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A Conversation Partner Scheme (CPS) can provide an opportunity for students to learn about acquired communication disorders, develop skills to support adults in conversations and reflect on their personal attitudes about communication disability. It can also enhance communication, facilitate social inclusion and participation and increase well-being for CPS partners with acquired communication disabilities. The format of a CPS generally includes conversation-training workshops followed by face-to-face supported conversations. The COVID-19 pandemic and associated public health guidance necessitated the transition of all components of the scheme (training and conversations) to an online format. The aim of this case study was to investigate the feasibility of an online CPS and explore the participants' experience of this format. A case study design was undertaken with feasibility objectives examining Implementation, Practicality, Adaption, Integration and Acceptability of the online CPS. Data was gathered from students using questionnaires. Online semi-structured interviews were carried out with seven persons with aphasia (PwA) who participated as CPS partners. Technical challenges, duration of conversations and topics of conversations were also recorded. Twenty-seven speech and language therapy students and 14 CPS partners took part in the CPS. Eighty-five online conversation sessions were carried out. All seven PwA and many of the students (87.5%) perceived an online format as suitable for CPS conversations. However, many students highlighted the value of in-person contact and reported that the online format constrained the use of some communication ramps. The PwA repeatedly commended their student conversation partners and noted the CPS provided an opportunity for increased social interaction during the public health restrictions. The online CPS provided a timely opportunity for students to practice supported communication skills and was perceived to be important for student training and communication skills development.
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BackgroundA black female in her 40s presented with a nonpruritic rash for 10 months consisting of bumps on the face, hands, forearms, and thighs. She had no prior treatment. Past medical history was significant for pulmonary embolism (PE) 6 years prior. She had no personal or family history of autoimmune disease. Physical exam revealed numerous smooth 2-3 mm skin-colored papules over the bilateral forearm dorsa, hands, anterior thighs, and face. Serum protein electrophoresis revealed monoclonal IgG lambda gammopathy. Skin biopsy of her left elbow showed dermal fibroplasia with mucin deposition. IgG was less than 1.5 grams/deciliter;bloodwork was otherwise stable. The diagnosis of scleromyxedema was rendered.ObjectivesThe objective of this clinical case was to evaluate a neurologic sequela of COVID-19 infection in a patient with scleromyxedema.MethodsOne month following diagnosis of scleromyxedema, our patient was diagnosed with COVID-19 five days before admission to the emergency department with altered mental status and aphasia. Rheumatology was consulted due to malignant hypertension and acute kidney injury with question of scleroderma-like renal crisis in the setting of recently diagnosed COVID-19 infection, although she had no other features of systemic sclerosis. The infectious disease team was consulted due to COVID-19-induced inflammatory reaction.ResultsThe patient's creatinine kinase and brain natriuretic peptide were elevated. Creatinine and potassium trended upwards. She developed seizures and became hemodynamically unstable with rapidly declining clinical status. She was transferred to the intensive care unit, where she developed respiratory arrest, shock, hyperkalemia, and acidemia. She received escalating doses of pressors but experienced frequent arrhythmic disturbances and developed asystole. Resuscitation efforts were unsuccessful;she expired within 24 hours of consultation.ConclusionDermato-neuro syndrome (DNS) is a potential complication of scleromyxedema associated with confusion, dysarthria, seizures, and coma. The patient's clinical presentation is consistent with DNS in the setting of scleromyxedema likely precipitated by COVID-19. Intravenous immunoglobulins are first-line treatment for scleromyxedema;however, it is associated with risk of venous thromboembolism. The patient was considered for treatment as an outpatient but deferred due to history of PE. She was reevaluated for treatment upon presentation to the hospital, but given the severity and rapidity of her condition, it was already too late. This is the second reported case of COVID-19 induced DNS in a patient with scleromyxedema. Given the severity, we recommend early initiation of treatment in patients with scleromyxedema and aggressive treatment for those contracting COVID-19.References[1] Haber R, Bachour J, El Gemayel M. Scleromyxedema treatment: a systematic review and update. Int J Dermatol. 2020;59:1191-1201.[2] Flannery MT, Humphrey D. Deep Venous Thrombosis with Pulmonary Embolism Related to IVIg Treatment: A Case Report and Literature Review. Case Rep Med. 2015;971321.[3] Lee YH, Sahu J, O'Brien MS, D'Agati VD, Jimenez SA. Scleroderma Renal Crisis-Like Acute Renal Failure Associated With Mucopolysaccharide Accumulation in Renal Vessels in a Patient With Scleromyxedema. J Clin Rheumatol. 2011;17:318-322.[4] Hoffman-Vold AM, Distler O, Bruni C, et al. Systemic sclerosis in the time of COVID-19. Lancet Rheumatol. 2022;4:e566-575.[5] Fritz M, Tinker D, Wessel AW, et al. SARS-CoV-2: A potential trigger of dermato-neuro syndrome in a patient with scleromyxedema. JAAD Case Rep. 2021;18:99-102.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Telepractice for people with aphasia (PWA) is gaining importance, not least because of the current SARS-CoV-2 pandemic. Many PWA are affected by a reduction of quality of life (QoL). Experts recommend focussing on psychosocial impacts more consistently, but the transfer to telepractice has been investigated in a limited number of studies so far. The aim of this paper is to examine the impact of different telepractice approaches on QoL in PWA. The evidence was identified through a broad literature research in five databases and other sources such as Google Scholar and referring papers or was searched by hand. In total, twelve studies met the eligibility criteria. Focus of the analysis was the association between therapeutic approaches and their effects on QoL. Half (n = 6) of the included studies clearly indicated positive effects of the applied methods on QoL. Further analysis showed no definable link between the therapeutic approaches and their impact on QoL. Nevertheless, decisive assumptions about QoL-enhancing telepractice can be derived from the literature. Telepractice in aphasia therapy can improve the patients' QoL. Benefits for QoL do not only depend on the utilised approach. Several factors (e.g., enhancing of communicative confidence) are significant in their impact on QoL and should be examined in future research.
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As the use of COVID-19 vaccines gains more prevalence, rare and uncommon side effects are reported in the medical literature. This is a case report of a 75-year-old male patient who presented on the second day after receiving the Moderna Bivalent mRNA COVID-19 booster vaccine with abrupt onset behavioral changes and global aphasia with no focal deficits. Stroke and infectious meningitis/encephalitis were ruled out. Signs of aseptic inflammation were seen on cerebrospinal fluid (CSF) analysis. Workup for autoimmune and paraneoplastic encephalitis was unyielding. The observation of rapid clinical improvement prompted watchful waiting that concluded in the resolution of clinical manifestations within less than a week of onset. This case is reported to support the currently limited knowledge of rare neurological sequelae of mRNA vaccine and is in line with recently published few cases that suggest vaccine-related encephalitis.
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Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).
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Purpose: The purpose of this article is to address an emerging issue in rehabilitation counseling: The effect of the COVID-19 pandemic on people with aphasia (PWA).Method: Based upon a review of the literature this article provides an overview of (a) COVID-19 and emergent aphasia-related disability, (b) COVID-19 effects on stroke and aphasia services, (c) COVID-19 effects on mental health and employment of PWA.Results: This review of the impact of COVID-19 on PWA highlights the increased and emerging needs for rehabilitation counseling services related to an anticipated increase in incidence of aphasia related to COVID-19 illness and secondary impact of medical care for this population.Conclusion: The impact of COVID-19 on aphasia care in rehabilitation settings underscores the need for increased interprofessional education and collaboration to address the many gaps in aphasia care. Likewise, interdisciplinary research focused on rehabilitation outcomes in aphasia is needed to provide a foundation for evidence-based practice that conforms to the WHO-ICF framework.
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Introduction Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current pen-and-paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Methods Patients are approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have preexisting condition i.e dementia, severe aphasia Participants could speak to the digital doctor on the ward or at home via a web-version. Results Recruitment started on 8th December 2020;We have screened 614 people assessed for suspected acute stroke/TIA at Sheffield Teaching Hospitals. Of those we have recruited 71 participants (13 with TIA) Mean NIHSS of 4.5 and mean MoCA of 24.6. We will present initial results of factors affecting participant recruitment. We will also compare the mood and anxiety screening scores used in this study to those collected via the SNAPP database. Discussion Screening was adapted due to Covid pandemic and utilising remote consent and participa- tion allowed the project to continue.
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Objective:To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.Methods:The full neurologic examination is described with attention to components that can be performed virtually.Results:A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).Conclusions:During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.
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Background: In the context of aphasia rehabilitation, there is a perceived need for interventions with a reduced linguistic demand targeting well-being. Mind-body and creative arts approaches are holistic and person-centred approaches, primarily relying on means other than verbal exchanges and promoting self-regulation strategies. Aim(s): This mixed-method systematic review aimed to evaluate the availability, feasibility and effectiveness of mind-body and creative arts therapies in promoting well-being for people with aphasia. Eight databases were searched using subject headings and keywords. Full-text screening, critical appraisal and data extraction were conducted independently by two reviewers. A segregated synthesis approach was used (i.e., Revised Effect Direction Plot technique and Thematic Synthesis approach). Findings are presented in a narrative and visual form. Main Contribution: Twenty-two studies were included (Mind-body: n = 11;Creative arts: n = 11). Heterogeneity of study design and quality, intervention type, procedures and dosage, outcomes, and level of offered communication support were identified. Improvements were noted across a wide range of well-being outcomes with more consistent positive results for anxiety and communication. One hundred and twenty-eight findings were extracted and synthesised in three broad themes: positive impact on self, empowering multifaceted experience, and relevance of needs-centred adjustments. Conclusion(s): Provisional findings about the benefits of mind-body and creative arts interventions on aspects of well-being for some individuals with aphasia were identified. However, findings are complex and need to be interpreted cautiously. Facilitators and barriers to these therapies are highlighted with related recommendations for practice. This review poses a demand for further research in the field, implementing rigorous methodology and aphasia-specific support to facilitate inclusion and engagement.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Due to the COVID-19 pandemic, digitalization in speech language therapy has progressed rapidly. Teletherapy, in particular, has become part of regular speech language therapy, as it has been reimbursed by German health insurance companies since March 2020. At the same time, political innovations such as the E-Health Act (E-Health-Gesetz, 2015), the Act to Improve Healthcare Provision through Digitalization and Innovation (Digital Healthcare Act - DVG, 2019), and the law on digital modernization of healthcare (DVPMG) (2021) offered new opportunities but also generate (future) tasks for speech and language therapists. For example, since the DVG was approved, applications (apps) can be prescribed by physicians and the statutory health insurance pays for them. In addition, speech language therapists are also to be connected to the telematics infrastructure starting in 2026. These and other digital innovations offer a variety of opportunities for improved care in speech language therapy but also incorporate new duties and responsibilities in the professional range of tasks of speech and language therapists. In order to be able to specify requirements and critically accompany (new) technological developments, it is highly relevant that speech language therapists acquire a critically reflected attitude towards digital technologies to acquire or expand digital competence. In addition, goal-oriented political frameworks and specifications are of enormous importance for successful implementation of digital technologies in speech language therapy.Copyright © Hippocampus Verlag 2023.
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Introduction: Psychological distress is common in people with aphasia, it causes avoidable suffering and impacts on healthcare outcomes and length of hospital stays. This pilot aimed to implement and evaluate a stepped psychological care approach for people with post-stroke aphasia in inpatient stroke rehabilitation. Method(s): A pathway was created to trial;[1] assessing mood using the Distress Thermometer [2] establishing goals to either improve or maintain mood, [3] creating an intervention plan in line with levels 1-2 of the stepped psychological care approach including mindfulness, behavioural activation, education, peer-group experience, and opportunities for mood discussion. Between June-September 2021, data was collected for all patients with aphasia admitted to the rehabilitation unit including Signs of Depression Screening Scale (SDSS) scores, and therapy assistant/researcher reflections. Result(s): Data was collected for nine patients;due to missing data five complete data sets were included. The pre-intervention median SDSS=3, and post-intervention SDSS=1. Reflection notes indicated positive feedback from two patients, increased rapport, greater role satisfaction, short term mood improvements within sessions. Several interventions were declined;mindfulness (3 patients), group/peer sessions (2 ), behavioural activation (2) and any mood intervention (3). Mood interventions had to be deprioritised at times due to workload. The COVID-19 pandemic also meant some activities were unavailable. Conclusion(s): This pilot showed that not all patients wanted to engage with specific or all mood interventions at this early rehabilitation stage. Further research is needed to establish which patients benefit from which intervention and at what stage it should be offered.
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Background: The use of digital technology is promoted as an efficient route for the delivery of intensive speech and language therapy in aphasia rehabilitation. Research has begun to explore the views of people with aphasia (PwA) in relation to Information and Communication Technology (ICT) usage in the management of aphasia but there is less consideration of the prescribers' views, i.e., speech and language therapists (SLTs). Aim(s): We aimed to explore SLTs' views of ICT use in aphasia management and identify factors that influence their decisions to accept and integrate ICT in aphasia rehabilitation. In addition, we considered the findings in the context of the Unified Theory of Acceptance and Use of Technology (Venkatesh, Morris, Davis & Davis, 2003). Methods & Procedures: Speech and language therapists (n = 15) from a range of clinical and geographical settings in the Republic of Ireland were invited to participate in one of four focus groups. Focus group discussions were facilitated by an SLT researcher and were audio-recorded and transcribed. Analysis was completed following Braun and Clarke's six phases of thematic analysis (Braun and Clarke, 2006). Outcomes & Results: Four key themes were identified;i. Infrastructure, Resources, and Support, ii. SLT beliefs, biases and influencers, iii. Function & Fit, and iv. ICT and Living Successfully with Aphasia. The SLTs discussed a wide range of factors that influence their decisions to introduce ICT in aphasia rehabilitation, which related to the person with aphasia, the SLT, the broad rehabilitation environment, and the ICT programme features. In addition, several barriers and facilitators associated with ICT-delivered aphasia rehabilitation were highlighted. Conclusion(s): This research highlights a range of issues for SLTs in relation to the use of ICT in aphasia rehabilitation within an Irish context. The potential benefits of using ICT devices in rehabilitation and in functional everyday communication were discussed. However, SLTs also identified many barriers that prevent easy implementation of this mode of rehabilitation.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Objective: To describe ischemic stroke due to floating thrombus of ascending aorta occurring as acute and subacute complication of SARS-CoV-2 infection. Material(s) and Method(s): consecutive identification in clinical practice of ischemic strokes secondary to aortic arch thrombosis and history of acute or recent Covid-19 infection. Result(s): two patients had ischemic stroke with evidence of aortic arch thrombosis. The first case had concomitant acute Covid-19 infection, the second had recent Covid-19 infection. Both patients underwent intravenous thrombolysis, and subsequent anticoagulation. One patient died due to cerebral hemorrhage. Discussion and Conclusion(s): aortic arch thrombosis can be an incidental finding in acute ischemic stroke in patients with concomitant and recent COVID-19 disease. However, the infection may lead to thrombosis in non-atherosclerotic vessels and to cerebral embolism. Our findings support active radiological search for aortic thrombosis during acute stroke in patients with acute or recent COVID-19 disease.Copyright © 2022
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Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.
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Background: Acute disseminated encephalomyelitis (ADEM) is classically considered as a monophasic immune-mediated demyelinating disorder. A relapse can occur in children but extremely rare in adults. Case-report: A 57-year-old man presented with fulminant ADEM-like episode without proceeding viral illness. Neurological deficits rapidly developed associated with extensive demyelinating brain lesions with vasogenic edema. After the initiation of aggressive immunotherapy, his symptoms resolved, but he relapsed twice during 26-month observation period;one was a mild episode characterized by rapidly evolving MRI lesions without development of symptoms, and the other was a fulminant ADEM-like episode similar to the first one. The second fulminant episode occurred only 2 days after getting a flu shot despite no clinical or radiological relapse when he received COVID-19 vaccinations. The patient's symptoms and extensive brain MRI lesions improved after the initiation of aggressive immunotherapy at the early stage. No autoantibodies against neuronal surface (such as GABA A receptor) or glial surface antigens (aquaporin 4, or myelin oligodendrocyte glycoprotein) were identified in either serum or CSF. Conclusion(s): Extensive white matter lesions can occur without neuronal or glial surface antibodies, recurrent fulminant ADEM-like episode can develop even in an adult patient, and flu shot may provoke fulminant ADEM-like episode.Copyright © 2022
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Introduction: Cerebral venous sinus thrombosIs (CVST) is a rare condition compared to other categories encountered in stroke medicine.It occurs more frequently in patients with conditions that predispose them to other venous thrombosis, such as thrombophilias, acute malignancies, nephrotic syndrome, and COVID-19. CVST was identified as one of the rare causative of stroke. The exact mechanism of the stroke is not fully understood. However, a commonly agreed pathophysiology is that a dysfunction in arachnoid granulation can lead to sinus occlusion. Subsequently, this leads to a reduction in cerebral fluid drainage, which can increase intracranial pressure, causing capillary hypertension, cerebral oedema, decrease in cerebral perfusion pressure and venous haemorrhage. The European Stroke Organisation (ESO) supports using both MRI/MR Venogram and CT venogram as modalities for diagnosis of CVST, with no particular preference of one over the other. The standard practice in the management of cerebral venous sinus thrombosis includes treating the clot and its precipitating factors and treating the sequela of the clot as in the case we are reporting. Yet, there is no clinical guideline for the more aggressive measures to break down the clot in either AHA or European Stroke Organization, but they are used in clinical practice, with promising results in certain cases. Our case is an example of a successful mechanical thrombectomy with a lifesaving outcome. Method(s): We are reporting an unusual case of a 27- year- old lady who presented to the hyperacute stroke unit with dense right- sided weakness and expressive dysphasia. After an initial CT (Computerised Tomography) scan confirming extensive cerebral venous sinus thrombosis, she went for urgent mechanical thrombectomy. The clinical assessment after the procedure showed significant recovery in power of the right limbs and speech. She was discharged 7 days later with near full recovery. Venous thrombectomy is a rarely performed procedure. However, in this case, it was potentially lifesaving and resulted in an excellent clinical outcome. Result(s): An MRI/MRV follow up in a month demonstrated that the lesion on left centrum semiovale had regressed compared to the first scan. Also, there was some evidence of recanalization of her transverse sinuses. She was assessed by the therapist two months from the event. The patient reported some word finding difficulties and clumsiness in the right hand and leg. However, no further major event since her thrombectomy, and now aiming to get back to work. Conclusion(s): Mechanical thrombectomy in cerebral venous sinus thrombosis can be an effective, life-saving, and safe procedure with an extremely rewarding outcome. It should be considered in patients with acute neurological deterioration despite anticoagulant therapy.
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A 56-year-old woman with new-onset aphasia and mood changes was diagnosed with a left temporal mass. The surgery was done. She was referred for a trial of post-operative study of in vivo evaluation of CXCR4 expression using [68Ga]Ga-Pentixafor (Pars-CixaforTM) PET/CT in high-grade glioma. The imaging from the brain revealed no evidence of tumoral remnant. Furthermore, the patient represented positive COVID-19 PCR about 4 weeks prior to the study. Surprisingly, mild diffuse uptake was noted in the base and periphery of both lungs with ground glass opacities (GGO) and consolidations (SUVmax = 2.60) with CXCR4-avid hilar lymph nodes (SUVmax up to 3.42).Copyright © 2023 The Authors.
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Many persons with aphasia (PWA) have limited access to speech-language treatment (SLT) due to limited funding, speech-language pathologist shortages, geographical barriers, physical disabilities, transportation barriers, and the COVID-19 pandemic. The purpose of this study was to determine if telepractice is an effective and feasible service delivery model for PWA. Ten PWA completed 8 hours of remote treatment over 4 weeks. Synchronous telepractice sessions employed Oral Reading for Language in Aphasia (ORLA) and Conversational Script Training (CST). Pre- and post-assessment outcome measures included the Communication Activities of Daily Living-3 (CADL-3) and the Communication Confidence Rating Scale for Aphasia (CCRSA). Participants completed a telepractice satisfaction survey following post-assessment. All participants demonstrated improvements in CCRSA scores, total words produced correctly on trained CST stimuli, and total words produced correctly on trained ORLA stimuli. No differences were noted in CADL-3 scores. All participants were highly satisfied with telepractice as a service delivery model.
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Background: Coronavirus disease 2019 (CoVID-19), primarily thought of as a respiratory system disease is actually a multi-system disease with immunological implications. CNS involvement in COVID has been explained in recent literature mainly for stroke, encephalopathy, encephalitis, acute disseminated encephalomyelitis and myelopathy. There are few studies characterizing clinical spectrum of COVID autoimmune encephalitis. We present a unique case of post-COVID autoimmune encephalitis in a diabetic male presenting with language dysfunction and novel radiologic findings. Case presentation: Patient admitted to inpatient department of a tertiary care hospital of India was evaluated by bedside clinical examination, routine blood tests, CSF study with intrathecal SARS-Cov-2 antibody detection, commercially available tests for autoimmune encephalitis, neuroviral panel with HSV PCR, EEG, 3-Tesla MRI and PET scan. Patient was found to have personality change and transcortical sensory aphasia in the outset of COVID encephalitis. MRI findings like temporal involvement and insular ribboning are also being reported. The patient was treated with IV immunoglobulin and is on an improving course. Conclusions: This case reports dysphasia due to COVID-mediated injury to the language networks, with novel radiologic findings. Role of parainfectious versus immune etiology is also discussed. Further studies are needed to elucidate the mechanism and clinical spectrum of post-COVID autoimmune encephalitis.