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The language disorder known as dysphasia significantly affects the ability to communicate effectively, presenting challenges in both comprehension and expression of language. To address this issue, the development of a visual treatment using augmented reality (AR) specifically designed for children with dysphasia has been proposed. The methodology selected for this project is analysis, design, development, implementation, and evaluation (ADDIE), an innovative methodology that encompasses analysis, design, development, implementation and evaluation. This methodology is perfectly adapted to the needs of the project, allowing a systematic and complete approach at all stages of the process of creating the visual treatment. The results obtained show that the visual treatment with AR has been positively evaluated by development experts and dysphasia specialists. Its innovative capacity to assist children with this disorder in health and educational settings is highlighted. This approach provides an effective tool to improve the communication and language development of children affected by dysphasia, offering new opportunities for their learning and growth. Its implementation in healthcare and educational settings could have a significant impact on the quality of life and development of these children. [ABSTRACT FROM AUTHOR]

In the neuroimaging workup of a suspected ischemic stroke, the involvement of more than one arterial territory without an anatomical substrate should raise the suspicion of a stroke mimic. We report the case of a 61-year-old male with a new-onset headache and transient phasic disturbances who presented a pattern of vascular abnormalities characterized by left-hemispheric leptomeningeal vessel paucity and hypoperfusion.

Key Clinical Message: Unilateral opercular lesions can result in Foix–Chavany–Marie syndrome, which is marked by acute anarthria, automatic‐voluntary movement dissociation—most notably the absence of voluntary facial and tongue movements—and a generally better prognosis. Better patient outcomes are mostly dependent on early detection, management, and rehabilitation. Opercular syndrome is a rare neurological disorder caused by bilateral or unilateral lesions of the operculum that result in symptoms related to speech and swallowing difficulties with dissociation of automatic‐voluntary movements in affected muscles. 78‐year‐old female presented with acute onset dysarthria, left sided facial deviation and difficulties in chewing, speaking, and swallowing. CT head revealed ischemic changes in left frontal operculum and was diagnosed with the unilateral opercular syndrome. The case was managed according to ischemic stroke protocol. The patient was discharged after 7 days of hospital stay, with MRS 2, NIHSS 9 and secondary stroke preventive measures. At 4 months follow‐up, her MRS was 1, with mild dysarthria, that could be understood, and her swallowing improved to some amount of drooling while feeding. Early recognition, treatment, and rehabilitation play important role in prompt improvement of symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria. Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates. Results: The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items. Conclusion: There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore.

Objectives: This manuscript aims to present a novel and successful intervention for intractable aspiration following a supracricoid laryngectomy (SCL) that may avoid the need for total laryngectomy in patients experiencing intractable aspiration after SCL. Study design: This report describes a novel approach to treat intractable aspiration and feeding tube-dependency due to an incomplete posterior apposition of the laryngeal surface of the epiglottis to the arytenoids after a SCL in a 67-year-old man. Methods: The right and left aryepiglottic folds and the median glossoepiglottic fold were denuded using a CO2 laser. Then, an arytenoepiglottopexy was completed by placing 4-0 Vicryl between the lateral aspect of the epiglottis and arytenoids; thus, approximating these structures. Results: Two weeks after surgery, fiberoptic endoscopic evaluation of swallowing demonstrated improved closure of the larynx upon swallowing with great upgrading in the Penetration-Aspiration scale (PAS). PAS improved from a 6 to 2, corresponding to, transient penetration for moderately thick liquids and puree solids. He also demonstrated improved secretion management and airway protection. Following a 4-week course of intensive dysphagia therapy, a modified barium swallow revealed a significant improvement in airway protection, with a PAS score of 1 (no airway invasion). Conclusions: Chronic aspiration is a life-threatening condition that can severely reduce patients' quality of life. Despite the use of current therapeutic approaches, a subset of patients will remain plagued by persistent symptoms. We introduce an innovative, simple, and quick endoscopic technique that offers benefit in controlling aspiration after SCL. Level of Evidence: NA [ABSTRACT FROM AUTHOR]

Objectives: Upper gastrointestinal tract illnesses are among the most typical issues in clinical practice. Many diseases can affect the upper GIT. One of the key components of creating a successful treatment strategy is making a correct diagnosis of upper gastrointestinal problems, which necessitates histological confirmation. Identify the range of upper gastrointestinal tract histopathological lesions and establish endoscopic biopsies as a valuable tool for accurately diagnosing and treating a variety of upper gastrointestinal tract lesions. Materials & Methods: The endoscopic biopsies of the upper GIT were the subjects of a prospective study, and the histological evaluation took place at the Department of Pathology at a tertiary care center for over a year. Results: 326 endoscopic biopsies from a total of 288 patients were examined. Patients who were men outnumbered patients who were women. A 9-88 age range was noted. There were cases involving the esophagus (18.4%), the GE junction (3.06%), the stomach (57.05%), the neo stomach (GJstoma), and the duodenum (20.85%). 20.24 percent of cases were benign neoplasms, 18.40 percent were malignant neoplasms, and 61.34 percent were non-neoplastic. The most often diagnosed inflammatory lesion, gastritis, was identified by histopathology as having 63 cases (63%), while the majority of the time identified malignant lesion, esophageal squamous cell carcinoma, had 19 instances (63.33%). Conclusion: In our study, 31.18% of neoplastic tumors and 69.89% of non-neoplastic lesions were found in the stomach (57%), which was also the most frequently used site for upper GI endoscopic biopsy. The most typical kind of stomach tumor is adenocarcinoma. Endoscopy enables the collection of biopsy samples from previously inaccessible sites without requiring a sizable resection. Recommendation: It is recommended to comprehend the variety of abnormalities that can be seen in these specimens to make the correct diagnosis and provide better patient treatment.

Here we present a case of Depersonalisation–Derealisation Disorder which involves an unusual environmental trigger and profile of symptoms in a patient with an underlying left frontal encephalomalacia. The clinical information has been collected from multiple neurological, psychiatric, neuropsychological examinations and from the patient's medical records. The neuropsychiatric assessment showed depersonalisation, derealisation, de-somatisation and de-affectualisation, along with a good response to SSRI + Lamotrigine; all typical features of DPD. The neuropsychological assessment showed language problems, and other mild cognitive difficulties that may provide a neuropsychological foundation contributing to the DPD episodes. Given Mr R's underlying neuropsychological deficit, hearing voices without speech-associated gestures might place excessive demands on his ability to process the information, exacerbating his feelings of threat. This sets up the pattern of suppressed insula activation, and possibly the suppression of the auditory cortex leading to the presented unusual DPD symptoms. [ABSTRACT FROM AUTHOR]

Developmental dysphasia is a speech disorder with normal hearing and intelligence, which develops against the background of organic brain damage in the period up to 3 years of life. In addition to speech disorders in dysphasia, motor and coordinator, sensory (disturbances in sensitivity and perception), and psychopathological manifestations can be noted. Diagnosis of speech disorders is very difficult, requires the exclusion of hearing loss and mental illness. After a successful diagnosis, speech therapy correction, behavioral therapy and developmental sessions with a psychologist are necessary. In some cases, neurotrophic drugs are prescribed. This article analyzes our own data on the use of the drug “Cogitum” in 140 children in comparison with the control group (n = 40), who had the same classes as in the main group, but without the use of Cogitum. Improvement in group 1 was shown.

Abstract Aim To translate the Self‐Care for Aspiration Pneumonia Prevention Scale into the Chinese and validate its reliability and validity among community dwelling elderly with risk of dysphasia. Design A cross‐sectional survey. Methods A total of 430 elderly with risk of dysphasia were recruited. The reliability was measured by internal consistency, split half reliability, and test–retest reliability. The validity was evaluated by expert consultation and factor analysis. Results The translated scale had ideal reliability. The content validity index (S‐CVI) was 0.952. The 3‐factor structure, supported by the eigenvalues, total variance explained, and scree plot, was obtained by using exploratory factor analysis. And as a result of a confirmatory factor analysis, the model fitting indexes were all in the acceptable range. The Chinese version of the Self‐Care for Aspiration Pneumonia Prevention scale can contribute to clinical practice and education to improve self‐care for aspiration pneumonia prevention among elderly at risk of dysphasia.

Refractory dysphasia could be the main symptom of Antisynthetase syndrome (ASS). IVIG may have a major impact in the successful treatment of dysphasia in patients with ASS. In our patient with ASS, IVIG treatment was an unreplaceable treatment option, and the patient regains her ability to swallow within 2 days. Refractory dysphasia could be the main symptom of Antisynthetase syndrome (ASS). IVIG may have a major impact in the successful treatment of dysphasia in patients with ASS. A cure can be possible within just 2 days of IVIG treatment. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to clarify the relationship among swallowing function, activity, and quality of life (QOL) in older adults with low activities of daily living (ADL). Materials and Methods: We conducted a cross-sectional study. In total, 271 Japanese adults aged over 65 years who underwent medical intervention at their residence (male: n = 107; female: n = 164; mean age = 84.6 ± 8.3 years) participated. We collected data regarding age, sex, body mass index (BMI), residence (their house/nursing home), activity status, consciousness level (eye response), history of aspiration pneumonia, other medical history, number of medication types, frequency of going out, and time spent away from bed. We judged consciousness level (eye response) using the Glasgow Coma Scale (GCS), calculated the Charlson comorbidity index, measured QOL using the short version of the Quality of Life Questionnaire for Dementia (short QOL-D), and assessed swallowing function using the Functional Oral Intake Scale (FOIS). To examine the relationship between scores for the FOIS and the other variables, we used the Spearman rank correlation coefficient and ordinal logistic regression analysis. Results: The FOIS was strongly correlated with BMI (ρ = 0.47), activity status (ρ = −0.60), GCS (ρ = −0.41), time spent away from bed (ρ = 0.56), scores for the short QOL-D (ρ = 0.40), weakly correlated with history of aspiration pneumonia (ρ = −0.27), and frequency of going out (ρ = 0.39). Results for the ordinal logistic regression analysis showed that the FOIS was associated with activity status, frequency of going out, time spent away from bed, and scores for the short QOL-D. Conclusion: The swallowing function of older adults with low ADL was related to their QOL and activities, such as time spent away from bed and home. Thus, in rehabilitation programs for swallowing function in older adults, not only functional but also psychological approaches may prove effective. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the P3 component between patients who have migraines with aura and healthy subjects, and to compare different subtypes of migraine with aura relative to the complexity of migraine aura. Methods: Average Migraine Aura Complexity Score was calculated for each MwA patient. Visual oddball paradigm was used to elicit the P3 component. P3 amplitudes and latencies elicited from frequent and rare stimuli, as well as from difference wave, were compared with healthy subjects. Subsequently, subtypes of migraine with aura were compared and Average Migraine Aura Complexity Score was used to explore the connection between features of the P3 and complexity of migraine with aura. Results: 37 patients who have migraine with aura (16 with simple aura and 21 with complex aura) patients and 28 healthy subjects were studied. Patients who have migraine with aura had significantly prolonged latencies compared to healthy subjects (411 ± 39 ms vs 372 ± 34 ms, p < 0.001) relative to a rare condition. Patients who have complex aura significantly differs from patients who have simple aura (427 ± 34 ms vs 389 ± 35 ms, p = 0.004) and healthy subjects (372 ± 34 ms, p < 0.001) relative to P3 latency in a rare condition and the patients who have complex aura significantly differs from healthy subjects (442 ± 37 ms vs 394 ± 33 ms, p < 0.001) relative to P3 latency in difference wave. P3 latency from rare condition positively correlated with the Average Migraine Aura Complexity Score (p < 0.001). Conclusions: Visual oddball paradigm, particularly rare stimuli, could serve as a potential new tool for deep profiling of different clinical complexities among patients who have migraine with aura. Also, the present pattern of P3 components provided new evidence for the cognitive dysfunctions in patients who have migraine with aura. [ABSTRACT FROM AUTHOR]

Aim: To translate the Self‐Care for Aspiration Pneumonia Prevention Scale into the Chinese and validate its reliability and validity among community dwelling elderly with risk of dysphasia. Design: A cross‐sectional survey. Methods: A total of 430 elderly with risk of dysphasia were recruited. The reliability was measured by internal consistency, split half reliability, and test–retest reliability. The validity was evaluated by expert consultation and factor analysis. Results: The translated scale had ideal reliability. The content validity index (S‐CVI) was 0.952. The 3‐factor structure, supported by the eigenvalues, total variance explained, and scree plot, was obtained by using exploratory factor analysis. And as a result of a confirmatory factor analysis, the model fitting indexes were all in the acceptable range. The Chinese version of the Self‐Care for Aspiration Pneumonia Prevention scale can contribute to clinical practice and education to improve self‐care for aspiration pneumonia prevention among elderly at risk of dysphasia. [ABSTRACT FROM AUTHOR]

The science of drug delivery has been increasingly innovative and quick evolving with ever-increasing demand in the current scientific scenario. Fast dissolving tablet (FDT) is one of those forms of an advanced and special drug delivery system that is rapidly gaining a lot of attention in the rapid dissolution technology research sector. Fast dissolving tablets appear as one of the common and widely accepted dosage types, particularly for paediatric patients due to incomplete muscle and nervous system development and a form of geriatric patients with Parkinson's disease or hand shivering. The most popular administrative path for different medications has drawbacks such as first-pass metabolism, psychotic patients, bedridden and Uncollaborative patients, is the oral delivery type and oral path FDTs disintegrate or quickly dissolve in the saliva without requiring water. Within few seconds, FDT will dissolve within saliva for approximately 60 seconds and these comprises will dissolve even faster

Purpose of the study: The present study was conducted to investigate the impact of the Cognitive Theory of Multimedia Learning for students with dysphasia in learning disabilities. Another aim was to find out the acquisition of vocabulary toward News in levels lesson - Robinson Crusoe for Students of English. Twenty-four students with dysphasia in learning disabilities have participated in the study. The sample population was exposed to a similar handing environment for the research though they had various backgrounds. All the instructions, experiments, teaching-learning activities were provided in the special education resource room. Methodology: The Experimental Research Design was employed in the study. Pre-test, post-test, retention test, and Vocabulary Knowledge Scale questionnaire were administrated to collect the required data from both the control and experimental groups to study the impact of the multimedia and nonmultimedia instructional methods. Major findings: The research findings revealed that the multimedia instructional method of teaching outperformed the non-multimedia instructional group. The retention test results and the Vocabulary Knowledge Scale questionnaire reaffirmed that students with dysphasia have motivated and store the new information in their long-term memory. They could retain most of the vocabulary when the multimedia instructional method was integrated into the teachinglearning process. All the test result scores were analyzed using the SPSS software package. A paired test value comparison was used to compare the results for both the control and experimental groups. [ABSTRACT FROM AUTHOR]

Introduction. Speech disorders in Parkinson’s disease are a very common clinical sign. The structure of speech disorders is at the moment not fully understood, there is no unified approach to classification, therapy effects have not been studied.Materials and methods: 324 PD patients were primarily included in the study, and from those the patients showing clinically significant speech disorders (22,4%) were selected. All the patients were assessed for motor disorders (UPDRS part 3), cognitive disorders (Addenbrooke’s cognitive examination), as well as affective disorders.Results: by means of cluster analysis we identified 4 subtypes of speech disorders as dysphasia (adynamic, disprosodic, constructive, and logopenic). None of the forms was associated with parkinsonism severity and general severity of cognitive impairment, which allowed to consider dysphasia as a separate clinical syndrome. Disprosodic dysphasia differentiated by severity of axial symptoms (F value = 3.279, p < 0,05), adynamic dysphasia was associated with more pronounced apathy (F value = 4,2, p < 0,01), constructive dysphasia – with impairment of visual-spatial functioning (F value 29,93, p

In 2015, researchers called for the preferred use of the term "aphasia" and the elimination of the term "dysphasia". They determined that speech-language pathologists, researchers and consumer organizations prefer the term "aphasia". However, individuals with aphasia, their family members and friends are faced with a probably unknown disorder and may rely on the internet to provide the information they need. To determine the frequency and use of the terms "aphasia" and "dysphasia" on publicly accessible websites. Using the Google search engine, three searches (general, news and Google Scholar) were conducted for the terms "aphasia" and "dysphasia" for the year 2019. A survey of the terms "aphasia" and "dysphasia" in 2019 reveals a reduced frequency of the latter term in general searches, news and accessible scholarly publications. However, the term continues to be used inconsistently and inaccurately. In general searches, a layperson had only around 50% chance of obtaining a correct explanation of dysphasia as a language disorder. In news items, only around one-third correctly identified dysphasia as a language disorder. Although the use of the term "dysphasia" has reduced compared to "aphasia" in internet searches, confusion and inaccuracy surrounding the meaning of these two terms persists. There is still a need for greater advocacy and awareness raising regarding accurate terminology amongst the wider society and the professional community. Only by doing this, can everyone affected by aphasia gain relevant and appropriate healthcare, support and opportunities. [ABSTRACT FROM AUTHOR]

Developmental dysphasia is one of the most common diagnoses encountered by clinical speech therapists. It is a diagnosis that brings with it a number of potential problems that the speech therapist has to solve. Dysphasia is not only about poor speech intelligibility, but also affects many other areas - vocabulary, morphology and syntax or language comprehension. One area that is less pronounced in relation to developmental dysphasia is the transmission of problems to written language - the high risk of reading and writing difficulties, which is much higher for children with developmental dysphasia than for intact children.The aim of this article is to highlight the relationship between developmental dysphasia and initial literacy in the context of domestic and foreign literature. We will try to summarize currently available knowledge on the effectiveness of intervention in skills that are responsible for initial literacy, and also encourage professionals from different areas to think about other possibilities of helping children with developmental dysphasia to prevent their failure in school skills. At the end of the article, a new edition of the stimulation program "Training of Language Skills by D. B. Elkonin" and its practical application in the Czech Republic at the present time will be presented.

Background: Ossification of the anterior longitudinal ligament (OALL) of the cervical spine is a relatively rare disease. If patients present with dysphagia, hoarseness, and/or dyspnea, they may require surgery. Case Description: Over a 7-month period, a 55-year-old female with a history of cerebral palsy developed a progressive quadriparesis accompanied by diffuse sensory loss (i.e., clumsiness of the hand/legs and gait disturbance). The cervical spine X-rays showed atlanto-axial subluxation with instability, while the cervical MRI demonstrated "pseudotumor in the retro-odontoid" region. Following an occipital cervical fusion (C0-C2) surgery, her quadriparesis resolved. Nevertheless, she had persistent dysphagia that worsened over 6 months. Video fluoroscopy revealed severe mechanical stenosis of the pharynx, which was attributed to OALL extending from the C3-C6 levels. Following OALL resection through a right anterior approach utilizing diamond burrs and an ultrasonic bone curette, the dysphagia rapidly resolved. Conclusion: We report a rare case of retro-odontoid pseudotumor successfully treated with a posterior C0-C2 cervical fusion. Additional symptomatic C3-C6 OALL, responsible for progressive dysphagia, was later managed with focal anterior OALL resection. [ABSTRACT FROM AUTHOR]

Background: Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. Objective: To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. Methods: Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. Results: MTP showed a significant positive correlation with SMI (r =.43, P <.01). PPWA showed a significant negative correlation with MTP (r = −0.30, P <.01), but no association with SMI. Conclusions: While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength. [ABSTRACT FROM AUTHOR]

There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system. [ABSTRACT FROM AUTHOR]

Transcranial Direct Current Stimulation (tDCS) is an adjunct to behavioral speech therapy to enhance the recovery of post-stroke dysphasia. Administration of tDCS involves the application of low-amplitude electrical currents through surface electrodes, which are placed onto the scalp to influence the neuronal activity. TDCS montage and patients' clinical characteristics are the important factors in determining the outcome of the intervention. We aim to describe the clinical characteristics, outcomes and local limitation factors of five post-stroke patients who received TDCS combined with behavioural therapy for dysphasia. All patients, except for Case #5 showed improvement at day 10 post-intervention in several speech and language domains. TDCS is a promising adjunctive intervention in enhancing neuroplasticity activity in a post-stroke brain. A further well design case-controlled study is warranted to prove its efficacy in our local population. Local factors and limitations that may influence the outcome should be considered. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence has shown a relationship between dehydration, falls, and pulmonary aspiration among older adults in nursing homes, all of which contribute to loss of independence and quality of life. It is believed that improving communication among healthcare professionals in nursing homes (physicians, nurses, rehabilitation team, psychologist, social workers, dieticians and medical assistants) decreases the number of adverse events in institutionalized patients. This study will evaluate the feasibility of using a set of written signs, designed to caution against the risk of falls, dehydration, and pulmonary aspiration, and will enable the proposal of tailored interventions to manage these events in nursing homes. Methods/Design All patients from Campus Neurológico Sénior (CNS) nursing home, at risk of falls and/ordysphagia and/or dehydration will be invited to participate in the study. Patients will undertake a screeningrisk assessment and the corresponding risk prompts will be attributed. Study duration will be a minimum ofthree months per participant, including daily record of falls, dehydration and pulmonary aspiration eventsand monthly interview assessments, conducted by a member of the research team. Data of the events that occur will be compared with historical data extracted retrospectively from medical and nursing charts. This study has been approved by the Ethics Committee of the Medical Academic Center of Lisbon, Faculty of Medicine, University of Lisbon (Ref. 176/15). All participants will give their written informed consent before entering the study. Discussion This study is unique in evaluating the feasibility of a communication system in preventing the three major risks in nursing home. Thoughtful selection and display of proper risk prompts in nursing homes could be an essential step along a path toward efficient communication of risks among healthcare teams. We expect that the displays will be easily applicable given their simplicity, low complexity, and minimal physical requirements. Trial registration NCT03123601 . March 7, 2017. Retrospectively registered.

Hiromichi Shinozaki, Haruka Tohara, Mariko Matsubara, Nobuhiro Inokuchi, Yasuhiro Yamazaki, Ayako Nakane, Yoko Wakasugi, Shunsuke Minakuchi Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan Purpose: This study aimed to examine the relationship between jaw opening force and hyoid bone dynamics and resting position in elderly individuals based on gender. Subjects and methods: Subjects were 36 healthy elderly individuals aged ≥65 years without dysphagia (16 men and 20 women; mean age 75.5 years, range 65–88 years). Videofluorographic images during the swallowing of 10 mL of 40% (w/v) barium sulfate were obtained and the degrees of anterior, superior, and hypotenuse displacements of the hyoid bone and maximum/resting hyoid position were evaluated. Jaw opening force was measured three times using a jaw opening force sthenometer; the mean of these three measurements was used for analysis. Results: In men, there was a positive correlation between jaw opening force and resting hyoid position and negative correlations among all the degrees of anterior, superior, and hypotenuse displacements of the hyoid bone. In women, there was no statistically significant correlation between jaw opening force and any of the measurement items. There was no statistically significant correlation between jaw opening force and maximum hyoid position in either men or women. Conclusion: Our findings suggest that low jaw opening force leads to low resting hyoid position only in elderly men, and a lower hyoid position in healthy elderly men results in a larger total amount of hyoid displacement during swallowing. Moreover, a maximum hyoid position in healthy individuals of either gender does not differ depending on their jaw opening force. Keywords: aging, deglutition disorders, dysphasia, gender differences

Background: Manifestations of typical migraine aura can be numerous. Investigation of its pathophysiological mechanisms can be challenging if a stratification of phenotypes is not performed. In this context, the Migraine Aura Complexity Score (MACS), recently developed, may help. Here we aimed to categorize migraine patients into homogenous groups using MACS and to compare those groups with respect to patients' characteristics and neuroimaging findings.Methods: Participants who have a migraine with aura (MwA) were interviewed after each attack in order to obtain the characteristics of migraine aura. Thereafter, we scored the complexity of their auras by MACS. The MACS was used to categorize patients into three groups: MwA-S (with simple aura), MwA-MC (with moderately complex aura), and MwA-C (with complex aura). The patient characteristics and estimated cortical thickness of regions of interest, which are potentially linked to the symptoms that develop during the aura, were used to compare these groups.Results: In total, 338 MwA attacks were recorded in analyzed groups. Scotoma was the most frequently reported symptom in the groups, followed by somatosensory aura in the MwA-C group and zig-zag lines in the MwA-MC and MwA-S groups. Patients in the MwA-C and MwA-MC groups had a thicker cortex in the left primary visual cortex with respect to MwA-S group. In addition, patients in the MwA-C group had a thicker cortex in several visual and somatosensory cortical regions relative to the MwA-S group.Conclusions: Our results show that the newly developed MACS can be used for the stratification of MwA patients, herewith allowing the better investigation of changes in migraineurs' brains.

Purpose Of the Review: Although visual and somatosensory disturbances are the most common migraine aura (MA) symptoms, patients can also experience other symptoms during their MA. The aim of this review is to provide an overview of studies that report symptoms of dysphasia and other higher cortical dysfunctions (HCDs) during MA, as well as to determine the frequency of HCDs.Recent Findings: Five studies met the inclusion criteria, corresponding to 697 patients overall. The most frequently reported HCDs were those of the language group (range 10-53%). The occurrence of visual HCDs was noted in 12-40 patients, somatosensory HCDs in 12-20%, and memory disturbances in 10-22% of the patients during MAs. MA is associated with a wide range of neurological symptoms, including symptoms of HCD. A better strategy for investigation of the HCD symptoms is needed to correctly stratify patients thus allowing meaningful studies of aura pathophysiology. [ABSTRACT FROM AUTHOR]

Study Design: Videoflurographic swallowing study in asymptomatic volunteers.Objective: The purpose of this study was to investigate the relationship between the severity of dysphagia and various parameters of the subjects.Summary Of Background Data: Occipitocervical fixation is associated with several potential complications. Malalignment of craniovertebral junction and associated dysphagia have been well described in the literature. However, there has been little attention given to investigate the association between the degree of swallowing dysfunction and various patient's parameters.Methods: Thirty-nine healthy asymptomatic volunteers, 18 males and 21 females, were enrolled in this study. Based on videofluorographic swallowing study (VFSS), two scoring systems of swallowing dysfunction (dysphagia rating scale [DRS], dysphagia outcome and severity scale [DOSS]) were measured in neutral and retraction position. Multiple linear regression analysis was performed to evaluate the relationship between the degree of swallowing dysfunction and various factors of the subjects such as radiological and clinical parameters.Results: There was statistically significant correlation between DRS and DOSS (r = -0.354, P < 0.05). Multiple regression analysis showed that there was a significant association of the dysphagia severity (DRS and DOSS) with the percentile change of the narrowest oropharyngeal diameter (OD) (%dn OD) (r = 0.121, P < 0.01 and r = 0.020, P < 0.01, respectively). Percentile change of OD (neutral and retraction position) was positively associated with the difference of C0-2 angle (r = 1.676, P < 0.01). None of the other variables such as age, sex, C0-1 angle, C1-2 angle, and C2-7 angle were significantly associated with the degree of dysphagia or %dn OD.Conclusion: This study demonstrated that the severity of dysphagia is significantly associated with the percentile change of OD and the C0-2 angle has considerable effect on the OD after O-C fusion. Therefore, C0-2 angle could be the most critical radiological parameter not only for predicting the stricture of oropharyngeal space but also for preventing postoperative dysphagia.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Manifestations of typical migraine aura can be numerous. Investigation of its pathophysiological mechanisms can be challenging if a stratification of phenotypes is not performed. In this context, the Migraine Aura Complexity Score (MACS), recently developed, may help. Here we aimed to categorize migraine patients into homogenous groups using MACS and to compare those groups with respect to patients' characteristics and neuroimaging findings. Methods: Participants who have a migraine with aura (MwA) were interviewed after each attack in order to obtain the characteristics of migraine aura. Thereafter, we scored the complexity of their auras by MACS. The MACS was used to categorize patients into three groups: MwA-S (with simple aura), MwA-MC (with moderately complex aura), and MwA-C (with complex aura). The patient characteristics and estimated cortical thickness of regions of interest, which are potentially linked to the symptoms that develop during the aura, were used to compare these groups. Results: In total, 338 MwA attacks were recorded in analyzed groups. Scotoma was the most frequently reported symptom in the groups, followed by somatosensory aura in the MwA-C group and zig-zag lines in the MwA-MC and MwA-S groups. Patients in the MwA-C and MwA-MC groups had a thicker cortex in the left primary visual cortex with respect to MwA-S group. In addition, patients in the MwA-C group had a thicker cortex in several visual and somatosensory cortical regions relative to the MwA-S group. Conclusions: Our results show that the newly developed MACS can be used for the stratification of MwA patients, herewith allowing the better investigation of changes in migraineurs' brains. [ABSTRACT FROM AUTHOR]

Background Communication disorders and dysphagia are debilitating sequelae associated with stroke. Speech and Language Therapy (SLT) has a pivotal role in stroke rehabilitation, and in improving outcomes. The research into dysphasia, dysphagia, and dysarthria post-stroke is extensive. In comparison, the research into cognitive-communication difficulties post-stroke is still emerging. Cognitive-communication difficulties (CCDs) are communication impairments resulting from underlying cognitive deficits due to neurological impairments1. The aim of this audit was to review SLT referrals in an Irish Stroke Rehabilitation Unit. Methods Single-centre retrospective review of all stroke admissions from January to December 2018. Communication outcomes were assessed using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM)2 a 7-point disability rating scale. Standard Bayesian statistics were employed for analysis. Results SLT received referrals for 66% (n=41) of all stroke admissions (n=62). Mean age was 68 years (SD+/-14), compared with 70 years (SD+/-14) for patients not referred. 65% were female and 35% male. Patients requiring SLT had significantly longer length of stay (p=0.0072). 83% of referrals were for communication, 12% dysphagia, and 5% inappropriate. Of communication referrals, primary diagnoses were as follows: 17.5% dysarthria (n=6), 26.5% dysphasia (n=9) and 56% CCD (n=19). Patients with dysphasia showed greater improvement in FIMFAM scores (x̄=1.3) than those with CCD (x̄=0.9) or dysarthria (x̄=0.7). Patients with CCD comprised the largest cohort who required SLT on discharge (68%). Conclusion CCDs are highly prevalent and represented the largest subtype of communication disorders in this cohort. FIMFAM scores appear useful in assessing CCDs however they display insufficient sensitivity in capturing change within this population. This audit highlights the need for further interdisciplinary research, education and training into cognitive-communication difficulties with post-stroke populations. [ABSTRACT FROM AUTHOR]

Background: Functional neurological disorder (FND) is common across healthcare settings. The Diagnostic and Statistical Manual of Mental Disorders states that speech and swallowing symptoms can be present in FND. Despite this, there is a dearth of guidelines for speech and language therapists (SLTs) for this client group. Aims: To address the following question in order to identify gaps for further research: What is known about speech, language and swallowing symptoms in patients with FND? Methods & Procedures: A scoping review was conducted. Six healthcare databases were searched for relevant literature: CINAHL PLUS, MEDLINE, ProQuest Nursing and Allied Health Professionals, Science Citation Index, Scopus, and PsychINFO. The following symptoms were excluded from the review: dysphonia, globus pharyngeus, dysfluency, foreign accent syndrome and oesophageal dysphagia. Main Contribution: A total of 63 papers were included in the final review; they ranged in date from 1953 to 2018. Case studies were the most frequent research method (n = 23, 37%). 'Psychogenic' was the term used most frequently (n = 24, 38%), followed by 'functional' (n = 21, 33%). Speech symptoms were reported most frequently (n = 41, 65%), followed by language impairments (n = 35, 56%) and dysphagia (n = 13, 21%). Only 11 publications comment on the involvement of SLTs. Eight papers report direct speech and language therapy input; however, none studied the effectiveness of speech and language therapy. Conclusions & Implications: Speech, language and swallowing symptoms do occur in patients with FND, yet it is a highly under‐researched area. Further research is required to create a set of positive diagnostic criteria, gather accurate data on numbers of patients with FND and speech, language or swallowing symptoms, and to evaluate the effectiveness of direct speech and language therapy involvement. [ABSTRACT FROM AUTHOR]

Sporadic Creutzfeld-Jakob disease (CJD) is a rare neurodegenerative disorder. It is uniformly fatal. Clinical signs include myoclonus, visual disturbances, cerebellar ataxia, akinetic mutism and pyramidal/extrapyramidal signs in addition to a rapidly progressive dementia. Premortem diagnosis is challenging due to the rarity of the condition and the subsequent low index of suspicion held for it. On literature review, isolated language impairment as the first neurological symptom occurs in only about 1% of patients with sporadic CJD (El Tawil et al. (2017, Acta Neurol Scand, 135: 316–23)). We present this patient's case, marked for the unusual presentation and the rapidity of decline, to emphasise the need for awareness of CJD as an important differential diagnosis on stroke units. In our case, magnetic resonance imaging findings drove the suspicion of sporadic CJD as the diagnosis. This seems to correlate with other case reports recognising CJD presenting with progressive aphasic disorders (Terrin et al. (2017, Neurol Sci, 38: 1535–7); Mandell et al. (1989, Neurology, 39: 55–8); Martory et al. (2012, Eur Neurol, 67: 360–2)). [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case control study.Objective: To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH).Summary Of Background Data: DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.Methods: We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O-C2 angle, M-C angle, C2-7 angle, and C2-6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre- and postoperative values in the S group.Results: The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22-27]) compared with the NS group (1 [1-6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0-1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2-7 and ΔC2-6a, and between pre- and postoperative values in the S group. There were no significant changes in O-C2 angle and M-C angle, which are parameters of the superior cervical vertebrae.Conclusion: The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Drug delivery by the oral route is the most prescribable and acceptable route in terms of patient’s compliance. Improvement of patient’s compliance has always a challenge towards the development of oral drug delivery system. In the market different types of oral dosage forms are available in which tablets, capsules, syrups, suspensions are preferred ones. Oral solid drug delivery faces drawback in case of swallowing especially with paediatrics and geriatric psychotic patients. Therefore scientists attracted towards fast mouth dissolving drug delivery systems to encounter existing problems with unique property of palatability and rapid disintegration. The concept of fast dissolving tablet came into existence in late 1970 and further improvements are still going on in connection with its preparation and methodology. Fast dissolving tablets have faster disintegration and dissolution rate and releases within 30 seconds as they come in contact with saliva. These systems also obviate the requirement of carry water during drug administration. This facilitate drug delivery to the patients of dysphasic, psychic, paediatrics, geriatric and bed-ridden, unconscious population. As fast dissolving tablets falls under desired expectation of safer, convenient and economical solid dosage forms, several techniques have been developed to improve disintegration quality in the recent past years. This article mainly focuses on formulation and evaluation technologies with recent advancement made so far in the field of fast dissolving tablets. [ABSTRACT FROM AUTHOR]

Résumé Objectif Explorer les caractéristiques intrapsychiques de jeunes enfants atteints de déficits langagiers afin de mieux comprendre leurs ruptures comportementales. Méthode Dix jeunes patients (4–8 ans) consultant en clinique psychiatrique ont été sélectionnés en fonction de la présence ou non de crises de colère et d'un déficit langagier. Leurs réponses suite à l'administration d'épreuves projectives ont été analysées avec la Grille d'analyse développée par l'école de Lausanne. Résultats Les profils des enfants se distinguent selon qu'ils présentent ou non des crises de colère. Les enfants en trouble langagier sans rupture comportementale ont une meilleure assise narcissique malgré un sentiment chronique d'incapacité et ont pu développer des capacités de mentalisation et d'autorégulation, soutenues par des processus de pensée plus structurants. Les enfants présentant des crises de colère ont des angoisses plus archaïques (morcellement, angoisse d'abandon) qu'ils souffrent ou non d'un déficit langagier. Le profil langagier ne détermine pas la présence de crises de colère. Discussion Les résultats permettent de distinguer deux profils du monde interne de ces enfants en fonction de la présence de crises de colère et soutiennent le caractère transnosographique du trouble de langage. Les indices de pathologies limites sont seulement observés chez les enfants qui présentent également une rupture comportementale. Conclusion Les méthodes projectives sont utiles pour mieux comprendre la spécificité du déploiement du trouble langagier chez les enfants qui consultent en clinique psychiatrique. Les évaluations et traitements offerts doivent tenir compte à la fois des aspects développementaux, relationnels et affectifs dans une perspective intégrative incluant les parents. Les milieux cliniques doivent être mieux informés de la forte prévalence des déficits langagiers chez les enfants qui y consultent et intégrer cette compréhension aux interventions proposées. Abstract Objective To help document underlying mechanisms that could explain the marked comorbidity between emotional and behavioural problems and language deficits, the present study looked at the contribution of projective measures to a better understanding of young language-disordered children's inner lives. Method Responses to projective assessment of ten consulting children with and without behavior problems and language disorder were analysed using the Swiss Lausanne model, and compared. Results Two distinct profiles were evidenced, distinguishing children with behavioral dysregulation, and those without. Children with a language disorder but without behavioural disorder showed chronic feelings of incapacity, but not necessarily an altered narcissistic base. They had developed mentalisation and self-regulation abilities, underpinned by more structured thought processes. Children presenting persistent tantrums showed more archaic defence mechanisms (fear of abandonment, fragmentation) whether or not they also presented a language deficit. The language skills profile does not determine the presence of tantrums and anger. Discussion Language deficits do not preclude children from developing satisfactory mentalisation and self-regulation. Assessment and treatment should integrate developmental, relational and affective aspects that move beyond the traditional opposition between internal conflicts versus biological causes of their developmental difficulties. Conclusions Projective measures are a useful part of the overall assessment of language-disordered children consulting in psychiatric settings. All clinicians should be more aware of the high prevalence of language deficits found among consulting children of all ages (71%) and should propose interventions that integrate all aspects of the child's functioning. Treatments should also include parents, without whom successful and tailored childcare is impossible. [ABSTRACT FROM AUTHOR]

Background: Aphasia is the most disabling functional defect after ischemic stroke. It affects more than a third of all stroke victims. Effective therapeutic strategies are needed to treat aphasic patients. Novel techniques, such as methods of delivering cortical brain stimulation to modulate cortical excitability, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), are just beginning to be explored. The purpose of repetitive transcranial magnetic stimulation (rTMS) application in the neurorehabilitation of aphasic patients is to act on specific networks involved in the pathophysiology of language processing and to promote adaptive cortical reorganization after stroke. TMS was shown to have lasting effects on cortical excitability that persisted beyond the actual stimulus delivery. Given the ability of this treatment to modulate cortical activity in a focal way, focus was soon placed on the use of this technique in various neurological and psychiatric diseases such as aphasia. Aim of the work: The aim of this work is to evaluate the effect of Transcranial Magnetic Stimulation as a therapy for dysphasia in order to promote an evidence-based practice. This will be made by conducting a systematic review of literature in this topic area. Materials and Methods: This was a systematic review. Seven electronic databases (Medline, Google scholar, CINHAL, Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Embase) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed. Results: The literature search yielded 5097 studies. Twenty-six articles were further evaluated to be included. Eleven studies met all inclusion criteria and were chosen for review. The studies provided moderate to strong evidence that rTMS may be an effective treatment for non-fluent stroke aphasia. We have found significantly higher scores on the language assessment scales of patients after the rTMS treatment than those with sham TMS treatment, in most of the included studies. The studies reviewed here established the beneficial effect of rTMS in multiple language domains. The domain of naming is the most affected, with almost all studies demonstrating improvement in naming after stimulation. Conclusion: The current systematic review suggests that inhibitory low frequency rTMS with 90% resting motor threshold (rMT) targeting pars triangularis of the right inferior frontal gyrus can improve multiple language domains in right-handed post-ischemic stroke patients. [ABSTRACT FROM AUTHOR]

The problems of speech and language disorders on children with central nervous system disorders are dealt with in the literature of the subject from the perspective of various disciplines – medicine, linguistics, pedagogy, psychology and speech therapy. However, there are no clear definitions in the literature of semantic terms, the clinical picture, the substance of the disorder and their etiopathogenesis. Diagnosis of raised disorders in neurologically impaired children is a structured and multi‑specialist procedure using neurological, linguistic and psychological data, further impeded by ambiguity in the criteria for their description. In practice, a variety of approaches to naming and defining these disorders often stumbles on the discrepancies in the diagnosis, which leads to errors in communication between specialists. This article discusses the case of a four‑year‑old child with intrauterine hypothyroidism and second‑degree intraventricular haemorrhage with speech and language disorders, the example of which is terminological discrepancies.