional alterations in communication, 17%; and 7% were normal. Statistically significant differences appeared when comparing the subgroup to controls in the Token Test. CONCLUSIONS We believe that this sample contributes to a better understanding of neurological patients with speech and language disturbances and may be useful as a reference for health professionals involved in the rehabilitation of such disorders.

Oral Motor Movements and Swallowing in Patients with Myotonic Dystrophy Type 1

Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1) using a standardized clinical protocol and surface electromyography (sEMG). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing.

Stuttering treatment control using P300 event-related potentials

UNLABELLED Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. EDUCATIONAL OBJECTIVES The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.

Persistent developmental stuttering as a cortical-subcortical dysfunction: evidence from muscle activation.

BACKGROUND One contemporary view of stuttering posits that speech disfluencies arise from anomalous speech motor control. PURPOSE To verify the rest muscle tension and speech reaction time of fluent and stuttering adults. METHOD 22 adults, divided in two groups: G1--11 fluent individuals; G2--11 stutterers. Electromyography recordings (inferior orbicularis oris) were collected in two different situations: during rest and in a reaction time activity. RESULTS The groups were significantly different considering rest muscle tension (G2 higher recordings) and did not differ when considering speech reaction time and muscle activity during speech. There was a strong positive correlation between speech reaction time and speech muscle activity for G2--the longer the speech reaction time, the higher the muscle activity during speech. CONCLUSION In addition to perceptible episodes of speech disfluency, stutterers exhibit anomalies in speech motor output during fluent speech. Correlations with a possible cortical-subcortical disorder are discussed.

Chondrodystrophic myotonia: electromyographic and cardiac features of a case

The Schwartz‐Jampel syndrome or chondrodystrophic myotonia is a rare disease characterized by dwarfism, diffuse osteoarticular alterations, ble‐pharospasm, perioral muscular contractions and electromyographic alterations. The authors present a case of chondrodystrophic myotonia focusing mainly on facial electromyographic and cardiac findings. The electromyo‐graphy of the orbicularis oculi muscles showed abundant myotonic discharges like other facial muscles as well as muscles of the members. It was not possible to obtain true electrical silence between myotonic discharges, suggesting that the blepharospasm is a consequence of persistent muscular contraction. No conclusive evidence of myocardiopathy was given by clinical or laboratory cardiac examinations. General characteristics of the syndrome are discussed as well as the treatment with procamide and phenytoin.

Enterovírus-70 na região metropolitana de São Paulo, Brasil, de 1984 a 1987: aspectos da infecção em períodos epidêmico e endêmico

Sao apresentados os resultados de estudos sobre o comportamento do Enterovirus-70 (EV-70) na regiao metropolitana de Sao Paulo desde sua provavel introducao no verao de 1984, determinando extensa epidemia de conjuntivite hemorragica aguda (C.H.A.), ate o final de 1987 abrangendo periodo em que este agravo foi pouco notado. Na fase epidemica ocorrida no primeiro trimestre de 1984 foram estudados 291 individuos divididos em tres grupos denominados A, B e C, o primeiro formado por pessoas atingidas pela C.H.A. e os outros dois por individuos nao atingidos por este agravo mas que, respectivamente, referiam contato domiciliar com casos de C.H.A. e os que nao referiam o citado contato. A demonstracao de anticorpos se fez pela tecnica de imunofluorescencia indireta (IFI) para detectar IgM especifico para EV-70 e pela prova de neutralizacao em cultura de celulas BHK-21. Verificou-se que 56,7%, 33,3% e 20,6% dos individuos pertencentes, respectivamente, aos grupos A, B e C apresentavam anticorpos especificos da classe IgM. No grupo A a faixa etaria mais atingida foi a de 10 a 29 anos. No periodo que vai do fim da primeira e unica epidemia ate o final de 1987, identificaram-se tres casos esporadicos de C.H.A. e 10 pacientes com afeccao neurologica aguda associada a infeccao recente pelo EV-70. Nove, destes 10 casos, apresentaram paralisia de nervos cranianos, todos evoluindo sem sequelas clinicamente discerniveis. As formas assintomaticas e os casos esporadicos de C.H.A. e de afeccoes neurologicas mantiveram a circulacao do EV-70 no periodo nao epidemico.

Language and visuospatial impairment in a case of crossed aphasia

Crossed aphasia in dextrals (CAD) constitutes an interesting model for understanding the lateralisation and interaction of language with other cognitive functions in the brain. The authors present a study of a right-handed patient with Wernickes aphasia following a right hemisphere cerebrovascular accident, who also had impairment in visuospatial skills. Although the patient presented a remarkable improvement in language symptoms on longitudinal follow-up, the combination of linguistic, visuospatial, and attentional impairments ultimately resulted in a persisting inability to perform complex tasks. The study of mild residual disturbances can improve our understanding of the interaction of language with other cognitive functions, going some way towards explaining the particular features found in CAD.

Miotonia congênita: relato de sete pacientes

Myotonia is the phenomenon of decrease of muscular relaxation rate, after either a contraction or a mechanical or electrical stimulus. Congenital myotonias are hereditary affections and do not present muscular dystrophy. The current trend is to group them as ionic channels diseases, together with the periodic paralysis.The authors accompanied the cases of seven patients, six males and one female, with ages ranging from 16 to 48 years (average 27 years) and onset of symptons between 1 and 10 years (average 5 years). These patients presented a myotonic phenomenon unleashed by intensive contraction and global muscular hypertrophy. Three patients were diagnosed as cases of Becker type generalized myotonia because they presented a recessive autosomic heredity and/or transient episodes of muscular weakness. Two patients fitted the description of Thomsen congenital myotonia, with a pattern of dominating autosomic heredity and/or absence of weakness episodes or worsening factors for their condition.Two patients presented fluctuating myotonia, which became worse in cold weather or at potassium intake. The clinical diagnosis was confirmed through complementary tests (electroneuromyography, muscle biopsy and DNA study). Each of the patients made use of different drugs, in the search of optimal lessening of their myotonia. There were five reports of amelioration with the use of diphenilhydantoine; one report with the use of carbamazepine; three reports with the use of acetazolamide; one report with the use of a calcium channel blocker; one report with the use of a beta-adrenergic; one report with the use of thiazide; and none with the use of quinidine/procainamide.Myotonia is the phenomenon of decrease of muscular relaxation rate, after either a contraction or a mechanical or electrical stimulus. Congenital myotonias are hereditary affections and do not present muscular dystrophy. The current trend is to group them as ionic channels diseases, together with the periodic paralysis.The authors accompanied the cases of seven patients, six males and one female, with ages ranging from 16 to 48 years (average 27 years) and onset of symptons between 1 and 10 years (average 5 years). These patients presented a myotonic phenomenon unleashed by intensive contraction and global muscular hypertrophy. Three patients were diagnosed as cases of Becker type generalized myotonia because they presented a recessive autosomic heredity and/or transient episodes of muscular weakness. Two patients fitted the description of Thomsen congenital myotonia, with a pattern of dominating autosomic heredity and/or absence of weakness episodes or worsening factors for their condition.Two patients presented fluctuating myotonia, which became worse in cold weather or at potassium intake. The clinical diagnosis was confirmed through complementary tests (electroneuromyography, muscle biopsy and DNA study). Each of the patients made use of different drugs, in the search of optimal lessening of their myotonia. There were five reports of amelioration with the use of diphenilhydantoine; one report with the use of carbamazepine; three reports with the use of acetazolamide; one report with the use of a calcium channel blocker; one report with the use of a beta-adrenergic; one report with the use of thiazide; and none with the use of quinidine/procainamide.

Inference comprehension in text reading: Performance of individuals with right- versus left-hemisphere lesions and the influence of cognitive functions

Background Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies between left-hemisphere lesions (LHL) and RHL are rare, especially regarding reading comprehension. Moreover, further knowledge of the influence of cognition on inferential processing in this task is needed. Objectives To compare the performance of patients with RHL and LHL on an inference reading comprehension task. We also aimed to analyze the effects of lesion site and to verify correlations between cognitive functions and performance on the task. Methods Seventy-five subjects were equally divided into the groups RHL, LHL, and control group (CG). The Implicit Management Test was used to evaluate inference comprehension. In this test, subjects read short written passages and subsequently answer five types of questions (explicit, logical, distractor, pragmatic, and other), which require different types of inferential reasoning. The cognitive functional domains of attention, memory, executive functions, language, and visuospatial abilities were assessed using the Cognitive Linguistic Quick Test (CLQT). Results The LHL and RHL groups presented difficulties in inferential comprehension in comparison with the CG. However, the RHL group presented lower scores than the LHL group on logical, pragmatic and other questions. A covariance analysis did not show any effect of lesion site within the hemispheres. Overall, all cognitive domains were correlated with all the types of questions from the inference test (especially logical, pragmatic, and other). Attention and visuospatial abilities affected the scores of both the RHL and LHL groups, and only memory influenced the performance of the RHL group. Conclusions Lesions in either hemisphere may cause difficulties in making inferences during reading. However, processing more complex inferences was more difficult for patients with RHL than for those with LHL, which suggests that the right hemisphere plays an important role in tasks with higher comprehension demands. Cognition influences inferential processing during reading in brain-injured subjects.

Transcranial brain stimulation (TMS and tDCS) for post-stroke aphasia rehabilitation: Controversies

Transcranial brain stimulation (TS) techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recovery from aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere with the brains response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left hemisphere truly desirable in all patients?; [c] Is the use of TS during the post-stroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.Transcranial brain stimulation (TS) techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recovery from aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere with the brains response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions are discussed in the present article: (a) Is inhibition of the right hemisphere truly beneficial?; (b) Is the transference of the language network to the left hemisphere truly desirable in all patients?; (c) Is the use of TS during the post- stroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.