Computers in the treatment of chronic aphasia.

Computers and related technology can increase the amount of treatment received by adults with chronic aphasia. Computers used in treatment, however, are only valuable to the patient if the intervention is efficacious. Real and potential applications of computer technology are discussed in the context of three roles of computerized aphasia treatment for adults with chronic aphasia. Pertinent studies regarding Phases 1 and 2 are briefly described. The only Phase 3 study of efficacy of computerized aphasia treatment is more fully described and its implications discussed.

Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: executive summary.

BACKGROUND: A panel of experts developed stroke rehabilitation guidelines for the Veterans Health Administration and Department of Defense Medical Systems. METHODS: Starting from previously established guidelines, the panel evaluated published literature through 2002, using criteria developed by the US Preventive Services Task Force. Recommendations were based on evidence from randomized clinical trials, uncontrolled studies, or consensus expert opinion if definitive data were lacking. RESULTS: Recommendations with Level I evidence include the delivery of poststroke care in a multidisciplinary rehabilitation setting or stroke unit, early patient assessment via the NIH Stroke Scale, early initiation of rehabilitation therapies, swallow screening testing for dysphagia, an active secondary stroke prevention program, and proactive prevention of venous thrombi. Standardized assessment tools should be used to develop a comprehensive treatment plan appropriate to each patient's deficits and needs. Medical therapy for depression or emotional lability is strongly recommended. A speech and language pathologist should evaluate communication and related cognitive disorders and provide treatment when indicated. The patient, caregiver, and family are essential members of the rehabilitation team and should be involved in all phases of the rehabilitation process. These recommendations are available in their entirety at http://stroke.ahajournals.org/cgi/content/full/36/9/e100. Evidence tables for each of the recommendations are also in the full document. CONCLUSIONS: These recommendations should be equally applicable to stroke patients receiving rehabilitation in all medical system settings and are not based on clinical problems or resources unique to the Federal Medical System.

Effects of mechanical, cold, gustatory, and combined stimulation to the human anterior faucial pillars.

Tactile-Thermal Application (TTA) is a therapy technique designed to enhance the swallowing response in persons with dysphagia. In this study, TTA was broken down into each component stimulus (i.e., Cold, Mechanical, Gustatory), and all combinations thereof, to study the effects of each condition on measurable parameters of the normal human swallow response. Using surface electromyography (EMG), latency to swallow-specific activity and duration of submental EMG activity were measured to examine the following questions: (1) Are there stimulus-dependent differences in onset latencies and contraction durations of the submental muscle activity? (2) Which stimulus components are responsible for this response? (3) How long do the effects of stimulation last on the response? (4) Are there response differences according to age and gender? Between-subjects multivariate analysis of variance showed that the main effects for Treatment, Gender, and Age were significant. Latency to swallow-specific activity was significantly shorter following Mechanical + Cold + Gustatory condition compared to No Stimulation. The effect of stimulation on the swallow response lasted for only one swallow.