Dysphagia in Huntington's Disease: Correlation with Clinical Features.

Huntington's disease (HD) is an inherited neurodegenerative disorder characterised by motor impairment, cognitive decline and psychiatric disorders. Dysphagia is a pathologic condition that increases morbidity and mortality of the affected people. Our aim was to evaluate dysphagia in a group of HD patients in view of motor, cognitive and functional decline. Thirty-seven genetically confirmed HD patients were submitted to clinical evaluations of swallowing. Bedside Swallowing Assessment Scale (BSAS) was used. Dysphagia Outcome and Severity Scale (DOSS) was applied for a preliminary classification of swallowing difficulties. All patients were also evaluated by the Unified Huntington's Disease Rating Scale (UHDRS). A group of 39 controls comparable for sex and age were recruited for BSAS scores normalisation. The BSAS scores indicated that in our HD cohort, 32.4% presented relevant or severe dysphagia. The DOSS levels were significantly correlated with main clinical features, such as age, disease duration and motor impairment, with special regard to lingual protrusion ability, dysarthria and bradykinesia. The total functional capacity (TFC) and cognitive scales did not show significant correlation with DOSS levels. The results of clinical examination of swallowing indicated that dysphagia is a prevalent motor symptom of HD.

[Telemonitoring of swallowing function: technologies in speech therapy practice.] / Telemonitoraggio della deglutizione: tecnologie in logopedia.

The process of medical-healthcare technological revolution represents an advantage for the patient and for the care provider, in terms of costs and distances reduction. The telehomecare approach could be useful for monitoring the swallowing disorder in neurodegenerative diseases, preventing complications. In this study the applicability of telemedicine techniques for the monitoring of swallowing function, in patients affected by Huntington's disease (HD), was evaluated through the acquisition and analysis of the sound of swallowing. Two patients with HD were outpatient screened for dysphagia through the Bedside Swallowing Assessment Scale (BSAS) sensitized with pulse oximetry and cervical auscultation. Subsequently, the swallowing functionality was telemonitored for three months with Skype. The swallowing sounds were acquired with a detection microphone attached to the lateral edge of the trachea during fluid intake. The sounds were instantly processed and graphically represented through the Praat software. The analysis of the acoustic signal acquired remotely has made it possible to identify the situations that required immediate speech therapy intervention, suggesting to the patients further modifications of food consistencies, and saving frequent moving to the hospital even in the absence of critical situations. Remote assistance applied to speech therapy could represent a benefit for patients and their carers and a more efficient use of medical and health resources.

[Neurofeedback in Parkinson's disease: technologies in speech and language therapy.] / Neurofeedback nella malattia di Parkinson: tecnologie in logopedia.

Neurofeedback (NF) is a form of biofeedback based on the self-modulation of brain activity; it aims to enhance mental and behavioral performances. The user modifies his brain functions thanks to EEG-mediated self-regulation and therapist's guidance. Recent advances in Brain-Computer Interfaces (BCI) have provided new evidence on the effectiveness of NF in reinforcing cognitive functions expecially in children with ADHD. The applications on adults with cognitive deficits are still few. The study aims to investigate the possible effect of NF techniques on cognitive performance of patients with Parkinson's disease (PD) in terms of changes in scores at the neurocognitive assessment. Ten PD patients, staged according to Hoehn & Yahr scale and cognitively evaluated, were recruited. INCLUSION CRITERIA: age 55-85, correct audio-visual functions, phase-on of dopaminergic therapy, Mild Cognitive Impairment. The rehabilitation program has been structured in 24 sessions. The NeuroSky MindWave headset and related software were used as BCI. At the end of the therapeutic path, the pre and post-treatment test's results were compared. Statistical analyzes were performed with SAS. Cognitive revaluation showed a significant increase in scores and satisfaction questionnaires reported high values. The application of NF techniques in PD patients was promising. The increase in satisfaction levels seems to be due to the perception of a direct control over one's cognitive performances.