An Investigation of Pulse Oximetry Levels During Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease.

To compare pulse oximetry (PO) levels during swallowing in healthy adults and adults with severe chronic obstructive pulmonary disease (COPD). Participants included two groups of 60 healthy adults, balanced for gender. The young group ranged from 18 to 38 years, and the older group from 60 to 87 years. In addition, there were 11 participants with COPD aged 43 to 82 years. PO levels were collected as each participant swallowed 10 mL of water, 10 mL of applesauce, and a piece of diced pear (three trials each). Analyses for the healthy groups revealed neither statistically significant main effects for bolus type nor interactions between gender and age. For between-subject effects, there was no main effect for gender, but there was a large main effect for age, and a gender and age interaction. In the group with COPD, there were no significant differences across bolus types; however, PO measures were consistently lower than the healthy groups for all bolus types. Healthy adults exhibited stable PO levels across bolus types. Adults with COPD, although exhibiting significantly lower PO levels, also remained stable. For clinicians who monitor PO measures, these results offer a more comprehensive understanding of the nature of these measures during swallowing in these groups.

Spatial-Temporal Parameters of Gait Associated With Alzheimer Disease: A Longitudinal Analysis.

Alzheimer's disease (AD) is one of the biggest social and medical concerns in the aging world. A dual task of walking and talking is a particularly practical means to assess AD considering the cognitive and behavioral changes that characterize the disease. The purpose of the study was to assess the effect of the dual task of walking and talking on people with early stage AD under differing cognitive load levels of talking. Participants (9 women and 5 men, mean age (years) = 78.03, standard deviation [SD] = 12.06) with mild or moderate AD (mean Dementia Rating Scale 2 score = 88.14, SD = 7.07) completed 12 monthly walking sessions under no, low, or high cognitive load. They also completed the low and high cognitive load tasks while seated. Linear mixed-effects modeling revealed that values in the Functional Ambulation Profile, stride length, and velocity decreased as tasks became more complex and double support time increased at the same rate. The walking and seated conditions comparison indicated that participants' performance on both low and high cognitive tasks was poor when they were walking rather than seated. The results show that people with early stage AD exhibited gait impairments that increased over time and when completing tasks with greater cognitive load.

Assessing Physiological Stress Responses to Word Retrieval in Individuals with Aphasia: A Preliminary Study.

OBJECTIVE: Word retrieval difficulty can be distressing for individuals with aphasia. However, physiological stress responses to word retrieval are relatively unstudied. This study aims to measure the physiological response (i.e., heart rate and respiratory rate) and perceived stress in individuals with aphasia during a naming task to understand whether word retrieval may be a stressor to them. METHOD: An aphasia group (n = 7) and a healthy group (n = 38) participated in 4 experimental conditions, including rest, counting, and high-frequency and low-frequency word conditions, while their physiological parameters were measured throughout the sessions. Stress ratings were also obtained for each condition. RESULTS: Significant differences in heart rate were found while participants were engaged in speech and/or language tasks, compared to the rest condition, for both groups. Significant differences in respiratory rate were found between the rest and low-frequency word conditions in the aphasia group. No significant difference was found in heart rate between 2 groups, but a difference in respiratory rate was found between 2 groups in the low-frequency word condition. There were some discrepancies between stress level and physiological parameters. CONCLUSIONS: Individuals with aphasia perceived greater stress in the naming tasks, however, the perceived stress was not necessarily parallel to the physiological parameters.

The Influence of Oropalatal Dimensions on the Measurement of Tongue Strength.

Tongue strength is routinely evaluated in clinical swallowing evaluations since lingual weakness is an established contributor to dysphagia. Tongue strength may be clinically quantified by the maximum isometric tongue pressure (MIP) generated by the tongue against the palate; however, wide ranges in normal performance remain to be fully explained. Although orthodontic theory has long suggested a relation between lingual function and oral cavity dimensions, little attention has been given to the potential influence of oral and palatal structure(s) on healthy variance in MIP generation. Therefore, anterior and posterior tongue strength measures and oropalatal dimensions were obtained across 147 healthy adults (aged 18-88 years). Age was confirmed as a significant, independent predictor explaining approximately 10.2% of the variance in anterior tongue strength, but not a significant predictor of posterior tongue strength. However, oropalatal dimensions predicted anterior tongue strength with over three times the predictive power of age alone (p < .001). Significant models for anterior tongue strength (R 2 = .457) and posterior tongue strength (R 2 = .283) included a combination of demographic predictors (i.e., age and/or gender) and oropalatal dimensions. Palatal width, estimated tongue volume, and gender were significant predictors of posterior tongue strength (p < .001). Therefore, oropalatal dimensions may warrant consideration when accurately differentiating between pathological lingual weakness and healthy individual difference.

Effects of Lingual Effort on Swallow Pressures Following Radiation Treatment.

PURPOSE: This article investigated the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. METHOD: A within-subject experimental design was used with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. RESULTS: Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. CONCLUSIONS: The results of this study suggest that use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore, therapeutic activities used to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical effect on swallow function for individuals with head and neck cancer.

Re-establishing Broca's initial findings.

The importance of the left inferior pre-frontal cortex (LIPC) for speech production was first popularized by Paul Broca, providing a cornerstone of behavioral neurology and laying the foundation for future research examining brain-behavior relationships. Although Broca's findings were rigorously challenged, comprehensive contradictory evidence was not published until 130years later. This evidence suggested that damage to left anterior insula was actually the best predictor of motor speech impairment. Using high-resolution structural magnetic resonance imaging (MRI) in patients with chronic stroke, we reveal that LIPC involvement more accurately predicts acquired motor speech impairment than insula damage. Perfusion-weighted MRI provides complementary evidence, highlighting how damage to left inferior pre-frontal gyrus often includes insula involvement, and vice versa. Our findings suggest that Broca's initial conclusions associating acquired motor speech impairment with LIPC damage remain valid nearly 150years after his initial report on this issue.

The effect of feedback and practice on the acquisition of novel speech behaviors.

PURPOSE: This study examined the effect of manipulating several parameters of motor learning theory on participants' phonetic acquisition and retention of utterances in a foreign language (Korean). METHOD: Thirty-two native English-speaking participants naïve to the Korean language were each given 10 Korean sentences to practice and learn. The independent variables in the study were the number of practice trials and the feedback schedule. The participants listened to sentences delivered by a native speaker and received feedback according to the schedule. Participant responses were then judged by a panel of native Korean speakers in terms of their intelligibility, naturalness, and precision. RESULTS: The combination of 20% feedback and 100 practice trials was more effective than other combinations of feedback and practice trial schedule for the retention of novel phonetic productions of Korean phrases both 1 day after training and 1 week later. CONCLUSIONS: These findings are in agreement with previously reported applications of motor learning-guided principles on the acquisition of motoric skills. These findings may have direct implications for both second-language learning and the treatment of neuromotor speech disorders such as apraxia of speech.

Lingual propulsive pressures across consistencies generated by the anteromedian and posteromedian tongue by healthy young adults.

PURPOSE: In the present study, the authors investigated lingual propulsive pressures generated in the normal swallow by the anterior and posterior lingual segments for various consistencies and maximum isometric tasks. METHOD: Lingual pressures for saliva, thin, and honey-thick liquid boluses were measured via the Iowa Oral Performance Instrument (IOPI Medical, Carnation, WA) at both anteromedian and posteromedian lingual segments of 62 healthy participants, ages 18-34 years (30 men, 32 women). RESULTS: A repeated-measures analysis of variance revealed that all lingual swallowing pressures were significantly greater at the anteromedian segment than at the posteromedian segment. Gender was not a significant factor; however, women exhibited greater swallowing pressures across all conditions. Lingual pressures increased as bolus viscosity increased. No significant interactions existed. Analysis of a subset of 30 participants revealed that men exhibited greater maximal isometric pressure at the anteromedian segment than women, with no significant gender difference at the posteromedian segment. A significantly higher percentage of maximum isometric tongue pressure was exerted by the posteromedian tongue than by the anteromedian tongue. CONCLUSION: Findings suggest that greater amplitudes of lingual pressures are generated during normal swallowing at the anteromedian lingual segment; however, a greater percentage of maximum isometric tongue pressure was exerted by the posteromedian lingual segment, suggesting increased effort by the posterior tongue during bolus propulsion.

Talking while walking: Cognitive loading and injurious falls in Parkinson's disease.

Multitasking has become a way of life, from operating multiple software packages simultaneously on a computer, to carrying on a conversation on a cell phone while driving. Perhaps one of the most common dual tasks performed is talking while walking. In isolation, neither task would be considered difficult to perform, yet when coupled, the relative ease of each task may change. This paper details significant problems that result from injurious falls, and points out the vulnerability of those who have been diagnosed with Parkinson's disease. In addition, it provides an illustrative study that demonstrates the potential danger of talking while walking, especially when the cognitive-linguistic complexity of verbal tasks is manipulated. In this investigation, 25 participants with Parkinson's disease and 13 participants without neurological compromise completed gait tasks while conducting tasks of low (counting by ones), middle (serial subtraction of threes), and high load (alpha-numeric sequencing). The results indicated that cognitive-linguistic demand had an impact on gait, the effects of which were demonstrated in individuals without neurological compromise as well as those with Parkinson's disease. One finding, altered double-support time, distinguished the Parkinson group from the control participants. These results suggest that it might be prudent for healthcare professionals and caregivers to alter expectations and monitor the cognitive-linguistic demands placed on elderly individuals, particularly those with neurological compromise who might be at greater risk for injurious falls.

Email intervention following traumatic brain injury: two case reports.

An email intervention for two individuals with TBI was conducted to investigate if this electronic medium shows potential as a therapeutic delivery method. Specifically, this study measured participants' compliance with a plan that incorporated email and a reading assignment. Prior to the email intervention, the clinician and participants designed an intervention plan which included specific guidelines for scheduled email correspondence regarding a daily reading task. After reviewing the daily emails, the clinician provided therapeutic feedback. The participants' compliance with the plan was measured by the punctuality of email correspondence and completion of tasks as detailed in the plan. Over a 4-week intervention period, both participants demonstrated improvement in task completion and time adherence. Email proved to be a feasible option as a therapeutic delivery method for these individuals.

Effects of a cell phone conversation on cognitive processing performances.

BACKGROUND: The ability to apportion cognitive resources to process multiple visual and auditory stimuli is essential for human communication in competing conditions. PURPOSE: The purpose of the current research was to examine the effects of a cell phone conversation on a battery of cognitive tests, using both timing (RT) and accuracy (A') as dependent measures. RESEARCH DESIGN: A repeated measures ANOVA was conducted. STUDY SAMPLE: Forty-two college-age (mean 22 yr) adult females with normal hearing and cognitive function participated in the study. DATA COLLECTION AND ANALYSIS: In one condition (quiet), a standardized cognitive assessment battery was administered to participants in a quiet room. In the (cell phone) condition, subjects were formulating and responding to specific questions about their travel experiences during administration of the same cognitive assessment battery. The computer automatically records subject performance. Post-hoc pairwise comparisons were conducted using the Bonferroni approach. The alpha level was set at .05 for all data analysis. This method of analysis was repeated for each of the dependent measures, RT, and A'. RESULTS: The results revealed a consistent, significant effect on reaction time between the two conditions. The same analysis was also conducted to examine the effect of participation in a cell phone discussion on accuracy. As with RT, results revealed a consistent, significant affect on A' between the two conditions. CONCLUSIONS: Our study supports the notion that there are differential effects of auditory distracters across cognitive spheres. For simple automatic type visual cognitive tasks, the effect is minimal. However, as visual tasks increase in difficulty, the effect of the auditory distraction is magnified, particularly when the task requires extensive division of language resources.

Effects of auditory distraction on cognitive processing of young adults.

OBJECTIVE: The effects of interference, competition, and distraction on cognitive processing are unclearly understood, particularly regarding type and intensity of auditory distraction across a variety of cognitive processing tasks. METHOD: The purpose of this investigation was to report two experiments that sought to explore the effects of types of distraction (4-talker babble; word repetition; combined 4-talker babble with word repetition) when compared to a control condition of quiet on a range of computerized measures (simple reaction time; choice reaction time; serial pattern matching; lexical decision-making; visual selective attention; response reversal and rapid visual scanning; and form discrimination) in 40 young adults (Experiment 1). RESULTS: Few distraction effects were found on cognitive processing at the comfortable loudness level (40dB SL). In Experiment 2, statistically significant differences for choice reaction time and serial pattern matching (working memory) were found in both speed and accuracy when distractions were presented at perceived uncomfortable loudness levels (ULL) and compared with conditions of quiet and comfortable loudness level (40dB SL). CONCLUSION: Cognitive resource allocation models may be useful in interpreting the effects of auditory distraction on cognitive-linguistic processing, and this model may help to explain differential distraction effects in clinical populations with attention deficits.

Lingual kinematic strategies used to increase speech rate: comparison between younger and older adults.

The primary objective of this study was to assess the lingual kinematic strategies used by younger and older adults to increase rate of speech. It was hypothesised that the strategies used by the older adults would differ from the young adults either as a direct result of, or in response to a need to compensate for, age-related changes in the tongue. Electromagnetic articulography was used to examine the tongue movements of eight young (M = 26.7 years) and eight older (M = 67.1 years) females during repetitions of /ta/ and /ka/ at a controlled moderate rate and then as fast as possible. The younger and older adults were found to significantly reduce consonant durations and increase syllable repetition rate by similar proportions. To achieve these reduced durations both groups appeared to use the same strategy, that of reducing the distances travelled by the tongue. Further comparisons at each rate, however, suggested a speed-accuracy trade-off and increased speech monitoring in the older adults. The results may assist in differentiating articulatory changes associated with normal aging from pathological changes found in disorders that affect the older population.

The effects of auditory distraction on visual cognitive performance in multiple sclerosis.

BACKGROUND: A subset of individuals with multiple sclerosis (MS) endures degradation of cognitive function during disease progression. The purpose of this study was to compare visual cognitive reaction time performance during three conditions of auditory distraction (four-talker babble; word repetition; babble combined with word repetition) to a quiet, undistracted condition. METHODS: Twenty-two patients with mild relapsing-remitting MS (Expanded Disability Status Scale mean of 3.0) and 17 age-matched and education-matched control subjects free of neurologic disease were tested on four cognitive visual processing subtests of simple reaction time, choice reaction time, and visual working memory for same and sequential digits concurrently during three conditions of auditory distraction. RESULTS: When reaction times for MS and control participants were pooled across all four cognitive tests, the scores of the MS patients in quiet (528 ms) were significantly slower than those of the control subjects (459 ms). The auditory distraction condition of word repetition combined with four-talker babble degraded cognitive performance more than most of the other distraction conditions in both groups. CONCLUSIONS: Even in mild MS, subtle visual cognitive processing deficits may be elicited by auditory distraction.

Effects of speaking rate on EMA-derived lingual kinematics: a preliminary investigation.

Electromagnetic articulography (EMA) was used to investigate how tongue movement characteristics (i.e., velocity, acceleration, duration, distance) change with, or indeed affect, increased rates of speech. Eight young adult males repeated /ta/ and /ka/ syllables first at a moderate rate that had been modelled at three syllables per second, and then 'as fast as possible'. Distance travelled by the tongue appeared to be the principal lingual kinematic feature manipulated by the group of speakers in producing increased syllable repetition rates, with velocity found to increase, decrease or remain unchanged. Acceleration remained unchanged. except in the case of increased velocity. One participant formed an exception in terms of manipulating distance by exhibiting marginally increased lingual velocities rather than distance changes. This preliminary study serves to direct future EMA-based studies of speech rate control as to the speech tasks that should be employed and the possible underlying anatomical and acoustic bases or constraints that could possibly influence the kinematic strategies employed to increase speech rate.