Interjudge Agreement in Videofluoroscopic Studies of Swallowing

1996 ◽  
Vol 39 (1) ◽  
pp. 144-152 ◽  
Author(s):  
Felicia Wilcox ◽  
Julie M. Liss ◽  
Gerald M. Siegel
Keyword(s):  
Motor Control ◽  
Treatment Strategy ◽  
Treatment Strategies ◽  
Speech Language Pathologists ◽  
Oral Motor ◽  
Observation Protocol ◽  
Patient’S History

Videofluoroscopic swallowing examinations of 3 patients with dysphagia were reviewed independently by 10 speech-language pathologists. Prior to viewing each video, clinicians were provided with information about the patient's history, the results of a bedside swallow examination, and oral-facial and oral motor control examinations. Clinicians completed a swallowing observation protocol as they viewed each video. They then recommended, from a list of treatment strategies, intervention techniques that would be most appropriate for each patient. Interjudge agreement was calculated by determining how many clinicians observed a given swallowing event or deficit, and how many recommended a given treatment strategy. Results suggest that the level of interjudge agreement for videofluoroscopic evaluations is not encouragingly high.

scholarly journals Study protocol: randomised controlled trial evaluating exercise therapy as a supplemental treatment strategy in early multiple sclerosis: the Early Multiple Sclerosis Exercise Study (EMSES)

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043699
Author(s):  
Morten Riemenschneider ◽  
Lars G Hvid ◽  
Steffen Ringgaard ◽  
Mikkel K E Nygaard ◽  
Simon F Eskildsen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomised Controlled Trial ◽  
Usual Care ◽  
Treatment Strategy ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
Control Group ◽  
Disease Course ◽  
Disability Progression ◽  
Randomised Controlled

IntroductionIn the relapsing remitting type of multiple sclerosis (MS) reducing relapses and neurodegeneration is crucial in halting the long-term impact of the disease. Medical disease-modifying treatments have proven effective, especially when introduced early in the disease course. However, patients still experience disease activity and disability progression, and therefore, supplemental early treatment strategies are warranted. Exercise appear to be one of the most promising supplemental treatment strategies, but a somewhat overlooked ‘window of opportunity’ exist early in the disease course. The objective of this study is to investigate exercise as a supplementary treatment strategy early in the disease course of MS.Methods and analysisThe presented Early Multiple Sclerosis Exercise Study is a 48-week (plus 1-year follow-up) national multicentre single-blinded parallel group randomised controlled trial comparing two groups receiving usual care plus supervised high-intense exercise or plus health education (active control). Additionally, data will be compared with a population-based control group receiving usual care only obtained from the Danish MS Registry. The primary outcomes are annual relapse rate and MRI derived global brain atrophy. The secondary outcomes are disability progression, physical and cognitive function, MS-related symptoms, and exploratory MRI outcomes. All analyses will be performed as intention to treat.Ethics and disseminationThe study is approved by The Central Denmark Region Committees on Health Research Ethics (1-10-72-388-17) and registered at the Danish Data Protection Agency (2016-051-000001 (706)). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences.Trial registration numberNCT03322761.

scholarly journals 18F-FDG-PET/CT Plays a Key Role in Formulating Treatment Strategies for Takayasu Arteritis

2020 ◽  
Author(s):  
Qing Han ◽  
Xiang Zhou ◽  
jin ding ◽  
zhaohui zheng ◽  
Fei Kang ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Fdg Pet ◽  
Clinical Remission ◽  
Treatment Strategies ◽  
Pet Ct ◽  
Significant Difference ◽  
Remission Criteria ◽  
Study Population ◽  
Predominantly Female ◽  
Fdg Pet Ct

Abstract Backgroud and Objective: Clinical evaluation alone cannot satisfy the prognosis of TAK. PET-CTmolecular imaging may be a useful tool to supplement the prognosis of TAK. The purpose of this study was to observe whether THE TAK patients who achieved clinical remission also achieved imaging remission with PET-CT. Pet-ct plays an important role in the prognosis of TAK patients and further formulation of treatment strategy.Results: 79% patients with TAK in remission were positive for 18F-FDG-PET /CT. The study population had a mean age of 38.8 years and was predominantly female (90%). Their mean disease duration was 3.5 years and they had a mean disease remission period of 9.4 months. Patients had a mean ESR of 37.3 mm/h and a mean CRP level of 13.5 mg/l at the first dignosis time and 4.9 mm/h/3.7 mg/l at the Courrent time point. There was a statistically significant difference between the two groups (p<0.01). All patients on initial treatment received oral glucocorticoids, 25% received methotrexate, 65% received leflumide, and 45% received cyclophosphamide. Quantitative analysis of the SUV of nineteen patients showed an increasing trend (Baseline SUVmax 2.16±0.46 vs Remission SUVmax 2.08±0.49, p=0.56; Baseline SUVmean 2.34±0.57 vs Remission SUVmean 2.42±0.81, p=0.46). The arterial SUVmax uptake was higher in 15 patients with remission than baseline (2.30 ± 0.62 vs 2.48 ± 0.91, p = 0.54). But it was not statistically significant. Most of the patients (13/19, 68%) had an SUVmax value ≥ 2.0 in visual vasculitis with positive PET/CT before treatment, and 32% ＜2.0. No correlation was found between the type of treatment used, the time that elapsed from remission, or laboratory parameters and the scintigraphic results. Conclusion: TAK's clinical remission criteria are not entirely consistent with actual vascular inflammatory activity. Patients with TAK that achieve clinical remission may not achieve imaging remission with PET-CT, and PET-CT plays an important role in the prognosis of TAK patients and further formulation of treatment strategy.

How Can Speech-Language Pathologists Think About Sensation During Swallowing Evaluation and Intervention?

2021 ◽  
pp. 1-11
Author(s):  
Aarthi Madhavan ◽  
Nicole M. Etter
Keyword(s):  
Behavioral Treatment ◽  
Sensory Information ◽  
Treatment Strategies ◽  
Clinical Importance ◽  
Functional Results ◽  
Future Research ◽  
Speech Language Pathologists ◽  
Swallowing Evaluation ◽  
Assessment And Treatment ◽  
Swallowing Assessment

Purpose Both the enjoyment of foods and safe swallowing revolve around incorporating multiple streams of sensory feedback to form a positive sensory experience; these include information about the taste, smell, texture, temperature, and even the sight of food. Traditional swallowing assessment and treatment paradigms have primarily focused on the motor aspects of swallowing. However, sensory information is vital for not only enjoying foods while eating but also coordinating safe and efficient swallow behaviors. The purpose of this clinical focus article is to discuss the clinical importance of sensation in swallowing evaluation and intervention. Conclusions During their clinical assessments of swallowing, speech-language pathologists are already documenting the functional results of oropharyngeal sensorimotor impairments (e.g., residue). A combination of sensory and motor aspects is already integrated within current behavioral treatment strategies for dysphagia. Focused attention to the salient sensory features of swallowing has the potential to improve swallowing evaluation and intervention efforts. A discussion of potential future research in improved measurement and documentation of altered sensation is provided.

Abstract 245: Risk of Readmission With Recurrent Myocardial Infarction After Index Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Moses Anabila ◽  
Jeevanantham Rajeswaran ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Patient Outcomes ◽  
Treatment Strategy ◽  
Medical Center ◽  
Parametric Method ◽  
Treatment Strategies ◽  
Recurrent Myocardial Infarction ◽  
Acute Mi ◽  
Increasing Risk ◽  
Considerable Morbidity

Background: Recurrent Myocardial Infarction (MI) after an index MI is a cause for considerable morbidity and mortality. However, the underlying factors that precipitate patients for a recurrent MI remain unclear. We aimed to assess the effect of index MI treatment strategy on the risk of developing a recurrent MI. Methods: We reviewed all cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 and identified all cases of recurrent MI within 90 days after index MI. Readmissions were further stratified depending on the treatment strategy undertaken during index MI into medically managed and revascularized patients. The instantaneous risk of readmission following each of these treatment strategies was estimated by the parametric method. Results: We identified 6,626 patients admitted with an index MI, of which 168 patients were readmitted with a recurrent MI within 90 days. Among the index admissions, 4354 (66%) patients underwent revascularization and 2272 (34%) patients underwent medical management. Time-varying instantaneous risk of readmission analysis showed an early peaking risk followed by a late increasing risk in the revascularization group whereas, in the medically managed group, the analysis yielded an early peaking followed by a late almost constant risk of readmission for MI. Conclusion: Patients with acute MI who are medically treated are at a higher risk of developing a recurrent MI than patients who undergo revascularization. Defining the characteristics and underlying factors contributing to these readmissions can be pivotal in improving patient outcomes.

scholarly journals Diabetes Mellitus-Related Dysfunction of the Motor System

2020 ◽  
Vol 21 (20) ◽  
pp. 7485
Author(s):  
Ken Muramatsu
Keyword(s):  
Motor Control ◽  
Motor Neurons ◽  
Motor System ◽  
Corticospinal Tract ◽  
Experimental Studies ◽  
Sensory System ◽  
Treatment Strategies ◽  
Motor Deficits ◽  
New Perspective ◽  
The Brain

Although motor deficits in humans with diabetic neuropathy have been extensively researched, its effect on the motor system is thought to be lesser than that on the sensory system. Therefore, motor deficits are considered to be only due to sensory and muscle impairment. However, recent clinical and experimental studies have revealed that the brain and spinal cord, which are involved in the motor control of voluntary movement, are also affected by diabetes. This review focuses on the most important systems for voluntary motor control, mainly the cortico-muscular pathways, such as corticospinal tract and spinal motor neuron abnormalities. Specifically, axonal damage characterized by the proximodistal phenotype occurs in the corticospinal tract and motor neurons with long axons, and the transmission of motor commands from the brain to the muscles is impaired. These findings provide a new perspective to explain motor deficits in humans with diabetes. Finally, pharmacological and non-pharmacological treatment strategies for these disorders are presented.

scholarly journals Age‐related changes in oral motor‐control strategies during unpredictable load demands in humans

2020 ◽  
Vol 128 (4) ◽  
pp. 299-307
Author(s):  
Nabeel Almotairy ◽  
Abhishek Kumar ◽  
Nadia Welander ◽  
Anastasios Grigoriadis
Keyword(s):  
Motor Control ◽  
Control Strategies ◽  
Oral Motor ◽  
Age Related ◽  
Age Related Changes

scholarly journals Measuring and Training Speech-Language Pathologists’ Orofacial Cueing: A Pilot Demonstration

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Aravind Kumar Namasivayam ◽  
Rohan Bali ◽  
Roslyn Ward ◽  
Krystal Danielle Tieu ◽  
Tina Yan ◽  
...  
Keyword(s):  
Motor Control ◽  
Procrustes Analysis ◽  
Speech Language Pathologists ◽  
Treatment Delivery ◽  
Consistency Results ◽  
Objective Metrics ◽  
Kinematic Measures ◽  
Level Of Experience ◽  
Monitoring Treatment ◽  
Speech Motor

Tactile-kinesthetic-proprioceptive (TKP) input used to facilitate speech motor control is considered an active ingredient within speech motor interventions. Objective metrics identifying skill level differences across speech-language pathologists (S-LP) providing TKP cues are crucial for monitoring treatment delivery fidelity. The study examined three kinematic measures indicating accuracy and consistency of TKP inputs by 3 S-LPs with varying experience levels (S-LP 1: novice; S-LP 2 and S-LP 3: advanced). Confidence interval measures were used to compare the accuracy of jaw movement amplitudes of the vowel /a/ made by a model participant versus S-LPs giving the TKP input. Generalised Orthogonal Procrustes Analysis (GPA) and cyclic Spatial Temporal Index (cSTI) were used to determine movement consistency. Results revealed passive jaw excursions induced by S-LP 2 and 3 to be not statistically significant from the model participant’s active jaw movements. cSTI values decreased with advanced level of experience (19.28, 12.14, and 9.33 for S-LP 1, S-LP 2, and S-LP 3, respectively). GPA analyses revealed a similar pattern for S-LPs with more experience demonstrating lower mean RMS values (0.22, 0.03, and 0.11 for S-LP 1, S-LP 2, and S-LP 3, respectively). Findings suggest kinematic measures adapted from the motor control literature can be applied to assess S-LP skill differences in providing TKP cues.

Opinions of Speech-Language Pathologists Regarding Speech Management for Children With Cleft Lip and Palate

2019 ◽  
Vol 57 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Mary Hardin-Jones ◽  
David L. Jones ◽  
Riley C. Dolezal
Keyword(s):  
Early Intervention ◽  
Interest Group ◽  
Special Interest ◽  
Online Survey ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Strategies ◽  
Large Degree ◽  
Special Interest Group ◽  
Speech Language Pathologists

Objective:The purpose of the present study was to examine practice patterns and opinions that speech-language pathologists (SLPs) have about speech-language intervention for children with cleft lip and palate.Methods:One hundred seven speech-language pathology members of the American Speech-Language-Hearing Association Special Interest Group 5: Craniofacial and Velopharyngeal Disorders Special Interest Group completed a 37-item online survey that examined common practices in early intervention as well as opinions about speech characteristics, assessment, and management strategies for children with cleft lip and palate.Results:The overwhelming majority of respondents (96%) agreed that speech-language pathologists (SLPs) should meet with parents before palatal surgery to discuss speech-language issues. Although 90% of the SLPs identified increasing consonant inventory as an early intervention goal, lack of consensus was evident regarding the type of consonant to stimulate. Respondents agreed that while blowing activities are not useful in strengthening labial, lingual, or velopharyngeal movements, they are useful in heightening awareness of oral airflow for children with cleft palate. A large degree of variability was evident in opinions regarding prevalence and treatment of compensatory articulations as well as the effectiveness of treatment strategies designed to reduce perceived hypernasality and audible nasal emission.Conclusions:The findings of this study indicate a large degree of variability in opinions of SLP respondents regarding assessment and treatment of children with cleft lip and palate.

scholarly journals Treatment Strategies for Chronic Cases

2003 ◽  
Vol 8 (1) ◽  
pp. 37-39
Author(s):  
Susan M Lord
Keyword(s):  
Chronic Pain ◽  
Upper Limb ◽  
Treatment Strategy ◽  
Treatment Strategies ◽  
Shoulder Girdle ◽  
Somatic Pain ◽  
Levels Of Evidence ◽  
Whiplash Associated Disorders ◽  
Chronic Whiplash ◽  
Head Neck

The treatment of chronic somatic pain, including pain referred to the head, neck, shoulder girdle and upper limb from somatic structures, is addressed. Levels of evidence for the various treatments that have been prescribed for chronic whiplash associated disorders are considered. The challenge to find a treatment strategy for chronic pain after whiplash that completely relieves the condition and prevents its sequelae is reviewed.

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