National Institutes of Health Stroke Scale: comparison of original and modified versions for Singapore culture

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.

Standard Recipes for the Preparation of Thickened Barium Liquids Used in the Diagnosis of Dysphagia

Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%–3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%–3.0% thickener concentrations. The apparent viscosity (η(a),₅₀) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.

Dysphasia due to Oral Anomaly / 대한연하장애학회지

Dysphasia related to oral anomaly is a common situation in oral and maxillofacial surgery. The etiology of oral anomalies causing dysphasia can be divided into congenital and acquired disease. Congenital diseases include teratoma or benign tumors and congenital defects such as cleft lip and palate. Benign tumors include cystic hygroma in the neck and hemangioma in the tongue. Certain syndromes with macroglossia and micrognathia are also related to difficulty in swallowing. The three common syndromes are Pierre-Robin syndrome, Beckwith-Widermann syndrome and ectodermal dysplasia. Taken together, these congenital diseases require a multi-discipline approach to obtain optimal results. Representative disease of acquired dysphasia is the oral cavity cancer. Cancer ablation results in tissue defect and decreased motor function. Free flap reconstruction is the choice of treatment following oral cavity caner operation; however, dysphasia after cancer operation is inevitable. In this review article, the full scopes of oral anomaly associated with dysphasia were classified and treatment was suggested.

Migraine with Aura: Surface-Based Analysis of the Cerebral Cortex with Magnetic Resonance Imaging

OBJECTIVE: Previous migraine studies have reported gray matter alterations in various cortical regions with conflicting results. This study aimed to explore a cortical morphometric difference in migraineurs with aura (MA) compared to healthy subjects (HS) and to delineate a possible difference between the cortical morphological features and different aura phenotypes. MATERIALS AND METHODS: Forty-eight MA and 30 HS that were balanced by sex, age, and educational level were selected for this study. T2-weighted and three-dimensional T1-weighted magnetic resonance imaging (MRI) of the brain were acquired using a 1.5T MRI scanner. Surface-based morphometry from the MRI data was used to identify differences between the MA and HS group, and then between MA subgroups. The MA group was subdivided into migraineurs who experienced only visual aura (MVA) and migraineurs who had visual, somatosensory and dysphasic symptoms (MVA+). RESULTS: The MVA+ group had significantly reduced cortical surface area of the left rostral middle frontal cortex compared with the MVA group (p < 0.001). Migraine patients had significantly reduced volume of the left fusiform gyrus relative to HS (p < 0.001). Also, the sulcal depth increased at the level of the left temporal pole in the MVA+ group relative to the MVA group (p < 0.001). The vertex-by-vertex analysis did not exhibit any significant difference in cortical thickness between MA and HS, and between MVA+ and MVA, when corrected for multiple comparisons. CONCLUSION: Migraineurs with aura demonstrates different morphometric features from HS in multiple cortical regions. MVA+ have different morphometric features in the left frontal and temporal lobe relative to MVA, which could be a source of distinct symptoms and serve as potential biomarkers of different MA subtypes.

Dental Problems Associated with Radiation Therapy / 대한연하장애학회지

Dental problems associated with radiation therapy are difficult to treat because of the irreversible nature of radiation therapy and permanent tissue damage. Common oral complications include oral mucosa ulceration, xerostomia, and radiation caries. Other oral complications found infrequently are mouth opening limitation and osteonecrosis of the jaw bone. The acute complication of oral ulceration is associated with dysphagia. In addition, delayed complications, such as xerostomia and dental caries, could lower the quality of life, particularly in terms of chewing and swallowing. The treatment of each complication is dependent on the condition and severity. Symptomatic treatment to relieve pain and discomfort is typical for oral complications. Surgical and radical resection is required for the advanced stage of osteoradionecrosis. In this review, oral complications and their treatments are suggested for clinical guidance.

Prosthetic Treatment after Oral Cancer Ablation / 대한연하장애학회지

Ablative surgery for oral cancer treatment results in tissue defect. Large tissue defect requires free flap reconstruction that requires long operation time. Maxillectomy involves the teeth and maxilla that separates the maxillary sinus and nasal cavity from oral cavity. Resection of the maxilla causes oro-antral or oro-nasal fistula, which results in difficulty while chewing and swallowing. Regurgitation of the ingested food into the maxillary sinus or nasal cavity makes it difficult for a patient to digest. Obliteration of the fistula is the most important part of dental prosthesis in patients who underwent maxillectomy. Local flap is indicated when the fistula is less than 10mm, however, larger sized defects are closed with free flap or obturator. The decision of treatments should be based on patient's general condition, risk of recurrence, size of the defect and financial aspect.

Advance of Transcranianl Direct Current Stimulation for Dysphagia after Stroke (review) / 中国康复理论与实践

Dysphasia is a fatal complication of stroke, and may result in other complications. Transcranial direct current stimulation (tDCS) is helpful for the recovery of dysphasia associated with stroke, which may involve in the polarity and cerebral plasticity. There are advantages and disadvantages of tDCS compared with repetitive transcrnial magnetic stimulation.

Effectiveness and Safety of Resuscitation-inducing Acupuncture for Post-stroke Dysphasia:A Systematic Review / 广州中医药大学学报

Objective To systematically evaluate the effectiveness and safety of resuscitation-inducing acupuncture for post-stroke dysphasia. Methods The randomized controlled trials ( RCTs) of resuscitation-inducing acupuncture for post-stroke dysphasia were searched in the domestic and overseas databases such as CBM, CNKI, Weipu VIP, Wanfang Data, PubMed, Web of Science, EMbase and the Cochrane Library ( from the founded date to December of 2014) . Literature screening, information extracting and literature quality assessment were done by 2 reviewers independently. RevMan5.3.0 software was used for Meta analysis. Results A total of 8 RCTs were included into the analysis, involving in 766 cases. The results of Meta analysis showed:( 1) for patients in the recovery stage of stroke, 4-week resuscitation-inducing acupuncture combined with routine treatment including internal medicine plus swallowing function training or not had better efficiency than the control group without resuscitation-inducing acupuncture (P<0.001) ; (2) for patients in the acute stage, the difference of efficiency between the combination group and the control group was insignificant (P=0.05); (3) The efficiency of resuscitation-inducing acupuncture combined with routine treatment for the complication of pulmonary infection stayed uncertain. Conclusion Resuscitation-inducing acupuncture combined with routine treatment is recommended to the patients with dysphasia in the recovery stage of recovery. But the cure time window, treatment course and effectiveness evaluation still need to be confirmed by more large-scale, high-quality randomized controlled trials.

Le symptôme dans la psychothérapie d'un enfant dysphasique. analyse de sa fonction dynamique dans une perspective psychanalytique / O sintoma na psicoterapia de uma criança disfásica. análise da sua função dinâmica a partir de uma perspectiva psicanalítica / The symptom in the psychotherapy of a dysphasic child. analysis of his dynamic function from a psychoanalytical perspective / El síntoma en la psicoterapia de un niño disfásico. análisis de su función dinámica desde una perspectiva psicoanalítica

Dans cet article, à partir d'un cas clinique, nous analysons la spécificité de la prise en charge psychothérapeutique de l'enfant dysphasique. Notre objectif principal est de montrer comment la succession de moments logiques donne une place à chaque fois nouvelle au symptôme. L'étude du déroulement de la séquence clinique, permet d'interroger la valeur du symptôme et son lien indissociable à la parole, dans la relation transférentielle, pour rendre compte du processus de subjectivation à l'œuvre chez cet enfant. En outre, ce travail amène à préciser la particularité de la démarche psychothérapeutique par rapport à celles des autres professionnels intervenant auprès des enfants dysphasiques.

Neste artigo analisamos a especificidade da cobertura psicoterapêutica de crianças com disfasia a partir de um caso clínico. Trata-se aqui de mostrar a sucessão de momentos lógicos que dão um lugar cada vez novo aos sintomas. A seqüência clínica vai permitir-nos a questionar o valor do sintoma e sua ligação inseparável com a palavra na relação de transferência para refletir o processo de historicização da subjetividade da criança. Além disso, este percurso vai permitir-nos situar a especificidade da abordagem psicoterapêutico comparados aos de outros profissionais que trabalham com crianças com disfagia.

In this article we analyze the specificity of the psychotherapy of a dysphasic child, based on a clinical case. Our aim is to show the succession of logical moments that give ever newer places to the symptom. The study of a particular clinical sequence will allow us to question the value of the symptom and its inseparable association with speech in the transference relationship, in order to discuss the "subjectivation" process at work in this child. This discussion will also allow us to situate the main specific characteristics of the psychotherapeutic approach as compared to approaches of other professionals who treat dysphasic children.

En este artículo, a partir de un caso clínico, analizaremos la especificidad del tratamiento psicoterapéutico de un niño disfásico. Nuestro objetivo principal es mostrar como la sucesión de momentos lógicos confiere en cada momento una nueva posición al síntoma. El estudio del desarrollo de la secuencia clínica, permite interrogar el valor del síntoma y su relación indisociable con la palabra, en la relación transferencial, lo que permite reflexionar sobre el proceso de historización de la subjetividad del niño en el caso considerado. Además, este recorrido nos permitirá precisar la particularidad del trabajo psicoterapéutico respecto al de otros profesionales que intervienen en el tratamiento de niños con disfasia.

Reversible Dysphasia and Statins

This paper presents a case of reversible dysphasia occurring in a patient prescribed atorvastatin in combination with indapamide. A milder dysphasia recurred with the prescription of rosuvastatin and was documented on clinical examination. This resolved following cessation of rosuvastatin. The case highlights both a need for a wider understanding of potential drug interactions through the CYP 450 system and for an increased awareness, questioning and reporting of drug side-effects.

Usefulness of Videofluoroscopic Swallow Study with Mixed Consistency Food for Patients with Stroke or Other Brain Injuries

This study evaluated the feasibility of mixed consistency foods test in patients with dysphagia which developed after stroke or other brain injuries. The findings of a videofluoroscopic swallow study (VFSS) were compared using single versus mixed consistency foods. Forty-nine patients with stroke or other brain injuries who had no significant abnormal findings in the single consistency food VFSS and started regular hospital diet were recruited for this study. Twenty-five (51%) of the 49 patients showed normal findings whereas 24 (49%) patients showed abnormal findings in the mixed consistency food VFSS. Abnormal findings included posterior spillage of liquid prematurely to pyriform sinus (n = 23), laryngeal penetration (n = 6), subglottic aspiration in the oral preparatory phase of swallowing (chewing), solid components (n = 2), and significant (more than 10%) residue in valleculae or pyriform sinus (n = 2). There was an increased risk of abnormal findings in mixed consistency food VFSS such as aspiration and penetration when a patient showed delayed pharyngeal delay time in single consistency food using liquids. In conclusion, VFSS protocols using mixed consistency foods would be useful before starting regular diet for patients after stroke or other brain injuries.

Exposure to radiation in videofluoroscopic swallowing studies:A neglected issue / 中华物理医学与康复杂志

Objective To investigate the radiation exposure of patients during videofluoroscopic swallowing studies (VFSSs) through literature study. Methods The English literature was searched using PUBMED with the search expression:(radiation) AND (swallow) AND (MBS OR VFSS OR barium OR dysphagia).The Chinese lite-rature was searched using CNKI with the search expression:(FT=dysphagia+deglutition disorder+swallowing function disorder) and (FT=radiation exposure+radiation injury+radiation protection+radiation+radiation dose). Results PUBMED returned 11 original articles and one review article focusing on the radiation exposure of patients during a VFSS.In addition,there were two review articles which mentioned this issue.These studies were published from 1990 to 2009.No original or review article was found through CNKI searching.Conclusions Radi-ation exposure of patients during a VFSS is an issue that has been neglected in China.

A Case of Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery in an Adolescent / 대한소화기내시경학회지

Dysphagia lusoria is used to describe the symptomatic compression of the esophagus from an anomalous vessel of the aortic arch. A right aortic arch with an aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then an aberrant right subclavian artery. These anomalous vessels may cause dysphagia from the compression of the esophagus in adults, but they usually do not produce symptoms and they are usually found incidentally. Several cases of adult dysphagia lusoria have been reported in Korea, but there has been no reported case in an adolescent. We experienced a case of a 17-year-old female who suffered from dysphagia. We evaluated the possible causes of her dysphagia by performing esophagogastroduodenoscopy, esophagoraphy, esophageal manometry and chest computed tomography. We finally diagnosed this case as dysphagia lusoria caused by an aberrant right subclavian artery.

Clinical Study on Acupuncture Treatment of Dysphasia in 80 Hypophrenia Children / 针灸推拿医学（英文版）

Objective: Investigate the curative effect of acupuncture on dysphasia in hypophrenia children. Methods: One hundred and sixty children with hypophrenia and dysphasia were randomly divided into an acupuncture group of 80 cases, a language training group of 40 cases and a composite group of 40 cases for clinical observation. Total intelligence quotient (TIQ), vocal intelligence quotient (VIQ) and practical intelligence quotient (PIQ) were compared between pretreatment and posttreatment in the children themselves and between the groups before and after treatment. Results: The total efficacy rate was 77.5% in the acupuncture group, 82.5% in the composite group and 52.5% in the language training group. Conclusion: Acupuncture significantly raises TIQ, VIQ and PIQ in the sick children. Language training only raises VIQ to some degree.Acupuncture in cooperation with language training is an effective way to treat this disease.

Effects of communication method improvement on patients with stroke dysphasia / 中国康复理论与实践

@#ObjectiveTo study the effect of improving communication methods on decreasing the depression of pstients with stroke dysphasia.Methods16 patients with stroke dysphasia communicated with carton cards,body signal.All the patients were assessed by Hamilton Depression Scale(HAMD) in admission day, one week and two weeks later.ResultsAfter two weeks, the patients' depressive level was decreased from(24.2±8.4) to(13.4±6.7)(P<0.001), the symptom of depression reduced 81.2%.ConclusionsImproving communication methods can decrease the depressive level of the patients with stroke dysphasia.

Prevalence and risk factors of bronchopulmonary dysphasia in neonates who requiring mechanical ventilation.

To find the prevalence and risk factors of bronchopulmonary dysphasia (BPD) in neonates requiring ventilator support, a retrospective study was performed of neonates admitted to the Pediatric Intensive Care Unit, Department of Pediatrics, Siriraj Hospital during January 1990-January 1992. Of the 195 neonates who were admitted, sixty-eight died before the age of 28 days. The data was analyzed from 107 neonates; 48.6% of the infants weighed less than 1,500 gm. According to Bancalari’s criteria, forty infants (37.4%) suffered from BPD. The mean birth weight and gestational age in the non BPD group was statistically significant higher than the BPD group (1,783 gm, 37 wk vs 1,486 gm, 30 wk). From this study, the incidence of prematurely, patent ducts arterioles, the amount and duration of oxygen therapy, peak inspiratory pressure (PIP), mean airway pressure (MAP) and amounts of fluid therapy during the first 7 postnatal dais in the BPD group are all statistically higher than in the non BPD group. The etiology of BPD may be multifactorial, but prematurely and oxygen toxicity seem to be the two most important factors. Prevention of prematurely, administration of artificial surfactant as an initial therapy for respiratory distress syndrome, the avoidance of barotrauma by using the lowest PIP to maintain PaO2, PaCO2, and the implementation of transcutaneous oxygen saturation monitoring, may decrease the incidence of BPD in these high risk neonates.