Mary Andrianopoulos

PVCM, PVCD, EPL, and irritable larynx syndrome: What are we talking about and how do we treat it?

Paroxysmal vocal cord movement/motion (PVCM), paroxysmal vocal cord dysfunction (PVCD), episodic paroxysmal laryngospasm (EPL), and irritable larynx syndrome (ILS) are terms used to describe laryngeal dysfunction masquerading as asthma, upper airway obstruction, or functional and organic voice disorders. The differential diagnosis of PVCM, PVCD, EPL, and ILS is critical to successful medical and behavioral management of the patient. During the past 10 years, 27 subjects, ages 15-79 years, were identified to have paroxysms of inspiratory stridor, acute respiratory distress, associated aphonia and dysphonia, resulting in misdiagnosis and unnecessary emergency treatments, including endotracheal intubation, cardiopulmonary resuscitation, massive pharmacotherapy, or tracheostomy. A multifactorial management program is proposed utilizing principles of motor learning, neurolinguistic programming model, respiratory and phonatory synchronization, relaxation techniques, concurrent monitoring of behavioral adjustments, and formal psychological counseling.

Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review

Objective: Studies involving the use of telepractice in the delivery of services to individuals with autism spectrum disorders (ASD) were reviewed with the intent to inform practice and identify areas for future research. Methods: Systematic searches of electronic databases, reference lists and journals identified eight studies that met pre-determined inclusion criteria. These studies were analysed and summarized in terms of the: (a) characteristics of the participants, (b) technology utilized, (c) services delivered via telepractice, (d) research methodology and (e) results of the study. Results: Telepractice was used by university-based researchers, behaviour analysts, psychiatrists and psychologists to assist caretakers and educators in the delivery of services to 46 participants with ASD. The services delivered included behavioural and diagnostic assessments, educational consulting, guidance and supervision of behavioural interventions and coaching/training in the implementation of a comprehensive early intervention programme. Conclusions: Results suggests telepractice is a promising service delivery approach in the treatment of individuals with ASD that warrants additional research. Guidelines for practitioners and potential directions for future research are discussed.

Multimodal Standardization Of Voice Among Four Multicultural Populations: Fundamental Frequency And Spectral Characteristics

A stratified random sample of 20 males and 20 females matched for physiological factors and cultural-linguistic markers were examined to determine differences in fundamental frequency and spectral characteristics during prolongation of three vowels: [a], [i], and [u]. The ethnic-gender breakdown included four sets of five male and five female subjects comprised of Caucasian and African-American speakers of standard American English, native Hindi Indian speakers, and native Mandarin Chinese speakers. Acoustic measures were analyzed using the Multidimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) (Model 4305) from which fundamental frequency and associated acoustic spectra were extracted from a 200-ms sample of each vowel token. Statistically significant group differences for the main effects of culture, race, and gender were found. The acoustic differences found are attributed to biomechanical, physiological, cultural, and linguistic factors.

Multimodal Standardization Of Voice Among Four Multicultural Populations Formant Structures

A stratified random sample of 20 males and 20 females matched for physiologic factors and cultural-linguistic markers was examined to determine differences in formant frequencies during prolongation of three vowels: [a], [i], and [u]. The ethnic and gender breakdown included four sets of 5 male and 5 female subjects comprised of Caucasian and African American speakers of Standard American English, native Hindi Indian speakers, and native Mandarin Chinese speakers. Acoustic measures were analyzed using the Computerized Speech Lab (4300B) from which formant histories were extracted from a 200-ms sample of each vowel token to obtain first formant (F1), second formant (F2), and third formant (F3) frequencies. Significant group differences for the main effect of culture and race were found. For the main effect gender, sexual dimorphism in vowel formants was evidenced for all cultures and races across all three vowels. The acoustic differences found are attributed to cultural-linguistic factors.

Sensory Differences and Mealtime Behavior in Children With Autism.

This study examined sensory differences and mealtime behaviors in children with autism spectrum disorder (ASD; n=34) and compared the results with those of similarly aged peers who were typically developing (TD; n=34). Results from parent-report and child-report questionnaires indicated that children with ASD scored significantly differently from TD peers on the measures of sensory differences and eating behaviors. Data also supported a correlation between sensory differences and eating difficulties in children with ASD. The results of this study will help caregivers and their children with ASD identify problem eating behaviors that may be associated with sensory differences. Sensory strategies and techniques offered by occupational therapy practitioners may contribute to greater success during mealtimes for children with ASD and their families, with increased comfort and less stress. The findings also support a need to further explore the influence of sensory differences on mealtime behaviors.

Motor speech skills in children with Down syndrome: A descriptive study

Abstract Purpose: Motor speech characteristics of children with Down syndrome (DS) have historically been viewed as either Childhood Dysarthria (CD) or, more infrequently, as Childhood Apraxia of Speech (CAS). The objective of this study was to investigate motor speech deficits in a systematic manner, considering characteristics from both CAS and CD. Method: Motor speech assessments were carried out on seven 3;4–8;11-year old children with DS in comparison with younger, typically-developing children using a Language-Neutral Assessment of Motor Speech for young children (LAMS). Additionally, the motor speech and non-speech oral motor skills of all participants were analysed qualitatively using an investigator checklist of characteristics of CAS, CD and Motor Speech Disorder–Not Otherwise Specified (MSD-NOS). Result: Results indicated that the children with DS exhibited symptoms of CAS, CD and MSD-NOS, with variability within the group and overlapping symptoms of the disorder types. This finding is different from previous assumptions that children with DS have either CD or CAS. Conclusion: The motor speech disorder accompanying DS is complex. The data provide some preliminary descriptions of motor speech disorders in this population and some tools that clinicians would find useful when assessing motor speech skills of young children with DS.

The Multi-faceted Implementation of Telepractice to Service Individuals with Autism

Telepractice is a method of service delivery in which professionals provide intervention, assessment and consultation services to individuals through the use of telecommunication technologies. In response to the nationwide school-based shortage of speech-language pathologists, telepractice has emerged as a viable way to reach underserved clients. Telepractice has the potential to extend to populations in need of services, including those diagnosed with autism. This paper examines an evidence-based clinical model for the delivery of telepractice services and describes the policies and procedures required for assessing individual need, confidentiality, technology, training and documentation within a telepractice program. Two clinical case studies involving individuals diagnosed with autism are described and provide initial evidence for the use of telepractice as a practical method for direct and consultative service delivery. Results indicated that both the student receiving direct services, and the treating clinician receiving consultative services via telepractice, demonstrated an increased skill level in target domains.

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILATs success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.