My Experience With Ptyalism Gravidarum During the COVID-19 Pandemic.

An immigrant woman and nurse describes her experience of ptyalism gravidarum in the United States during the COVID-19 pandemic.

Long-term impact of saliva control surgery in children with disability.

Sialorrhea is a common problem in children with disability, often negatively affecting socialization, self-esteem, and burden of care. Saliva control surgery is an available option to manage this problem, particularly when other conservative methods have failed. As little is known about the long-term impact of surgery, we followed up 62 patients who had combined bilateral submandibular duct translocation and bilateral sublingual gland excision at our pediatric hospital between 1994 and 2014. Eligible individuals were identified through a search of ICD procedure codes. When families of patients were contacted successfully, they were invited to complete a 14-item questionnaire designed specifically for this study. The results indicated that long-term outcomes of surgery were very good; 13/62 (21%) individuals no longer had a drooling problem and another 30 (48%) experienced only mild to moderate drooling. Although 84% families reported some or major improvement in drooling, 9 families reported that they would not go through the experience again because of a difficult recovery period, lack of effectiveness of the intervention, changes in saliva consistency that caused coughing and gagging, and dental decay. None of the collected variables were predictive of good or poor outcome. The study indicated that surgical intervention is effective in the long term in the majority of cases and can be recommended to other families who attend our saliva control clinic.

Drooling in Parkinson's Disease: Evidence of a Role for Divided Attention.

Drooling is a frequently reported symptom in Parkinson's Disease (PD) with significant psychosocial impact and negative health consequences including silent aspiration of saliva with the associated risk of respiratory infections. It is suggested that in PD drooling is associated with inefficient oropharyngeal swallowing which reduces the effective clearance of saliva rather than hyper-salivation. This is compounded by unintended mouth opening and flexed posture increasing anterior loss of saliva. It is reported to occur most frequently during cognitively distracting concurrent tasks suggesting an impact from divided attention in a dual-task situation. However, this supposition has not been systematically examined. This study assessed whether frequency of saliva swallows reduced, and drooling severity and frequency increased, when people with PD engaged in a cognitively distracting task. 18 patients with idiopathic PD reporting daytime drooling on the Unified Parkinson's Disease Rating Scale (UPDRS) were recruited. They completed the Radboud Oral Motor Inventory for PD saliva questionnaire and the Montreal Cognitive Assessment. UPDRS drooling score, disease stage, duration, gender, and age were recorded. Swallow frequency and drooling severity and frequency were measured at rest and during a distracting computer-based language task. There was no significant difference between drooling severity at rest and during distraction (Wilcoxon signed rank test z = - 1.724, p = 0.085). There was a significant difference between at rest and distraction conditions for both drooling frequency (Wilcoxon signed rank test z = - 2.041, p = 0.041) and swallow frequency (Wilcoxon signed rank test z = - 3.054, p = 0.002). Participants swallowed less frequently and drooled more often during the distraction task. The frequency of saliva swallows and drooling are affected by divided attention in a dual-task paradigm. Further studies are needed to explore the exact role of attention in saliva management and the clinical applications in assessment and treatment.

Sialorrhea in children with cerebral palsy / Sialorreia em crianças com paralisia cerebral

Abstract Objective: To review the literature on sialorrhea in children with cerebral palsy. Source of data: Non-systematic review using the keywords "sialorrhea" and "child" carried out in the PubMed®, LILACS®, and SciELO® databases during July 2015. A total of 458 articles were obtained, of which 158 were analyzed as they were associated with sialorrhea in children; 70 had content related to sialorrhea in cerebral palsy or the assessment and treatment of sialorrhea in other neurological disorders, which were also assessed. Data synthesis: The prevalence of sialorrhea is between 10% and 58% in cerebral palsy and has clinical and social consequences. It is caused by oral motor dysfunction, dysphagia, and intraoral sensitivity disorder. The severity and impact of sialorrhea are assessed through objective or subjective methods. Several types of therapeutic management are described: training of sensory awareness and oral motor skills, drug therapy, botulinum toxin injection, and surgical treatment. Conclusions: The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist. Botulinum toxin injection and the use of anticholinergics have a transient effect and are adjuvant to speech therapy; they should be considered in cases of moderate to severe sialorrhea or respiratory complications. Atropine sulfate is inexpensive and appears to have good clinical response combined with good safety profile. The use of trihexyphenidyl for the treatment of sialorrhea can be considered in dyskinetic forms of cerebral palsy or in selected cases.

Resumo Objetivo: Revisar a literatura referente à sialorreia em crianças com paralisia cerebral. Fonte de dados: Revisão não sistemática com as palavras-chave "sialorreia"; e "criança" feita nas bases de dados Pubmed®, Lilacs® e Scielo® em julho de 2015. Foram recuperados 458 artigos, 158 foram analisados por terem relação com sialorreia em crianças, foram aproveitados 70 com conteúdo relativo à sialorreia na paralisia cerebral ou à avaliação e ao tratamento da sialorreia em outros distúrbios neurológicos. Síntese dos dados: A sialorreia tem prevalência entre 10% e 58% na paralisia cerebral e implica consequências clínicas e sociais. É causada por disfunção motora oral, disfagia e distúrbio da sensibilidade intraoral. A gravidade e o impacto da sialorreia são avaliados por meio de métodos objetivos ou subjetivos. Estão descritas diversas formas de manejo terapêutico: treino para consciência sensorial e habilidades motoras orais, terapia farmacológica, injeção de toxina botulínica e tratamento cirúrgico. Conclusões: O tratamento mais eficaz e que aborda a causa da sialorreia nas crianças com paralisia cerebral é o treino para consciência sensorial e habilidades motoras orais, feito por um fonoaudiólogo. Injeção de toxina botulínica e o uso de anticolinérgicos têm efeito transitório e são auxiliares ao tratamento fonoaudiológico ou devem ser considerados nos casos de sialorreia moderada a grave ou com complicações respiratórias. O sulfato de atropina tem baixo custo e parece ter boa resposta clínica com bom perfil de segurança. O uso de triexifenidil para o tratamento da sialorreia pode ser considerado nas formas discinéticas de paralisia cerebral ou em casos selecionados.

The impact of submandibular duct relocation on drooling and the well-being of children with neurodevelopmental disabilities.

OBJECTIVE: The aim of this study was to evaluate the impact of a reduction in drooling after bilateral submandibular duct relocation (SMDR) with sublingual gland excision on daily life and care, as well as social and emotional consequences in children and adolescents with neurodevelopmental disabilities. METHODS: This prospective cohort study included 72 children and adolescents (46 males, 26 females) with moderate to severe drooling, and their caregivers. Mean age at the time of surgery was 15 years 2 months (SD 4y 3mo). Fifty-two children were diagnosed with cerebral palsy and 20 had other non-progressive developmental disabilities. A caregiver questionnaire to document the impact of drooling on daily care and economic consequences, social interaction and emotional development and self-esteem was administered before, and 8 and 32 weeks after surgery. RESULTS: Following bilateral SMDR the mean Visual Analogue Scale (VAS, 0-100) scores demonstrated a significant (p < 0.001) reduction in the severity of drooling from 81 at baseline to 28 and 36 after 8 and 32 weeks, respectively. This was accompanied by a decrease in the amount of daily care required and reduced economic consequences. In addition, an increase in social contact with other children and adults was reported by caregivers after surgery. CONCLUSION: Bilateral SMDR with sublingual gland excision provides a significant positive reduction in daily care of children suffering from drooling. Caregivers also report positive changes in their child's social interaction and sense of self-esteem.

Sialorrhea in children with cerebral palsy.

OBJECTIVE: To review the literature on sialorrhea in children with cerebral palsy. SOURCE OF DATA: Non-systematic review using the keywords "sialorrhea" and "child" carried out in the PubMed®, LILACS®, and SciELO® databases during July 2015. A total of 458 articles were obtained, of which 158 were analyzed as they were associated with sialorrhea in children; 70 had content related to sialorrhea in cerebral palsy or the assessment and treatment of sialorrhea in other neurological disorders, which were also assessed. DATA SYNTHESIS: The prevalence of sialorrhea is between 10% and 58% in cerebral palsy and has clinical and social consequences. It is caused by oral motor dysfunction, dysphagia, and intraoral sensitivity disorder. The severity and impact of sialorrhea are assessed through objective or subjective methods. Several types of therapeutic management are described: training of sensory awareness and oral motor skills, drug therapy, botulinum toxin injection, and surgical treatment. CONCLUSIONS: The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist. Botulinum toxin injection and the use of anticholinergics have a transient effect and are adjuvant to speech therapy; they should be considered in cases of moderate to severe sialorrhea or respiratory complications. Atropine sulfate is inexpensive and appears to have good clinical response combined with good safety profile. The use of trihexyphenidyl for the treatment of sialorrhea can be considered in dyskinetic forms of cerebral palsy or in selected cases.

Effectiveness of botulinum toxin B in the treatment of drooling.

The aim of this audit was to assess the effectiveness of botulinum toxin B (NeuroBloc(®), Eisai Ltd.) in the treatment of drooling. Over a period of 18 months patients treated with NeuroBloc(®) botulinum toxin (BTX) for serious drooling (drooling score more than 7) were invited to complete a questionnaire on their experience of drooling and the impact of treatment. A total of 170 questionnaires were given to consecutive patients or carers and 145 (85%) responded. Of these, 128 (88%) reported that symptoms had improved by 6/10 or more on a visual analogue scale (VAS), and 54 (37%) reported compete resolution of drooling (10/10 VAS). A total of 139 (96%) would recommend the treatment to others.

Persons with multiple disabilities increase adaptive responding and control inadequate posture or behavior through programs based on microswitch-cluster technology.

Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed.

Four-duct ligation in children with drooling.

OBJECTIVES: The objective of this study is to assess the improvement in drooling in children undergoing 4-duct ligation procedure for excessive drooling and to study its effect on their quality of life. MATERIALS AND METHODS: A prospective, nonrandomized interventional study was done between November 2009 and September 2011. Thirty drooling children of both sexes aged 4 to 15 years underwent 4-duct ligation, that is, ligation of bilateral submandibular ducts and bilateral parotid ducts. Comparison of preoperative and postoperative drooling scores using Thomas-Stonell and Greenberg classification was done. Glasgow Children's Benefit Inventory Score was used to assess the improvement in the quality of life. RESULTS: Success rate in terms of improvement in drooling was 93.33%. A complication rate of 16.67% was found. The mean improvement in total drooling score after 12 months was 4.43. The paired t test applied on preoperative and postoperative combined drooling scores showed P < .001. The mean Glasgow Children's Benefit Inventory score was 36.15. In the postoperative period, transient swelling of cheeks, transient swelling of submandibular glands, change in the consistency of saliva, cheek abscess, collection of saliva in the cheek, and parotid duct fistula were observed. CONCLUSIONS: Four-duct ligation causes marked improvement in drooling and significantly increases the quality of life in drooling children. It has few complications, which can be managed effectively.

Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson's disease.

OBJECTIVE: To report on the development and psychometric evaluation of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP), a newly developed patient-rated assessment of speech, swallowing, and saliva control in patients with Parkinson's disease (PD). DESIGN: Reliability and validity study. SETTING: Tertiary-care Parkinson center for multidisciplinary assessment. PARTICIPANTS: Consecutive community-dwelling patients with PD (n=129) or atypical parkinsonism (AP; n=49; mean ± SD age, 64±9.8y; mean ± SD disease duration, 7y; median Hoehn and Yahr [HY] stage, 2.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To evaluate reproducibility, 60 patients completed the ROMP twice within a mean of 24±12 days. To study validity, another cohort of 118 patients who had completed the ROMP was assessed by both a neurologist (HY stage, Unified Parkinson's Disease Rating Scale III) and speech-language pathologist (severity of dysarthria, dysphagia, drooling) who were blinded to ROMP scores. RESULTS: Confirmatory factor analysis identified the 3 a priori-designed ROMP domains of speech, swallowing, and saliva control. Internal consistency was .95 for the total ROMP and .87 to .94 for the 3 domains or subscales. Intraclass correlation coefficients for reproducibility were .94 and .83 to .92 for the subscales. Construct validity was substantial to good with correlations ranging from .36 to .82. The ROMP differentiated significantly (P<.001) between patients indicated for speech therapy (based on independent assessment) and those who were not and between mild, moderate, and severe PD according to HY stage. CONCLUSIONS: The ROMP provides a reliable and valid instrument to evaluate patient-perceived problems with speech, swallowing, and saliva control in patients with PD or AP.

[Drooling in neuropediatric patients]. / Drooling bei neuropädiatrischen Patienten - ein Update.

Drooling is defined as an anterior salivary flow which can be insufficiently controlled due to dysphagia und orofacial motoric deficits. It leads to moistened lips, chin, hands and surrounding in diverse extent. Drooling can severely interfere social contacts and requires more nursing facilities. A multidisciplinary approach in diagnostics and therapy is essential. Key points are the evaluation of inhibited swallowing and of orofacial motoric deficits. In the therapy of drooling, scopolamine patches and oral stimulation plates are useful but within the last few years, the injection of botulinum toxin into the salivary glands produced positive effects, as this therapy is an effective, well tolerated and safe option in these children. Surgical corrections of the salivary glands are more and more reserved for isolated cases.

Management of drooling in children.

Drooling beyond the age of 4 years is neurodevelopmentally abnormal. Chronic "sialorrhoea" is seen in children with abnormal oral sensation and/or motor control and more infrequently when there is excessive production of saliva. Salivary production from the paired glands is under autonomic parasympathetic control. Management of the problem relies on multidisciplinary teams with a focus on assessment and when appropriate conservative interventions, oral motor training, dental appliances, medical and surgical treatment programs. Medically, the focus is on modifying the neuroglandular control of saliva with the use of anticholinergic agents. The article covers these areas of background, assessment and management in detail.

[Mothers' perception of dental eruption syndrome and its clinical manifestation during childhood]. / Percepção de mães sobre a síndrome da erupção dentária e suas manifestações clínicas na infância.

OBJECTIVE: This study was aimed at identifying primiparous and multiparous mothers perceptions about tooth eruption and related symptoms as well as discussing such events occurrence in the light of the relevant literature. METHODS: The research adopted a qualitative, descriptive design; 61 mothers who had already given birth to babies aged 3 to 12 months old were studied. Their children were outpatients at Rio Grande do Norte Federal Universitys Paediatric Hospital in Natal, RN, Brazil. A semi-structured interview was used for collecting data. ALCESTE 4.5 software was used for analysing data based on primiparous and multiparous mothers as variables; the former term referred to mothers bearing a child for the first time and multiparous to those who had born more than one child. RESULTS: Symptomatology was related by 75 % of the mothers interviewed here. The perception of the mothers from both groups probably pointed to a lack of knowledge regarding child development and the process leading to the presence of clinical symptoms due to tooth eruption. However, the great difference lay in how this reality was perceived; mothers having a single child clearly affirmed that knowledge was acquired by common sense, whilst mothers of more than one child reproduced such knowledge according to their experience with previous children. DISCUSSION: It was concluded that during this phase of tooth eruption, professionals must adopt a firm and defined position based on the literature providing evidence of the real relationship between tooth eruption and general symptoms, paying attention to every patient and their complaints to demystify and better understand this whole process.

Patient benefit from treatment with botulinum neurotoxin A for functional indications in otorhinolaryngology.

The objective of the study was to evaluate patient benefit and health-related quality of life after use of botulinum neurotoxin (BoNT) A for various otorhinolaryngological, functional (non-cosmetic) indications. The design consisted of a survey study of a patient cohort (n = 40) treated with BoNT A for functional indications. Patients were asked to answer the Glasgow Benefit Inventory (GBI), a retrospective questionnaire well validated for measuring the effect of otorhinolaryngological interventions on the health-related quality of life. GBI scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). A total of 29 patients (72.5%) returned a valid questionnaire. Mean total GBI scores for the particular indications were 1.2 (sialorrhea, n = 7), 22.6 (gustatory sweating, n = 8), 20.6 (palatal tremor, n = 5), 15.0 (postlaryngectomy voice disorders due to pharyngoesophageal spasm, n = 5), 38.9 (adductor spasmodic dysphonia, n = 2) and 27.8 (oromandibular dystonia, n = 2), showing a mean overall positive effect of BoNT A treatment on the health-related quality of life, respectively. A varying percentage of patients reported an increase in their health-related quality of life, indicated by positive total GBI scores: sialorrhea 28.6%, gustatory sweating 87.5%, palatal tremor 60%, postlaryngectomy voice disorders 60%, spasmodic dysphonia 100% and oromandibular dystonia 100%. Use of BoNT A can be considered an effective therapeutic option for all the indications investigated. However, the possibility of raising patients' health-related quality of life with this kind of therapy varies significantly for different indications. Further studies are needed to analyze the patients who will benefit most from a treatment with BoNT A.

Burning mouth syndrome and oral health-related quality of life: is there a change over time?

BACKGROUND: The symptoms associated with burning mouth syndrome can be quite varied and can interfere with the every day lives of patients. Management of the condition can be challenging for clinicians. AIMS: To determine the oral health-related quality of life (OHRQOL) implications of BMS on patients over a period of time whilst undergoing treatment and to evaluate whether treatment interventions had a positive effect on OHRQOL. MATERIALS AND METHODS: Thirty-two individuals (26 females, 6 males, mean age 61 years, range 38-83 years) were enrolled in this study. Individuals were interviewed using Short-Form McGill Pain Questionnaire (SFMPQ), Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) and the Oral Health Impact Profile (OHIP-14), at weeks 0, 8 and 16. RESULTS: Scores from all outcome measures used decreased over the 16 weeks of the study. Statistically significant differences were found between time points for VAS pain scores (P < 0.001), HADS depression scores (P = 0.029), SFMPQ sensory pain scores (P < 0.01) and total scores for OHIP-14 (P < 0.05). CONCLUSION: Burning mouth syndrome has a negative impact on OHRQOL; however, individually tailored management of the condition can result in an improvement in patient-reported outcome measures including quality of life.

Percepção de mães sobre a síndrome da erupção dentária e suas manifestações clínicas na infância / Percepción de las madres acerca del síndrome de erupción dental y manifestaciones clínicas de la infancia / Mothers perception of dental eruption syndrome and its clinical manifestation during childhood

Objetivo Este estudo objetivou identificar a percepção de mães primíparas e multíparas sobre a erupção dentária e suas manifestações, ao mesmo tempo em que relacionou e discutiu a ocorrência destas manifestações a luz da literatura pertinente. Método Trata-se de um estudo qualitativo descritivo, onde os sujeitos foram 61 mães, com bebês na faixa etária entre 3 e 12 meses de idade, usuários do Hospital de Pediatria da UFRN, na cidade de Natal, RN, Brasil. Utilizou-se uma entrevista semi-estruturada para coleta das informações. A análise dos dados foi feita pelo Software ALCESTE 4.5, utilizando-se as variáveis primíparas, para designar mães com apenas um filho e multíparas para mães com dois filhos ou mais. Resultados A presença de sintomatologia foi relatada por 75 por cento das mães entrevistadas. A percepção das mães de ambas as classes, provavelmente reflete desconhecimento do processo de desenvolvimento infantil e convergem para a presença de sintomas clínicos atribuídos ao processo eruptivo, porém, o grande diferencial está na forma de apreensão desta realidade. As primíparas manifestam claramente que o conhecimento foi adquirido através do senso comum, enquanto que as multíparas reproduzem este mesmo conhecimento baseado na experiência com os filhos anteriores. Discussão Concluiu-se que durante essa fase de erupção dentária os profissionais tenham uma posição firme e definida, baseada em evidências fartamente colocadas pela literatura, da relação direta entre erupção dentária e sintomatologia geral, dando a devida atenção a cada paciente e suas queixas, para desmistificar e melhor compreender esse processo na sua totalidade.

Objective This study was aimed at identifying primiparous and multiparous mothers perceptions about tooth eruption and related symptoms as well as discussing such events occurrence in the light of the relevant literature. Methods The research adopted a qualitative, descriptive design; 61 mothers who had already given birth to babies aged 3 to 12 months old were studied. Their children were outpatients at Rio Grande do Norte Federal Universitys Paediatric Hospital in Natal, RN, Brazil. A semi-structured interview was used for collecting data. ALCESTE 4.5 software was used for analysing data based on primiparous and multiparous mothers as variables; the former term referred to mothers bearing a child for the first time and multiparous to those who had born more than one child. Results Symptomatology was related by 75 percent of the mothers interviewed here. The perception of the mothers from both groups probably pointed to a lack of knowledge regarding child development and the process leading to the presence of clinical symptoms due to tooth eruption. However, the great difference lay in how this reality was perceived; mothers having a single child clearly affirmed that knowledge was acquired by common sense, whilst mothers of more than one child reproduced such knowledge according to their experience with previous children. Discussion It was concluded that during this phase of tooth eruption, professionals must adopt a firm and defined position based on the literature providing evidence of the real relationship between tooth eruption and general symptoms, paying attention to every patient and their complaints to demystify and better understand this whole process.

Objetivo Este estudio tuvo como objetivo identificar la percepción de las madres primíparas y multíparas en la erupción de los dientes y sus manifestaciones, así como examinar la ocurrencia de estos hechos a la luz de la documentación pertinente. Método La investigación tuvo un diseño cualitativo descriptivo y 61 madres cuyos bebés habían entre 3 y 12 meses de edad fueron estudiadas. Sus hijos eran pacientes del Hospital de Pediatría de la Universidad Federal de Rio Grande do Norte, en la ciudad de Natal, RN, Brasil. Para recoger los datos, se utilizó una entrevista semi-estructurada. El ALCESTE 4.5 fue utilizado para analizar los datos basados en las primíparas y multíparas madres como variables. El primero se utilizó para las madres que lleven a un niño por primera vez y multíparas que los cuales habían nacido más de un niño. Resultados La sintomatología fue referida por 75 por ciento de las madres entrevistadas. La percepción de las madres de ambos grupos probablemente señala desconocimiento del desarrollo del niño y el proceso converge a la presencia de síntomas clínicos debido a la erupción del diente. Sin embargo, la gran diferencia está en la forma de recoger esta realidad. Madres de un niño afirmaron claramente que el conocimiento fue adquirido por el sentido común, mientras que las madres de más de un niño se reproducen en este mismo conocimiento de acuerdo con la experiencia basada en los niños mayores. Discusión Se concluyó que durante esta fase de la erupción de los dientes, los profesionales deben tener una postura firme definida, basados por la literatura, la relación directa entre la erupción de los dientes y los síntomas generales, prestando atención a cada paciente y sus quejas, para así desmitificar y comprender mejor este proceso en su totalidad.

Side-effects of antipsychotic medication and health-related quality of life in schizophrenia.

OBJECTIVE: This analysis used data from the large (n = 1208) European Schizophrenia Cohort to examine the association between subjective side-effects of antipsychotic medication and the Mental and Physical Composite Scores (MCS; PCS) of the SF-36 scale. METHOD: Relationships between the subjective evaluation of side-effects identified from the Subjective Side-Effects Scale and the adjusted mean score on the PCS and MCS were examined. Where appropriate, these associations of subjective side-effects were compared with those of the same side-effects measured objectively. RESULTS: In this study, subjective side-effects of antipsychotic medication were linked either to both the PCS and the MCS or, in a few instances, to neither. Subjective evaluations of sexual side-effects were associated only with the MCS, those of sialorrhoea only with the PCS. Objective ratings of extrapyramidal side-effects were related neither to PCS nor to MCS. CONCLUSION: These data suggest that side-effects, whether subjective or objective, may need to be considered individually in relation to their impact on quality of life.

Upgraded technology for contingent stimulation of mouth wiping by two persons with drooling and profound developmental disabilities.

Many persons with developmental and physical disabilities experience drooling (i.e., loss of saliva from the mouth). Technology was recently developed to help two of these persons reduce the negative effects of drooling by increasing mouth-wiping responses. This study upgraded our initial approach and tested it with the two persons who we previously treated. Upgrading ensured that all technology components, including the stimulation sources, were on the participant's body and that stimulation for mouth wiping caused no (or limited) environmental disturbance. We also conducted a social validation assessment of the new technology and its effects, employing university students as social raters. Evidence showed that the participants used the upgraded technology successfully in settings attended by varieties of other persons. The university students involved in the social validation viewed the use of the technology as enjoyable, beneficial, and environmentally acceptable, and they largely supported it.