Oskar Schindler

Alzheimer's disease-associated disability: An ICF approach

Purpose. The aim of the study is to provide a description of dementia-associated disability in Alzheimers disease (AD) patients through the International Classification of Functioning, Disability and Health (ICF). Method. Twenty-six AD patients at different stages of disease participated in the study. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. All subjects were classified using the ICF categories in the more detailed four-level version. Correlation between compromised ICF items and both MMSE and GDS scores were calculated through Spearman Rho test. Results. Mental functions were impaired in all the subjects examined. Data on activity and participation showed that not only domestic life, self care, and mobility but also communication and interaction and social relationships are compromised in AD patients. Three main areas appeared as the most relevant facilitators: products and technology, support and relationship and services, systems and policies. ICF codes were generally correlated with both MMSE and GDS: subjects who appeared more compromised on MMSE and GDS showed higher impairment of functions, activity limitation, and participation restriction. Conclusion. ICF is a useful tool to describe health status in AD patients in that it underlines important aspects of daily living generally not considered by activity of daily living scales such as communication, social relationships, and recreation and leisure.

Rehabilitative management of oropharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital.

A high incidence of oropharyngeal dysphagia (OD) in acute-care settings has been reported; however, no data on its management are found in the literature. Here we report the experience with rehabilitative management of OD in a large Italian hospital. The characteristics of inpatients with OD during 2004 have been studied prospectively. For each patient, demographic data, the department referring the patient, the disease causing OD, and the presence of a communication disorder were registered. The swallowing level at the beginning and at the end of rehabilitation were recorded. Of the 35,590 inpatients admitted to San Giovanni Battista Hospital of Turin during 2004, 222 of them were referred for the assessment and rehabilitation of OD. The inpatients with OD came from different departments and mainly had a neurologic disease. In 110 patients a communication disorder was present. The swallowing impairment was moderate to severe at the moment of referral, while on average patients were able to eat by mouth after swallowing therapy. Dysphagia rehabilitation in an acute care setting is requested from different departments because of its prevalence and severity; skilled specialists are needed for early assessment and the best management.

Voice after supracricoid laryngectomy: Subjective, objective and self-assessment data

Supracricoid laryngectomy (SCL) is an efficient surgical procedure for the treatment of selected laryngeal carcinoma, presently being performed not only in Europe but also in North America. The functional goals of the technique are voice and swallowing without a permanent tracheostoma. Perceptual and acoustic voice characteristics after SCL have been reported by different authors, but self-assessment data together with subjective and objective data have only been reported for a small number of subjects. Twenty male subjects, with a mean age of 71 years (range: 51–82 years) who underwent a SCL at least one year before our observation, were included in the study. Each subject underwent a flexible laryngoscopy and his voice was perceptually rated using the GRBAS scale. Objective examination included: maximum phonation time (MPT), voice spectrograms and syllable diadochokinesis on a single breath. Finally, each subject assessed his own voice using the Voice Handicap Index (VHI). The mean values of the GRBAS scale were respectively 2.4, 2.6, 2.4, 0.8, 0.5, 0.8. Mean MPT was 7.5 s, while for voice spectrograms the mean value of the Yanagihara scale was 3.7. Mean syllable diadochokinesis appeared as 3.3 syllables/s. Mean value of the VHI was 29.9. Subjective and objective data show a severely dysphonic voice after SCL; self-assessment data, on the contrary, reveal only moderate functional and emotional consequences. While perceptual, aerodynamic and acoustic data are in line with previous reports, self-assessment data were less severe in our subjects compared to what appears in the literature. It is concluded that self-assessment explores a different dimension of the patients voice and that even if a severe dysphonia is present the consequences on everyday oral communication are only moderate.

La logopedia in Europa

La collocazione della logopedia in Europa, come giu ampiamente riferito nei primi tre capitoli di questo libro, e andata definendosi e affermandosi nell’ultimo secolo, con alcuni tratti comuni ai piu importanti Paesi europei. In tutta Europa si e infatti affermata la richiesta di figure specifiche competenti negli ambiti del linguaggio, con necessita di una formazione post-secondaria superiore, piu o meno lunga e articolata a seconda dei Paesi di appartenenza (la parola d’ordine negli anni ’90, quando si e iniziato a parlare di libera circolazione dei titoli di studio in Europa, era “livello minimo BAC+3”, cioe minimo tre anni di Universita dopo la maturita). Ancora: in tutti i Paesi i logopedisti hanno iniziato a occuparsi dei deficit di linguaggio partendo dai bambini, per poi estendere il loro raggio d’azione a tutte le fasce di eta, con la presa in carico degli anziani iniziata alquanto timidamente in Gran Bretagna e in Francia all’inizio degli anni ’80, e poi diventata ovunque sempre piu importante con l’allungarsi della vita media e il diffondersi di migliori aspettative di mantenimento e recupero del ruolo sociale dell’individuo, a qualunque eta. Altri aspetti professionali sono stati piu faticosamente raggiunti e diffusi, pur presentando anche attualmente differenziazioni dipese dalle coordinate storiche e politiche di ciascun Paese; per esempio, l’occuparsi da un punto di vista logopedico dell’intero campo della comunicazione umana e non strettamente solo degli aspetti verbali e linguistici, e una tendenza che ha permeato i Paesi e i Centri piu avanzati fin dalla meta degli anni ’70, sulla spinta della Scuola di Palo Alto (Watzlavitck, 1965), ma anche di scienze come la sociolinguistica (Bowlby, 1983; Bruner, 1989) e la psicolinguistica (Austin, 1962; e in Italia, Parisi, 1972).

L’evoluzione epistemologica

Come ben emerge dagli antecedenti foniatrico-logopedici (Capitolo 1), fino agli ultimi anni dell’800 la comunicologia, sia come scienza che come professionalita, era quasi sconosciuta, praticamente prossima all’inesistenza. Una sola eccezione era rappresentata dall’educazione dei sordi (Tabella 2.1), praticata sporadicamente a partire dal Rinascimento e poi in via piu sistematica in numerosi centri per sordomuti per lo piu religiosi. La gestione dei sordi peraltro era totalmente svincolata da serie conoscenze scientifiche ed era effettuata al di fuori degli ambienti sanitari. Bisognera arrivare fino a oltre la meta del ’900 perche la presa in carico dei sordi profondi prelinguali passi nelle mani di otorinolaringoiatri, audiologi, foniatri e logopedisti.

Gli antecedenti foniatrici-logopedici

Attualmente la foniatria e la logopedia costituiscono una scienza: la comunicologia medica (cui si e aggiunta negli anni ’80–90’ la deglutologia). In realta nel secolo scorso l’indicazione scientifica e professionale concerneva voce, parola e linguaggio, con un’eventuale appendice per l’udito per le sue ripercussioni sulla succitata triade. Il concetto di comunicazione compare solo negli anni ’60–70’.

PLAYING A BRASS INSTRUMENT AFTER TOTAL LARYNGECTOMY: A CASE REPORT

A brass instrument is a musical instrument in which the tone is produced by vibration of the lips as the player blows into a tubular resonator. The case of a professional brass player who continued his activity after total laryngectomy, with insertion of a voice prosthesis in a tracheoesophageal shunt, is reported.