Quality of Life and Clinical Response to On-Demand Maintenance Doses of Infliximab in Patients With Ankylosing Spondylitis.

AIM: The aim of this study was to study the effect of modified maintenance doses (MDs) of infliximab on the quality of life (QoL) of patients with ankylosing spondylitis (AS) over a period of 3 years. METHODS: Medical records of AS patients (n = 25) who received a normal induction dose but modified MDs as required were retrospectively analyzed. After induction dose and the first MD, patients were followed up every month and were treated with infliximab whenever Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 4 or greater. The study end points were the percentage of responders defined as reduction of 40% or greater in BASDAI score and improvement in QoL defined by mean change in SF-36 Physical Component Summary score, SF-36 Mental Component Summary score, and Ankylosing Spondylitis Quality of Life (ASQoL) values at week 6 and after the last MD (ie, at the end of 3 years) compared with baseline. RESULTS: Majority of the patients were males (n = 20), and the mean age of the analysis population was 40.6 ± 10.79 years. At the end of 6 weeks and after the last MD, BASDAI 40 scores were achieved in 100% and 92% of the patients, respectively. From baseline, the mean change in BASDAI score at the end of 6 weeks and after the last MD is -3.56 and -3.40, respectively. The overall mean change in scores (BASDAI, SF-36 Physical and Mental Component Summary, and ASQoL) versus baseline, at 6 weeks, and after the last MD was statistically significant (P < 0.0001). CONCLUSIONS: The results of the study suggest that initial induction and an on-demand MD regimen of infliximab based on BASDAI were associated with significant improvement in disease activity and QoL.

Struggling to Breathe: Inspiratory Muscle Training in Adolescent Athletes.

OBJECTIVE: Dyspnea is a primary characteristic of exercise-induced laryngeal obstruction and prevents individuals from inhaling and exhaling without effort. This single subject research study investigated the effects of inspiratory muscle training (IMT) on exercise-induced symptoms characteristic of exercise-induced laryngeal obstruction in adolescent athletes. METHODS: Five weeks of IMT was provided to five adolescent athletes, four females and one male, aged 10 to 16. Variables that were measured prior to, during, and after completion of IMT program included maximum phonation time, maximum perceived breathlessness, duration of running, and quality of life regarding dyspnea. RESULTS: Results showed a reduction in maximum perceived breathlessness as well as a significant increase in maximum phonation time across participants. The majority of participants rated their quality of life regarding dyspnea as significant improved after IMT. CONCLUSIONS: These findings contribute to the increasing body of literature investigating the use of alternative therapy strategies for treatment of symptoms of exercise-induced laryngeal obstruction in adolescent athletes.

Prevalence of the use of complementary and alternative medicine in an eastern Indian population with emphasis on tribal/ethnic minority groups.

OBJECTIVES: Complementary and alternative medicine (CAM) includes various therapies that are not recognized by modern scientific medicine. However, in chronic diseases, such as diabetes, the use of CAM is quite common. Data on the use of CAM are needed to understand the health behaviour of individuals and to identify possible side effects. In this study, we aimed to obtain data on the pattern of CAM use in a population in eastern India. METHODS: This was a hospital-based quantitative cross-sectional survey involving adult patients. The study was conducted simultaneously in an urban university hospital and a rural hospital. Data on the demographic characteristics of the participants and their reasons for CAM use were collected. RESULTS: In total, 442 participants were included in the study, and among them, approximately 50% were aged 31-50 years. Moreover, around 26.7% of the participants belonged to the tribal population, 36.7% used CAM within the last year, and 57.2% used CAM in their lifetime. Body ache and dyspepsia were the most common indications for CAM use among the participants. The pattern of CAM use was significantly higher in the tribal population (p < 0.001). On logistic regression analysis, being part of the tribal population was the only demographic factor related with CAM use within the last year (odds ratio [OR]: 3.205) or with lifetime CAM use (OR: 2.885). CONCLUSION: The use of CAM for certain symptoms was quite significant in the study population, particularly in the tribal population.

Orofacial myofunctional deficits in elderly individuals.

Orofacial myofunctional deficits in elderly individuals impact nutrition, swallowing, speech, quality of life, and other aesthetic functions. This paper explores briefly the common orofacial myofunctional disorders (OMD) due to various etiologies. Ideally, the available evidence suggests that an interdisciplinary team should be able to diagnose and document effectively the OMD and provide evidence-based services to the clientele.

Perspectives of speech language pathologists regarding success versus abandonment of AAC.

This three-phase investigation used focus groups and a survey to identify factors that perceived by speech language pathologists as being related to long-term success versus inappropriate abandonment of augmentative and alternative communication (AAC) systems. Factors deemed most important by six focus groups were included in a 106-question survey that was returned by 275 ASHA Special Interest Division #12 (AAC) members. Factor analysis indicated the constructs of Support, Attitude, and System characteristics and Fit as most important to the long-term success of AAC systems. The constructs of Not Maintaining/Adjusting the System, Attitude, Lack of Training, Lack of Support, and Poor Fit were most often related to inappropriate abandonment of AAC systems. Systematic implementation of intervention targeting the constructs is recommended.

Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments.

This study examined the effects of orofacial myofunctional therapy (OMT) on speech intelligibility in adults with persistent articulation impairments. Six adults in the age range of 18-23 years were selected to receive orofacial myofunctional therapy for a period of six weeks. The results showed that five out of six clients made significant progress in oral postures and speech sound production across all three speech production tasks: single words, sentences, and spontaneous speech. Speech intelligibility increased significantly in all clients except the one diagnosed with developmental apraxia of speech. Orofacial myofunctional therapists, speech-language pathologists, and other professionals need to rule out underlying orofacial myofunctional variables when targeting speech sounds for intervention. Speech production tasks may be considered as important measures to understand the efficacy of OMT in clinical settings.

Orofacial myofunctional therapy in dysarthria: a study on speech intelligibility.

Various types of orofacial myofunctional disorders co-exist with speech problems in individuals with dysarthria. Controlled studies stating the efficacy of orofacial myofunctional therapy (OMT) in dysarthric individuals are very scant. The present study was undertaken to examine the efficacy of OMT in twelve patients diagnosed with mild to moderate dysarthria following right hemisphere brain damage. Pre-therapy assessment focused on existing orofacial myofunctional problems and speech intelligibility in the clients. The goals of OMT were to increase strength and mobility of buccal, facial, labial, and lingual musculature. No speech intervention was provided while OMT was in progress. Post-therapy measures indicated significant improvements in the stated goals as well as in speech intelligibility for single words. Patients observed functional improvements in swallowing functions too. A high positive correlation was found between speech intelligibility and diadochokinetic rate. Clinical implications regarding use of OMT in dysarthria are discussed.