Feasibility of the Lee Silverman Voice Treatment-BIG Intervention in Stroke.

Lee Silverman Voice Treatment-BIG (LSVT BIG) has been used in Parkinson's disease and in two case studies with individuals post-stroke. The purpose of this study was to examine the feasibility, acceptability, and preliminary clinical effect of the LSVT BIG program for individuals post-stroke. This study was a waitlist crossover design. Outcomes were assessed at baseline, after 4 weeks, and after crossover. The primary outcomes were feasibility and acceptability; clinical outcomes were also assessed. We contacted 888 potential participants. Of the 35% of individuals who were interested in the study, most were ineligible to participate because they lacked transportation to the clinic. Five individuals were eligible and enrolled in the study. All completed 100% of in-clinic sessions. Four participants rated their occupational performance higher after the LSVT BIG intervention. It is feasible to deliver the LSVT BIG in the chronic stroke population. Individuals who complete the protocol demonstrate clinically relevant improvements.

Topical application of highly concentrated water-in-oil emulsions: Physiological skin parameters and skin penetration in vivo - A pilot study.

Important aspects in the development of new dermal drug delivery systems are the formulations' physicochemical properties and stability. Moreover, their influence on skin physiology and their penetration performance in vivo are of crucial interest. We have recently developed novel concentrated water-in-oil emulsions based on a non-ionic silicone surfactant; the present study deals with the effect of these formulations on physiological skin parameters of healthy volunteers after repeated application. Variations in skin condition and barrier integrity were investigated using classical biophysical and spectroscopic techniques. After four weeks of continuous treatment, no signs of skin irritation could be observed. Both tested emulsions had a positive effect on skin properties despite their relatively high water content and low lipid content. In vivo tape stripping studies revealed penetrated amounts of the incorporated model drug fluorescein sodium of almost 50% of the applied dose, with a superior performance of emulsions with isopropyl myristate when compared to liquid paraffin. In summary, our study confirmed the suitability of the developed W/O emulsions for pharmaceutic and cosmetic applications.

The role of viscosity on skin penetration from cellulose ether-based hydrogels.

BACKGROUND: The rheological properties of dermal drug delivery systems are of importance when designing new formulations. Viscosity not only affects features such as spreadability and skin feel, but may also affect the skin penetration of incorporated actives. Data on the latter aspect are controversial. Our objective was to elucidate the relation between viscosity and drug delivery performance of different model hydrogels assuming that enhanced microviscosity might delay drug release and penetration. MATERIALS AND METHODS: Hydrogels covering a broad viscosity range were prepared by adding either HPMC or HEC as gelling agents in different concentrations. To investigate the ability of the gels to deliver a model drug into the skin, sulphadiazine sodium was incorporated and its in vitro skin penetration was monitored using tape stripping/HPLC analysis and non-invasive confocal Raman spectroscopy. RESULTS: The trends observed with the two different experimental setups were comparable. Drug penetration depths decreased slightly with increasing viscosity, suggesting slower drug release due to the increasingly dense gel networks. However, the total penetrated drug amounts were independent of the exact formulation viscosity. CONCLUSION: Drug penetration was largely unaffected by hydrogel viscosity. Moderately enhanced viscosity is advisable when designing cellulose ether hydrogels to allow for convenient application.

Simultaneous penetration monitoring of oil component and active drug from fluorinated nanoemulsions.

In the field of dermal drug delivery, determining the penetration depth of actives is a standard procedure for the development of novel formulations. Regarding the vehicle components, respective penetration studies are rather scarce due to their often challenging analytics. However, an understanding of the interactions between drugs and additives during skin penetrating could help to develop promising drug delivery systems. Thus, the objective of the present study was to simultaneously monitor the skin penetration of the incorporated model drug diclofenac sodium and the semifluorinated oil perfluorohexyloctane (F6H8) from newly developed nanoemulsions. In vitro tape stripping studies were conducted and the tapes were analysed for their content of drug and additive in parallel by HPLC and 19F NMR. The penetration depth and total recovered amount of both substances of interest were successfully determined on each tape strip. The vehicle oil compound F6H8 itself showed a very small skin penetration, while the penetration of diclofenac sodium was consistently about 9- to 10-fold higher. Higher amounts of the oil content led to higher skin penetration of diclofenac sodium and slightly increased oil penetration; this effect might be explained by the increasing occlusion effect caused by increasing amounts of fluorinated oil.

Penetration monitoring of drugs and additives by ATR-FTIR spectroscopy/tape stripping and confocal Raman spectroscopy - A comparative study.

Vibrational spectroscopy is a useful tool for analysis of skin properties and to confirm the penetration of drugs and other formulation compounds into the skin. In particular, attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy and confocal Raman spectroscopy (CRS) have been optimised for skin analysis. Despite an impressive amount of data on these techniques, a comparative methodological assessment for skin penetration monitoring of model substances is still amiss. Thus, in vitro skin penetration studies were conducted in parallel using the same porcine material and four model substances, namely sodium laureth sulfate (SLES), sodium dodecyl sulfate (SDS), sulfathiazole sodium (STZ) and dimethyl sulfoxide (DMSO). ATR-FTIR spectroscopy in combination with tape stripping and CRS were employed to evaluate the skin penetration of the applied substances. In addition, the skin hydration status or change in skin hydration after application was investigated. The results show that both methods provide valuable information on the skin penetration potential of applied substances. The penetration profiles determined by CRS or ATR-FTIR/tape stripping were comparable for all substances; a slow decrease in relative substance concentration was visible from the skin surface inwards within the stratum corneum (SC). In general, deeper penetration into the SC was observed with CRS, which may be related to the depth resolution of the employed device. However, when related to the respective total SC thickness of each experiment, the penetration depths determined by parallel CRS and ATR-FTIR analysis were in good agreement for all model substances. The observed order of the penetration depth was DMSO > SDS > SLES > STZ with both techniques. A decrease of the relative concentration to 10% of the maximum value was found approximately between 34 and 89% of total SC thickness. Summarising these findings, advantages and drawbacks of the two techniques for in vitro skin penetration studies are discussed.

Confocal Raman spectroscopy: In vivo measurement of physiological skin parameters - A pilot study.

BACKGROUND: In vivo application of confocal Raman spectroscopy (CRS) allows non-invasive depth measurement of the skin. Thereby obtained knowledge of the skin composition is essential to reliably assess the actual skin state. Besides other components, the skin cholesterol concentration is of interest; however, little is known about its connection to the cholesterol concentration quantified in venous blood. OBJECTIVE: In this study, the skin composition of the volar forearm was characterised in vivo using CRS. In particular, the potential of CRS as a non-invasive method to determine cholesterol levels was validated. METHODS: Raman spectra of the volar forearm of 15 participants were recorded twice within two weeks. Depth concentration profiles for major skin components were generated. Stratum corneum (SC) thickness was calculated from water concentration profiles. In order to examine the usability of dermal CRS for cholesterol level determination, results were compared to fasting total cholesterol values in venous blood as determined by an enzymatic method. RESULTS: Depth concentration profiles for the skin components of interest showed a comparable curve progression for the participants. It was possible to link changes in concentration to physiological processes. Moreover, age-related differences could be found. Several novel mathematical approaches for the comparison of the skin cholesterol content and the blood cholesterol concentration have been developed. However, no correlation passed the Bonferroni multiple testing correction. CONCLUSION: CRS serves as useful tool for the in vivo monitoring of skin components and hydration. Concentration depth profiles provide information about the current skin condition. No distinct correlation between the skin and blood cholesterol concentration was found within the scope of the present study. Concerning this matter, the heterogeneous distribution of cholesterol in the skin may be a factor influencing these results.

Novel concentrated water-in-oil emulsions based on a non-ionic silicone surfactant: Appealing application properties and tuneable viscoelasticity.

Silicone excipients are non-irritating ingredients that are extensively used in topical formulations. In the present study, innovative water-in-oil emulsions with a high water content stabilised by a non-ionic silicone surfactant were developed. Effects of formulation composition on its properties and stability were investigated. It was possible to prepare highly stable emulsions with a water volume fraction of up to 80%. The emulsions exhibited desirable application properties such as non-sticky and cooling qualities. A dependency of the viscosity on the water fraction was found; this offers the opportunity to create emulsions with fine-tuned rheological properties. Furthermore, it could be shown in skin studies that the in vitro release of a hydrophilic model drug is influenced by the configuration of the oil phase. The penetration of the silicone surfactant and the other deployed additives was monitored using combined tape stripping and ATR-FTIR experiments, revealing that the compounds remain in the superficial layers of the stratum corneum, thus minimising the risk for skin irritation.

Investigation of microemulsion microstructure and its impact on skin delivery of flufenamic acid.

Microemulsions are well known penetration enhancing delivery systems. Several properties are described that influence the transdermal delivery of active components. Therefore, this study aimed to characterize fluorosurfactant-based microemulsions and to assess the impact of formulation variables on the transdermal delivery of incorporated flufenamic acid. The microemulsion systems prepared in this study consisted of bistilled water, oleic acid, isopropanol as co-solvent, flufenamic acid as active ingredient and either Hexafor(TM)670 (Hex) or Chemguard S-550-100 (Sin) as fluorosurfactant. Characterization was performed by a combination of techniques including electrical conductivity measurements, small-angle X-ray scattering (SAXS) and nuclear magnetic resonance (NMR) self-diffusion experiments. In vitro skin permeation experiments were performed with each prepared microemulsion using Franz type diffusion cells to correlate their present microstructure with their drug delivery to skin. Electrical conductivity increased with added water content. Consequently, the absence of a conductivity maximum as well as the NMR and SAXS data rather suggest O/W type microemulsions with spherical or rod-like microstructures. Skin permeation data revealed enhanced diffusion for Hex- and Sin-microemulsions if the shape of the structures was rather elongated than spherical implying that the shape of droplets had an essential impact on the skin permeation of flufenamic acid.

Simultaneous analysis of skin penetration of surfactant and active drug from fluorosurfactant-based microemulsions.

The purpose of this study was to investigate the penetrated amount of the incorporated model drug diclofenac-sodium and of a fluorosurfactant as specific vehicle constituent of topically applied microemulsions at the same time. To this end, the penetration depth of each compound was elucidated through tape stripping studies by the simultaneous quantification of diclofenac-sodium and the fluorosurfactant from the same sample. A new approach was made by using the very sensitive and specific (19)F NMR (nuclear magnetic resonance) for quantification of the fluorinated vehicle component. The tape stripping experiments with the microemulsions showed an almost similar penetration velocity of diclofenac-sodium and fluorosurfactant, suggesting that the surfactant within the microemulsion-structure intensified the stratum corneum uptake of the incorporated active constituent. Moreover, ATR-FTIR studies on porcine ear skin revealed significant shifts of the CH2 stretching absorbances, which are associated with an enhanced disorder of the SC lipids resulting in a decreased skin barrier function, after application of the microemulsions. However, the application of pure fluorosurfactant did not cause any shifts in the CH2 stretching absorbances. It can be thereby concluded that the prepared microemulsions exerted specific effects on skin integrity resulting in a "push" of diclofenac-sodium penetration.