Interventions Involving Biofeedback to Improve Swallowing in People With Parkinson Disease and Dysphagia: A Systematic Review.

OBJECTIVES: To examine the effectiveness of biofeedback used in the treatment of adults with Parkinson disease (PD) and dysphagia, define the factors associated with biofeedback treatment outcomes, and inform a theory to guide the implementation of biofeedback in future dysphagia interventions. DATA SOURCES: A systematic review using a narrative synthesis approach of all published and unpublished studies were sought with no date or language restrictions. Ten electronic databases (EMBASE, PubMed, CINAHL, Web of Science, Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses A & I, Google Scholar) were searched from inception to April 2019. This search was updated in January 2020. The methodological quality of included studies was assessed using Downs and Black checklist. STUDY SELECTION: Four studies were included. The methodological quality of the included studies was low with a high risk of bias. Data were analyzed narratively and descriptively. Despite the heterogeneity of the included studies, the findings suggest that interventions incorporating visual biofeedback may have positive effects on swallowing-related quality of life. CONCLUSIONS: Based on these preliminary findings, we provide directions for further research and clinical interventions that incorporate an augmentative biofeedback component of swallowing interventions in people with PD. Future studies should be rigorously designed and set appropriate biofeedback treatment in terms of types, schedules, and timing.

Evaluation of an Automatic Speech Recognition Platform for Dysarthric Speech.

INTRODUCTION: The use of commercially available automatic speech recognition (ASR) software is challenged when dysarthria accompanies a physical disability. To overcome this issue, a mobile and personal speech assistant (mPASS) platform was developed, using a speaker-dependent ASR software. OBJECTIVE: The aim of this study was to evaluate the performance of the proposed platform and to compare mPASS recognition accuracy to a commercial speaker-independent ASR software. In addition, secondary aims were to investigate the relationship between severity of dysarthria and accuracy and to explore people with dysarthria perceptions on the proposed platform. METHODS: Fifteen individuals with dysarthric speech and 20 individuals with nondysarthric speech recorded 24 words and 5 sentences in a clinical environment. Differences in recognition accuracy between the two systems were evaluated. In addition, mPASS usability was assessed with a technology acceptance model (TAM) questionnaire. RESULTS: In both groups, mean accuracy rates were significantly higher with mPASS compared to the commercial ASR for words and for sentences. mPASS reached good levels of usefulness and ease of use according to the TAM questionnaire. CONCLUSIONS: Practical applicability of this technology is realistic: the mPASS platform is accurate, and it could be easily used by individuals with dysarthria.

Predictors of Oral Feeding Resumption after Stroke in a Rehabilitation Hospital: A Retrospective Study.

BACKGROUND: Dysphagia is common after stroke, requiring exclusive enteral feeding in 20% of patients. Recovery of oral feeding is associated with increased quality of life, better functional outcomes, and decreased mortality rates. However, evidence is heterogeneous and not conclusive on which factors are predictive of oral feeding recovery for stroke patients in rehabilitation units. AIM: To investigate predictors of complete oral feeding recovery. DESIGN: Retrospective study. SETTING: Intensive inpatient rehabilitation hospital. POPULATION: Poststroke dysphagic individuals with enteral feeding. METHODS: Retrospective chart review of demographic, clinical, rehabilitation, and swallowing factors. Univariate analysis and multivariate regression analysis were used to compare variables between the oral feeding recovery group and the enteral feeding group at discharge. RESULTS: One hundred thirty-nine patients were included in the analysis. A total of 61.9% of the sample population resumed complete oral intake at discharge. There were statistically significant differences between the 2 groups in Functional Independence Measure cognitive score, clinical swallow evaluation, and instrumental swallow evaluation at admittance, and dysphagia rehabilitation. Multiple logistic regression analysis identified the absence of aspiration signs with liquids associated with a higher probability of the resumption of complete oral feeding (odds ratio [OR] 3.57; 95% confidence interval [CI] 1.07-11.89). Age between 73 and 79 years (OR .96; 95% CI .01-.58), the presence of aspiration and/or penetration (OR .22; 95% CI .07-.72), and the presence of residue (OR .14; 95%CI .04-.43) during fiberoptic endoscopic evaluation of swallowing presented lower probability of returning to complete oral feeding. CONCLUSION: Several demographic and swallowing characteristics predicted oral feeding recovery. Absence of dysphagia signs documented on fiberoptic endoscopic evaluation of swallowing was the strongest predictor of complete oral feeding resumption.

Cross-Cultural Validation of the Italian Version of the Functional Oral Intake Scale.

Outcome measures and scales translated into other languages according to conventions are important for international clinical research in dysphagia. Typically, assessments and scales are translated locally without cultural adaptation and validation. The Functional Oral Intake Scale (FOIS) is widely used in dysphagia research and clinical practice in English-speaking countries. Nevertheless, it is not available in Italian. The aim of this study was to translate the FOIS into Italian and validate it, allowing the FOIS to be available to speech-language pathologists (SLPs) and clinicians working with individuals with dysphagia in Italy. The FOIS was translated following 5 stages of cross-cultural adaptations. This involved (1) translation from English to Italian, (2) synthesis and solution of discrepancies between translators, (3) back-translation from Italian to English, (4) expert revisions, and (5) pretesting. To validate the translated scale, 10 SLPs were recruited from 3 different facilities across Italy. A questionnaire containing similar information to the FOIS and the Italian version of the FOIS (FOIS-It) was completed by SLPs for 227 people with dysphagia; the correlation was high (intraclass correlation coefficient [ICC] = 0.99). Interrater reliability, calculated for 2 blinded SLPs completing scales for 30 patients, was excellent (ICC = 0.99). In conclusion, the FOIS-It is now available for use in clinical practice and research studies in Italy.

Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review.

The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.

On the Relation between Assistive Technology System Elements and Access to Assistive Products Based on 20 Country Surveys.

The objective of this study was to explore the relationship between assistive technology system elements and access to assistive products. Data on assistive technology system elements and self-reported survey data on access to assistive products from 20 countries were analyzed using multivariate statistical methods, including orthogonal partial least squares analyses. Access to assistive products was primarily associated with the geographic coverage of assistive technology services in a country, followed by system elements related to policy and personnel. To achieve universal access to assistive technology, geographic coverage of assistive technology services is an instrumental system element. However, it requires the implementation of appropriate policies along with sufficient funding, recruitment of adequately trained personnel, and availability of assistive products in need.

[Formula: see text] Post-stroke acquired childhood aphasia. A scoping review.

Aphasia has a great impact on children's lives, with stroke being its most common and studied etiology. However, our knowledge about this disorder is limited, the studies on this topic are sparse, and a consensus regarding its definition is lacking. In particular, the interpretation of this condition varied over time: from the rigid description of the so-called "standard doctrine" to the adoption of adult models for post-stroke aphasia. Therefore, this review provides a critical overview of childhood aphasia after stroke, focusing on its epidemiology, definition, diagnosis, and clinical manifestation. The scoping review approach was adopted, following PRISMA-ScR guidelines. PubMed, Web of Science, and PsycInfo databases were searched for related peer-review papers in English. Forty-six records were identified; the majority were single cases and case series, only a few were reviews and observational studies. Epidemiologic data are scarce; a few studies report that aphasia affects about one-third of children post-stroke. Despite terminological differences, there is an overall agreement on the definition of post-stroke aphasia in children as a language disorder acquired after the age of two. Approaches for the diagnosis and evaluation vary widely, including both assessments for developmental language disorders and tests for aphasia in adults. The clinical manifestations described in children are numerous and varied, similar to those found in adults, in contrast with the "standard doctrine." This review highlights the need for further studies to improve the knowledge of this condition, develop validated and specific assessment tools, and standardize clinical management.

Assistive Technology during the COVID-19 Global Pandemic: The Roles of Government and Civil Society in Fulfilling the Social Contract.

The COVID-19 pandemic imposed significant challenges to users of assistive technology (AT). Three key issues emerged from a series of structured qualitative interviews with 35 AT users in six low- and middle-income countries. These were (1) access to information about COVID-19 and available supports and policies, (2) insufficiency of the government response to meet the needs of AT users, and (3) the response of civil society which partially offset the gap in government response. AT users noted the need for better communication, improved planning for the delivery and maintenance of AT during times of crisis, and higher-quality standards to ensure the availability of appropriate technology.

Assistive Technology Provider Experiences during the COVID-19 Pandemic.

Globally, health systems face challenges in the delivery of assistive technology (AT) and only 10% of people are currently able to access the assistive products they need. The COVID-19 pandemic presented an uncharted path for AT providers to navigate, placing them under pressure to be agile and rapidly adapt. This article, part of a series, explores the experiences and impacts of the COVID-19 pandemic on AT providers and aims to inform how AT providers can be better prepared and supported in the future. A mixed methods approach was used to gather service data and perspectives from AT providers via a survey. A total of 37 responses were received from 18 countries. Service data showed extensive service disruption throughout 2020. Thematic analysis suggested significant changes to routine AT service delivery including rapid momentum towards home-based, decentralised, and digital services for which many AT providers were not prepared. Providers were required to make difficult decisions and deliver services in new ways to balance meeting demands, complying with government restrictions, and ensuring the safety of staff and clients. Few but important positives were expressed including the belief that expanded capacity to use remote and digital AT service delivery would remain useful in the future.

Access to Assistive Technology during the COVID-19 Global Pandemic: Voices of Users and Families.

The SARS COVID-19 pandemic emerged in 2019 and has impacted people everywhere. Disparities in impact and outcomes are becoming apparent for individuals and communities which go beyond the trajectory of the disease itself, influenced by the strength and weaknesses of systems of universal health care, and the actions of civil society and government. This article is one of a series exploring COVID-19-related experiences of assistive technology (AT) users across the globe and implications for AT systems strengthening. AT such as mobility products, braille devices, and information communication technologies are key enablers of functioning, necessary to the achievement of the UN Sustainable Development Goals and enshrined in the Convention on the Rights of Persons with Disabilities. Reporting on a survey of 73 AT users across six global regions, we demonstrate that minority groups already living with health inequities are unduly impacted. An AT ecosystem analysis was conducted using the WHO GATE 5P framework, that is, people, products, personnel, provision and policy. AT users and families call for inclusive pandemic responses which encompass their needs across the lifespan, from very young to very old. We offer specific recommendations for future action to strengthen access to AT across public policy and civil society in pandemic preparedness and response.

A new method of providing pulsatile flow in a centrifugal pump: assessment of pulsatility using a mock circulatory system.

Previous studies have demonstrated the potential advantages of pulsatile flow as compared with continuous flow. However, to date, physiologic pumps have been technically complex and their application has therefore remained in the experimental field. We have developed a new type of centrifugal pump, which can provide pulsatile as well as continuous flow. The inner wall of a centrifugal pump is pulsed by means of a flexible membrane, which can be accurately controlled by means of either a hydraulic or pneumatic driver. The aim of this study was to assess the hydraulic behavior of the new pump in terms of surplus hemodynamic energy (SHE). We conducted experiments using a mock circulatory system including a membrane oxygenator. No differences were found in the pressure-flow characteristics between the new pump and a conventional centrifugal pump, suggesting that the inclusion of the flexible membrane does not alter hydraulic performance. The value of SHE rose when systolic volume was increased. However, SHE dropped when the percentage of ejection time was reduced and also when the continuous flow (programmed by the centrifugal console) increased. Mean flow matched well with the continuous flow set by the centrifugal console, that is, the pulsatile component of the flow was exclusively controlled by the pulsatile console, and was therefore independent of the continuous flow programmed by the centrifugal console. The pulsatility of the new pump was approximately 25% of that created with a truly pulsatile pump.

Effects of chin-up posture on the sequence of swallowing events.

BACKGROUND: Chin-up posture is frequently used to manage oral dysphagia after head and neck cancer. This prospective study investigates the effects of chin-ups on the sequence of pharyngeal swallowing events. METHODS: Twelve healthy young adults performed 45 consecutive swallows of 5 mL water across 3 phases on videofluoroscopy: 5 swallows in the neutral head position; 30 swallows during chin-up posture; and 10 swallows in the neutral head position. Swallowing kinematic and bolus flow measures for 9 swallowing events were recorded. Linear trends were analyzed across 30 chin-up swallows; pairwise comparison was used to compare the 3 phases. RESULTS: Time to hyoid peak and laryngeal vestibule closure changed abruptly during chin-up swallowing compared to the initial neutral position. No measure changed across 30 chin-up swallows. Time of hyoid burst decreased upon returning to the neutral position. CONCLUSION: Our findings indicate that chin-up posture challenges the pharyngeal sequence of events for both swallowing kinematics and bolus flow. © 2017 Wiley Periodicals, Inc. Head Neck 39: 947-959, 2017.

Endometriosis de la pared abdominal / Abdominal wall endometriosis

Objetivo. Descripción de los hallazgos radiológicos y clínicos de las pacientes con endometriosis de la pared abdominal (EPA). Material y métodos. Estudio retrospectivo de 11 casos de pacientes intervenidas por EPA en nuestro hospital durante 4 años. Se analizaron la sospecha clínica, los factores de riesgo, las manifestaciones clínicas y hallazgos de imagen mediante ecografía, tomografía computarizada (TC) y resonancia magnética (RM). Resultados. La manifestación clínica más frecuente fue la palpación de un bulto en la pared abdominal con o sin dolor. El 70% de las pacientes tenían antecedentes de cesárea. Ecográficamente la mayoría de las lesiones eran hipoecoicas. En la TC se mostraban sólidas, con realce moderado. En la RM los endometriomas presentaban un comportamiento similar al de los hematomas en diferentes estados evolutivos. Conclusiones. Los hallazgos de imagen de masas sólidas cercanas a la cicatriz de una cesárea anterior sugieren el diagnóstico prácticamente de certeza de EPA (AU)

Objective. To describe the radiological and clinical findings in women with abdominal wall endometriosis (AWE). Material and methods. A retrospective study of 11 patients who underwent surgery for AWE in our hospital over a 4-year period was performed. Clinical suspicion, risk factors, clinical manifestations and imaging findings using ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) were analyzed. Results. The most frequent clinical manifestation was palpation of a lump in the abdominal wall with or without pain. Seventy percent of the patients had a previous cesarean section. Sonographically most of lesions were hypoechoic. On CT scanning, the masses were solid with moderate enhancement. On MRI, the endometriomas showed a similar behaviour to hematomas at distinct stages of progression. Conclusions. An imaging finding of a solid mass close to a scar from a previous caesarean section strongly suggests a diagnosis of AWE (AU)

Inmigrante ecuatoriana con cefalea / Ecuadorian immigrant with headache

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