Renata Whurr

A meta-analysis of studies carried out between 1946 and 1988 concerned with the efficacy of speech and language therapy treatment for aphasic patients

An examination of the empirical evidence for the efficacy of speech and language therapy treatment for adult aphasic patients is undertaken with the aid of meta-analysis which affords a statistical method of systematic data summary and synthesis. Patient characteristics and treatment outcomes are correlated to identify factors that contribute to the demonstration of a treatment effect. One of the most striking results of this retrospective study was the identification of the overwhelming failure to report data or include, in experimental controls, variables that might crucially affect outcome.

Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review

Background: Spasmodic dysphonia is a neurological voice disorder characterized by involuntary adductor (towards midline) or abductor (away from midline) vocal fold spasms during phonation which result in phonatory breaks. Botulinum toxin is currently the gold standard of treatment. Objective: To determine the efficacy of botulinum toxin therapy for the treatment of spasmodic dysphonia. Design: Systematic Cochrane review. Search strategy: The search strategy for this review complied with Cochrane standards. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL (through February 2005), Dissertation Abstracts International (1975 to February 2005) and PsycINFO (1975 to February 2005). The search engine FirstSearch was also used (February 2005). Reference lists for all the obtained studies and other review articles were examined for additional studies. Selection criteria: All randomized control trials where the participants were randomly allocated prior to intervention and in which botulinum toxin was compared to an alternative treatment, placebo or non-treated control group were included. Data collection and analysis: Two reviewers independently evaluated all potential studies meeting the selection criteria noted above for inclusion. Main results: Only one study in the literature met the inclusion criteria. This was the only study identified which reported a treatment/no treatment comparison. It reported significant beneficial effects for fundamental frequency (Fo), Fo range, spectrographic analysis, independent ratings of voice severity and patient ratings of voice improvement. Reviewers conclusions: The evidence from randomized controlled trials supporting the effectiveness of botulinum toxin for management of spasmodic dysphonia is deficient. The lack of supporting evidence from randomized controlled trials results in an inability to draw unbiased generalized conclusions regarding the effectiveness of botulinum toxin for all types of spasmodic dysphonia.

Plasticity of motor cortex excitability induced by rehabilitation therapy for writing

The mechanisms of rehabilitation-induced plasticity in the motor system after stroke are not defined. The authors studied seven patients with residual poststroke agraphia, aphasia, and right hemiparesis. After a 40-minute rehabilitation therapy that promoted use of the paretic hand for writing, the authors observed a task-specific increase in recruitment of ipsilateral corticospinal pathways. Rehabilitation aimed to increase the use of the paretic hand may induce recruitment of previously silent ipsilateral corticospinal pathways even in poorly recovered poststroke patients.

The use of a prosthesis to facilitate writing in aphasia and right hemiplegia

Abstract Two case studies are presented which demonstrate the therapeutic utility of a new prosthesis to aid the treatment of agraphia in hemiplegic aphasics.

Review of differential diagnosis and management of spasmodic dysphonia.

Purpose of reviewThe recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. Recent findingsAdvances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. SummaryFifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a ‘rare’ disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

Tracing Spasmodic Dysphonia: The Source of Ludwig Traube's Priority.

Objectives: Since the mid–20th century, one citation is given historical priority as the first description of spasmodic dysphonia (SD): Ludwig Traube’s 1871 case of the “spastic form of nervous hoarseness.” Our objective is to understand how this case serves as the foundation of understanding laryngeal movement disorders. Methods: The original German paper was located and translated. Bibliographical and bibliometric methods are used to determine the citation history of this original source over the past 140 years. Results: Although secondary citations in contemporary publications typically credit Traube for establishing the clinical entity SD, his case does not conform to currently accepted diagnostic features. Citation patterns indicate the source of Traube’s priority is publications by Arnold and Luchsinger, mid–20th-century ENT clinicians, particularly their influential 1965 textbook used to train US and UK clinicians on voice disorders for several generations. Conclusions: Sometimes secondary citations in medical literature lead to the inadvertent perpetuation of factual misrepresentation. The clinical picture of Traube’s original case does not represent what clinicians would recognize as SD today. The rich 19th-century literature on voice disorders is a valuable resource for present day clinicians.

Morell Mackenzie’s contribution to the description of spasmodic dysphonia

Objectives: Since the middle of the 20th century, most discussions of spasmodic dysphonia (SD) reference a paper by Ludwig Traube published in1871 as the first historical citation, crediting him with priority for this clinical syndrome. However, our recent research has determined that the original observation by Traube was published in 1864 and does not in fact describe what is currently recognized as SD. It appears that many clinics throughout Europe and North America were investigating and publishing observations on a range of voice disorders. Methods: The wider context of work on laryngeal disorders in the 1860s-1870s is considered. One of Traube’s contemporaries, Morell Mackenzie, made significant contributions to the understanding of laryngeal movement disorder and its consequences for the voice. These will be examined to gain a clearer focus on the characterization of this disorder. Results: The clinical descriptions published by Morrell Mackenzie in the 1860s provide details that conform quite closely to our current-day understanding of SD. Conclusions: The citation of Traube’s “hysterical” patient links to mid 20th–century views of the functional nature of SD and the utility of psychiatric treatment. The description presented by Mackenzie is consistent with current views of SD as a movement disorder.

The utility of meta-analysis in the determination of efficacy of treatment in aphasia: a reply to Robey (1994).

In response to Robey (1994) we argue that his judgment of our study and conclusions (Whurr, Lorch, & Nye, 1992) are inaccurate. We point out that our study was in fact an analysis of the effects of treatment for aphasic patients. Further, the results obtained in Robeys analysis, though obtained via a different strategy of analysis, yielded essentially the same degree of overall treatment outcome effect. Thus, we conclude that while Robey does provide a different model of effect size data organization and measurement, the results are no different and do not in fact contradict our data.

Meta-analysis in Aphasia Therapy

Publisher Summary This chapter explains meta-analysis in aphasia therapy. It focuses on the summarization and integration of research data in the treatment of aphasic patients. The term meta-analysis is applied to the statistical analysis aspect of a review, but would not necessarily be a requirement of a systematic review. The position assumes that there are data available in the body of literature that can be subjected to a statistical analysis at some level. If in the process of identifying, coding, and organizing the data for a review, no studies are found which are amenable to statistical analysis, then the appropriate term would be “systematic review” however, it finds this to seldom be the case. Meta-analysis (MA) provides a mechanism to deal with these types of problems in combining findings by using statistically systematic procedures. It follows the same guidelines of scientific experimentation as the original primary research. At its most global level, and finally, meta-analysis is a method of combining results from several different studies into a common metric interpreted as a z-distribution.

Children's Acquired Aphasia Screening Test

Diagnosis in acquired childhood aphasia (ACA) is a multi-stage process. After the medical condition has stabilised, the diagnostic evaluation requires careful assessment to establish a profile in the differential diagnosis of listening, understanding speaking, and gesture. Children with ACA were traditionally assessed on adapted batteries often used for adults. The Childrens Acquired Aphasia Screening Test (CAAST) was specifically designed to evaluate linguistic and non-linguistic function in brain-damaged children aged between 3 and 7 years.