The effectiveness of transcranial magnetic stimulation for dysphagia in stroke patients: an umbrella review of systematic reviews and meta-analyses.

Numerous studies have explored the use of repetitive Transcranial Magnetic Stimulation (rTMS) intervention in post-stroke dysphagia. The primary aim of this umbrella review was to appraise the methodological quality of systematic reviews (SRs), with and without meta-analyses (MAs), that synthesized the findings of randomized controlled trials (RCTs) exploring the effectiveness of rTMS in the management of dysphagia post-stroke. A secondary aim of was to evaluate the consistency and reliability of translational implications of rTMS for swallowing recovery after stroke across these SRs and MAs. We searched several databases from inception to the 14th of May 2023, to identify SRs and MAs that examined the effectiveness of rTMS in the management of dysphagia post-stroke. The methodological quality of the included studies was evaluated utilizing the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) instrument. To investigate the extent of literature overlap among the primary studies included in the SRs, the Graphical Overview of Evidence (GROOVE) was utilized. Of the 19 SRs that were identified, two studies received low quality ratings, while the rest (17) were rated with critically low quality based on the AMSTAR 2 rating. A high literature overlap across the SRs was observed. In all SRs and MAs reviewed, there was a consistent presence of at least some significant evidence supporting the effectiveness of rTMS in enhancing swallowing outcomes for individuals with dysphagia post-stroke, that is, all MAs reported at least a moderate overall effect in favor of rTMS (SMD range = [0.59, 6.23]). While rTMS shows promise for improving dysphagia post-stroke, the current evidence remains limited and inconclusive due to the methodological flaws observed in the published SRs and their respective MAs on the topic so far. Concerning the limitations of our study, language restrictions and methodological shortcomings may affect the generalizability of our findings.

Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects.

Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.

The Effectiveness of Transcranial Magnetic Stimulation (TMS) Paradigms as Treatment Options for Recovery of Language Deficits in Chronic Poststroke Aphasia.

BACKGROUND: In an effort to boost aphasia recovery, modern rehabilitation, in addition to speech and language therapy (SALT), is increasingly incorporating noninvasive methods of brain stimulation. The present study is aimed at investigating the effectiveness of two paradigms of neuronavigated repetitive transcranial magnetic stimulation (rTMS): (i) 1 Hz rTMS and (ii) continuous theta burst stimulation (cTBS) each as a standalone treatment for chronic aphasia poststroke. METHODS: A single subject experimental design (SSED) trial was carried out in which six people with aphasia (PWA) were recruited, following a single left hemispheric stroke more than six months prior to the study. Three individuals were treated with 1 Hz rTMS, and the remaining three were treated with cTBS. In all cases, TMS was applied over the right pars triangularis (pTr). Language assessment, with standardized and functional measures, and cognitive evaluations were carried out at four time points: twice prior to treatment (baseline), one day immediately posttreatment, and at follow-up two months after treatment was terminated. Quality of life (QoL) was also assessed at baseline and two months posttreatment. In addition, one of the participants with severe global aphasia was followed up again one and two years posttherapy. RESULTS: For all participants, both rTMS paradigms (1 Hz rTMS and cTBS) generated trends towards improvement in several language skills (i.e., verbal receptive language, expressive language, and naming and reading) one day after treatment and/or two months after therapy. Rated QoL remained stable in three individuals, but for the other three, the communication scores of the QoL were reduced, while two of them also showed a decline in the psychological scores. The participant that was treated with cTBS and followed for up to two years showed that the significant improvement she had initially exhibited in comprehension and reading skills two months after TMS (1st follow-up) was sustained for at least up to two years. CONCLUSION: From the current findings, it is suggested that inhibitory TMS over the right pTr has the potential to drive neuroplastic changes as a standalone treatment that facilitates language recovery in poststroke aphasia.

Severe and Fatal Multilobar Nonclassic Radiation Pneumonitis following Stereotactic Body Radiation Therapy (SBRT) for Treatment of Inoperable Non-Small-Cell Lung Cancer: A Report of Two Cases and Possible Enhancement by Concurrent Amiodarone.

Stereotactic body radiation therapy (SBRT) is considered the standard of care for treatment of inoperable early stage non-small cell carcinoma of the lung. SBRT delivers a very high dose of ionizing radiation to a relatively small region encompassing the tumor and spares a significant portion of the remaining lung from high doses. However, the conformal high dose comes at the expense of treating a larger volume of normal lung to lower doses. In general, this has been deemed to be acceptable with an overall lower risk of radiation pneumonitis. However, in the face of predisposing factors, the higher doses delivered by this technique may lead to an increase in radiation pneumonitis. We report on two patients being treated with SBRT in which severe radiation pneumonitis developed in spite of our radiation dosimetry being significantly below the acceptable limit for lung toxicity. Both patients developed a "fulminant" form of radiation pneumonitis with radiographic abnormalities well beyond the treated volume. In one patient, the disease proved fatal. Both patients were on amiodarone at the time SBRT was administered. Given the rarity of fulminant radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that amiodarone enhanced the pulmonary toxicity.

A critical review of the factors leading to cardiopulmonary resuscitation as the default position of hospitalized patients in the USA regardless of severity of illness.

BACKGROUND: Physicians are occasionally faced with patients requesting full resuscitation against medical advice. More commonly, neither patients nor their family members make such a request, but physicians simply presume that providing cardiopulmonary resuscitation comports with the patient's wishes. In the USA, in contrast to other countries, a unilateral Do-Not-Resuscitate order by the physician is either forbidden by State Statute or not enforced by hospital policy. Unless otherwise specified, performing cardiopulmonary resuscitation on all hospitalized patients, regardless of the severity of the underlying illness, is the default position. Unlike other medical interventions, no deference is given to the medical judgment of the physician even when a patient is in the last days of a terminal illness. We examine the factors that have led to cardiopulmonary resuscitation having this unique status. MAIN BODY: A review of the historical factors leading to cardiopulmonary resuscitation as the default position was undertaken. Articles published in the medical literature, lay-press articles, legislative enactments of law, and judicial opinions involving the issue of Do-Not-Resuscitate and cardiopulmonary resuscitation were reviewed regarding their impact on physician and hospital practice in the USA. CONCLUSION: A critical review of the historical factors reveals that the rapid dissemination of cardiopulmonary training for the public, inaccuracies in the media regarding successful cardiopulmonary resuscitation, well-meaning legislative efforts with inadvertent consequences, and judicial interpretation outside the generally accepted concept of malpractice law have contributed to the situation faced by today's physicians and hospitals in the USA.

Neuronavigated theta burst stimulation for chronic aphasia: two exploratory case studies.

The present study reports the findings of a 10-day neuronavigated continuous theta burst stimulation (cTBS) over the right pars triangularis for two individuals with chronic aphasia after a single left hemispheric stroke. Baseline language and quality of life measures were collected prior to the treatment study, post-treatment and at 3-month follow up. Therapy was tolerated well by both participants and no side effects were noticed during and after treatment. Results from one individual showed potential for positive change in performance in comprehension and expressive language both post-treatment and at the follow-up stage. Also, a trend towards improvement post-treatment was noticed in discourse and sentence productivity, and grammatical accuracy. In the follow up stage, grammatical accuracy showed a trend towards improvement; discourse productivity decreased and; sentence productivity skills showed mixed results. Results from the other participant showed potential for positive change in comprehension post-treatment, that was maintained at the follow-up stage. However, a decline in expressive language post-treatment and at follow-up, stronger post-treatment, was noticed. Regarding quality of life measurements, participant one appeared to have improved as his performance increased in the overall, physical and communication domains, but decreased slightly in the psychosocial domain. The second participant improved in the physical and communication domains and declined overall and in the psychosocial domains. Findings from this study indicate that cTBS over the right pars triangularis may have the potential to improve various language skills in patients suffering from chronic aphasia post-stroke. However, the potential benefits of this fast, non-invasive brain stimulation protocol on improvement of language abilities post-stroke need further exploration.

Morphophonology and compensation in Specific Language Impairment: Evidence from Standard Modern Greek and Cypriot Greek.

The current study investigates the role of the morphophonological realisation of grammatical features as a compensatory mechanism for morphosyntactic deficits in specific language impairment (SLI). The phenomenon examined is past tense formation in Standard Modern Greek (SMG) and Cypriot Greek (CG) as it manifests a distinction in morphophonological salience realisation in the two linguistic varieties via differential use of a stress shift and stressed syllabic augment [é] required for past tense rule formation. Participants were pre-schoolers with typical language development (TD) and children with SLI. Subjects produced real verb (RV) and pseudo-verb stimuli (PV) in sentence completion tasks. Results indicated that morphophonological properties of past tense formation affected SLI but not TD performance. We attribute the results to the difference in the status of the augment in each variety and the effects it has on its realisation at the phonetic interface. Furthermore, verb contractibility appeared to pose particular difficulties in the performance of all groups.

Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey.

Recent and specific data on the prevalence and/or incidence of oropharyngeal dysphagia in the general population are scarce. This study focuses on obtaining this data by means of a literature review and telephone survey. A literature review was performed to obtain data on the prevalence of dysphagia in the general population. Secondly, a quasi-random telephone survey using the functional health status questionnaire EAT-10 was conducted with the aim of establishing prevalence data on oropharyngeal dysphagia in the Netherlands. The literature review revealed six articles which met the inclusion criteria. The prevalence data on oropharyngeal dysphagia in the general population varied between 2.3 and 16 %. For the telephone survey, a total of 6,700 individuals were contacted by telephone, of which, 2,600 (39 %) participated in the study. Of the 2,600 participants, as many as 315 (12.1 %) were identified as having swallowing abnormalities and showed increased risk of oropharyngeal dysphagia with age. Prevalence data on oropharyngeal dysphagia in the Dutch general population were as high as 12.1 %. This data are in line with the retrieved prevalence data from the literature.