Exploring the Influence of the Coronavirus Disease 2019 Pandemic on the Accessibility of Rehabilitation Services Provided to Children with Disabilities: A Cross-Sectional Study.

Background and Objectives: Children with disabilities (such as cerebral palsy, autistic spectrum disorder, and Down syndrome) are the most vulnerable and marginalized subset of the population, representing 2.7% of the total population of Saudi Arabia. The COVID-19 outbreak might have disproportionately affected children with disabilities, augmented their isolation, and induced severe disruptions to the services on which these children rely. Limited research has been conducted in Saudi Arabia to understand the impact of the COVID-19 pandemic on the rehabilitation services provided to children with disabilities and barriers. This study aimed to investigate the effect of the lockdown implemented as a result of the coronavirus disease-2019 (COVID-19) pandemic on the accessibility of rehabilitation services, including communication, occupational therapy, and physical therapy, in Riyadh, Kingdom of Saudi Arabia. Materials and Methods: In this cross-sectional study, a survey was conducted between June and September 2020 during the lockdown in Saudi Arabia. A total of 316 caregivers of children with disabilities from Riyadh participated in the study. The accessibility of rehabilitation services provided to children with disabilities was assessed by designing a valid questionnaire. Results: A total of 280 children with disabilities received rehabilitation services before the COVID-19 pandemic and showed improvement following therapeutic sessions. However, during the pandemic, most children stopped receiving therapeutic sessions because of lockdown, which deteriorated their condition. This shows a significant reduction in the accessibility of the rehabilitation services provided during the pandemic. Conclusions: The findings of this study revealed a drastic decline in services provided to children with disabilities. This caused a notable deterioration in the abilities of these children.

The era of technology in healthcare: an evaluation of telerehabilitation on patient outcomes-a systematic review and meta-analysis protocol.

BACKGROUND: The World Health Organization announced the outbreak of the Coronavirus disease as a global pandemic on March 11, 2020. Since then, rapid implementation of telehealth approaches into the healthcare system have been evident. The pandemic has drastically impacted the lives of many around the globe and has detrimentally affected our healthcare systems, specifically with the delivery of healthcare. This has had many implications on rehabilitation services such as, occupational therapy, physiotherapy, and speech therapy. The delivery of mental health services remotely may be referred to as teletherapy, telemental health, telepsychiatry, and telepsychology. Telerehabilitation has become a necessity over the course of the pandemic due to safety concerns with COVID-19 transmission. The primary aim of this systematic review protocol is to evaluate the literature on the effect of telerehabilitation on patient outcomes and propose directives for future research based on the evidence reviewed. METHODS: A systematic review and meta-analysis will be conducted to examine the literature on the effect of telerehabilitation on patient outcomes following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PRISMA, 2015). The systematic review will use the following databases to examine the literature on telerehabilitation and patient outcomes: APA PsychINFO, Embase (Ovid), MEDLINE (Ovid), CINAHL, and Scopus. DISCUSSION: The utilization of telerehabilitation and similar telehealth treatments has increased throughout the COVID-19 pandemic. However, much is still unclear regarding the effectiveness of these methods in the delivery and service of healthcare, and their effect on health outcomes. This review will identify and address the knowledge gaps in the literature, which will provide further directions for future research. TRIAL REGISTRATION: This systematic review has been registered with PROSPERO under registration number CRD42022297849.

Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents to Misophonia: A Case Example

Misophonia is a condition in which individuals suffer a wide range of intense emotions in response to sound triggers. Emotions such as anxiety, irritability, and disgust may lead individuals to engage in avoidance behaviors to escape or suppress sound triggers. Transdiagnostic treatment may serve as a practical intervention for misophonia as it addresses a broad scope of emotions and physiological sensations. This paper presents the first reported case example of misophonia treated with a transdiagnostic treatment protocol, the Unified Protocol for Emotional Disorders in Adolescents (UP-A). In this case, the UP-A was efficacious in treating a client with autism spectrum disorder, comorbid misophonia and anxiety symptoms. The client evidenced reliable change in misophonia and related problems. Future research should investigate the efficacy of the UP-A in a larger sample of youth with misophonia, as well as assess mechanisms of change in transdiagnostic treatment of this disorder in youth.Copyright © 2022 Society of Clinical Child & Adolescent Psychology.

A Systematic Review of the Efficacy of Early Initiation of Speech Therapy and Its Positive Impact on Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a condition that consists predominantly of an apparent early delay in communication and social skills. Among the multiple identified etiologies, genetics play a key role. The implementation of early interventional therapy for children with ASD is starting to show promising results. A few medical databases were used to collect multiple published types of research, which were thoroughly screened. Ultimately, a small amount was selected according to the defined eligibility criteria. The 12 articles that were reviewed involved a more significant number of boys than girls, and most clinical trials displayed the importance of starting early therapy. Astonishingly, the overwhelming effects of the COVID-19 pandemic did not affect the continuation of speech therapy in certain areas. In addition, studies emphasize knowledge scarcity, insufficient resources in certain areas, and the demand to educate the community. Conversely, no difference in the level of severity was noted with the implementation of early therapy. Early therapy, chiefly speech therapy used to treat children with ASD, demonstrated favorable outcomes. Communities require awareness about the condition on a broader scale to educate caregivers on early alarming symptoms. All in all, additional exploration needs to be done.

Tasks performed by parents to enable telepractice for children with communication disorders: an interview study with clinicians and parents.

PURPOSE: Current service models in childhood rehabilitation promote the active participation of parents/caregivers in their children's therapies. The existing literature provides a limited understanding of the tasks and responsibilities parents undertake in their children's therapies, especially over telepractice. This study describes the tasks undertaken by parents in their children's speech therapy delivered virtually during the COVID-19 pandemic. METHODS: A qualitative descriptive study was conducted with parents and speech-language pathologists, using open-ended interviews. Interviews were analyzed using a combination qualitative content analysis and thematic analysis. RESULTS: Parents performed many tasks to enable telepractice. These tasks happened before (e.g., setting up both physical and virtual space for therapy), during (e.g., managing child's behavior), and after the virtual therapy session (e.g., carrying out home practice). While parents were willing to perform these tasks in order to help their children, some expressed the toll that it can take on them. CONCLUSIONS: Compared to what is known from in-person visits, some of these tasks were novel and unique to telepractice. We recommend that clinicians and parents collaboratively decide on tasks and responsibilities to avoid burdening parents, and that they weigh the costs associated with performing these tasks against the benefits of teletherapy.IMPLICATIONS FOR REHABILITATIONParents perform many tasks to support their children's therapies, both during and outside of therapy sessionsTherapies delivered virtually require parents to assume additional tasks to support their childrenFor services to be Family-Centered, tasks and responsibilities need to be decided collaboratively between parents and clinicians.

Changes in telepractice use and perspectives among speech and language therapists in Singapore through the COVID-19 pandemic.

BACKGROUND: Much has been written about the changes in use and perspectives of telepractice among speech and language therapists (SLTs) during the global COVID-19 pandemic. However, no long-term study has been done to examine whether there is a permanent shift in attitudes towards telepractice as the world adjusts to new norms and endemic COVID-19. AIMS: To compare the speech telepractice use and perspectives of SLTs at two time points of the pandemic: during and after the height of the pandemic. METHODS & PROCEDURES: Two online surveys were distributed a year apart among SLTs in Singapore. The first survey was disseminated during an initial lockdown period in 2020 and the second survey was done in 2021 when Singapore was starting to reduce strict quarantine and safe-distancing regulations. These surveys were distributed via communication channels of the local speech therapy association. A total of 115 and 71 responses to the survey were collected in 2020 and 2021, respectively. Responses were captured and analysed using descriptive statistics and statistical analysis while qualitative content analysis was used to derive key themes from open-ended questions. OUTCOMES & RESULTS: Telepractice use across all age groups and client types peaked at the height of the pandemic. Even as lockdown measures were eased, telepractice utilization was still higher than what it was before the pandemic. Dysphagia management was the only area where SLTs reduced their use of telepractice during the stabilization phase. After more experience with telepractice during the height of the pandemic, SLTs acknowledged the benefit of being able to use a wide range of media through telepractice and were less worried about not having the resources or knowledge to set up telepractice. SLTs also reported increased confidence in providing telepractice, which was reflected in their willingness to continue to provide telepractice even after the pandemic ends. CONCLUSIONS & IMPLICATIONS: The increase in use of telepractice during this pandemic is likely to be sustained as a majority of respondents believed they would continue to provide this mode of service delivery even after the pandemic ends. However, clinicians will still have to assess for client suitability, as clients with more complex medical or behavioural issues may still require in-person therapy. Additionally, dysphagia management via telepractice will still be limited given that swallow presentations may be more variable. Lastly, although generic resources are helpful for clinicians, the long-term sustainability of telepractice can be boosted by the sharing of resources that are suitable for the local context. WHAT THIS PAPER ADDS: What is already known on this subject Current studies have examined telepractice use and perspectives of SLTs before and during the COVID-19 pandemic. Despite the evidence for the efficacy of telepractice, uptake was low due to perceived lack of training and resources. Although more clinicians provided telepractice during the pandemic, many still doubted its efficacy over in-person therapy and most studies concluded that longer term studies are required to ascertain if SLTs will continuing providing telepractice after the pandemic. What this paper adds to existing knowledge This study shows that there is a definitive shift in perspectives in favour of telepractice after the pandemic, as clinicians continued to provide telepractice across most service areas even without lockdown restrictions. The previous challenges of insufficient resources, knowledge and privacy concerns were reduced with more experience in providing telepractice. Although client suitability remained a major barrier, more clinicians saw benefits of easy access to therapy and range of resources used as benefits that they could harness from telepractice. What are the potential or actual clinical implications of this work? A majority of respondents stated that they are more confident in providing telepractice and would want to continue providing this service delivery mode after the pandemic, so more training and resources suitable for the local contexts can be provided by national associations to sustain this. More research and resources can be gathered to make telepractice more efficacious for dysphagia management and clients who may be deemed unsuitable for telepractice.

Decannulation after Covid-19 Ards: Are There Differences between Rehabilitation and Respiratory Wards?

Background: During Covid-19 pandemic, several patients (pts) suffering from ARDS underwent tracheostomy. Decannulation was managed in different step-down units and no standardized procedures are available. Aim(s): To compare time of decannulation and clinical management of tracheostomized pts for Covid-19 ARDS in rehabilitation (R) vs respiratory wards (RW). Method(s): This retrospective, multicenter study compared tracheostomized pts for Covid-19 ARDS, admitted to RW (51 pts) and R (45 pts) from March 2020 to May 2021. Demographic and clinical data, duration of tracheostomy and standard of care in both settings were collected. Result(s): No differences were showed in demographic and clinical data, except the prevalence of Invasive Ventilation (IV): 59% pts in RW vs 38% pts in R (p=0.04). All pts were weaned from IV;time of weaning did not differ in the two wards (median days: 0 [IQR: 0-6.5] in R vs 1 [IQR: 0-7] in RW;p=0.17). In both settings, more than 90% of pts were decannulated and decannulation time was not different (median days: 13 [IQR: 7.5-18.5] in R vs 14 [IQR: 9-17.5] in RW;p=0.67). High flow therapy was more used in R (69% vs 47% pts in RW;p=0.03). The assessment of swallowing was performed in 93% pts in R vs 63% pts in RW (p<0.01). Dysphagia was showed in 43% vs 37% of screened pts in R e RW respectively (p=0.08). The physiotherapy (FT) was carried out in 100% pts in R vs 84% pts in RW (p=0.17). Conclusion(s): The setting of care does not affect time or success of decannulation in Covid-19 tracheostomized pts, probably thanks to FT implementation in both wards. High prevalence of dysphagia was detect indicating the need for swallowing screening and speech therapy.

Using DTI tractography to guide tDCS interventions in a complex acquired brain Injury neurorehabilitation protocol - a case report

51-year-old man (C.P.) had a diffuse-axonal-injury after falling from a 5-meter height, followed by a 22-minute anoxia due to a cardiac arrest. In the ICU, he tested positive to COVID-19, and needed intubation. After coronavirus infection, C.P. presented Guillain-Barre syndrome. 2months after discharge, he was admitted to rehabilitation. DTI tractography for evaluation of the structural integrity of white matter tracts revealed: i) Lesions in the basal ganglia;ii) Sequelary lesions in the right frontal, cortical, subcortical, temporal, parieto-occipital and cerebellar hemispheres;iii) Asymmetry of the corticospinal tracts - less fibers on the left;iv) Poor definition of the fibers of the right arcuate fasciculus;v)Asymmetrical thinning of the cortico-ponto-cerebellar tracts, worse on the left, and more discreetly in the spinocerebellar tracts. Based on this, C.P. underwent 4 different 30-session tDCS protocols consisting of twice-daily 20min 2mA sessions (10min interval), 5days/week (120sessions total), combined with physiotherapy, cognitive, swallowing and speech therapy. Montages: Pr1 (anode: Cz - 5x10cm;cathode: 10th Thoracic Vertebra - 5x7cm);Pr2 (1 - anode:C3;cathode:Fp2 / 2 - anode: Cerebellum;cathode:Fp2);Pr3 (anode:F3;cathode:Fp2) and Pr4 (anode:Cp5;cathode:Fp2). Except for Pr1, electrode size for all protocols were 5x7cm. We used the Coma Recovery Scale (CRS-R) and Rancho Los Amigos Scale (RLAS) for clinical assessments at the baseline and after every 10 sessions until the end of the intervention. At the baseline, C.P. presented a minimal responsive state of consciousness (CRS-R: 3;RLAS: Level 1) and tolerated well the tDCS interventions. CRS-R scores gradually improved in various domains during the treatment. At the end, RLAS score was level 5 and CRS-R, 19. Our preliminary results suggest DTI tractography may be a potential biomarker to guide more personalized tDCS interventions for complex cases of patients with acquired brain injuries. A second DTI tractography will be made in the future for comparison purposes. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: Acquired Brain Injury, Traumatic Brain Injury, COVID-19, Guillain Barre SyndromeCopyright © 2023

A comparison of clinical management and treatment outcome of ischemic stroke prior to and during Covid- 19 pandemic in Hospital Universiti Sains Malaysia

Introduction: Covid-19 pandemic had significant impact on stroke care management and reduced the number of stroke admissions. A delay in treatment resulted in a more severe stroke with higher morbidity and mortality. Objective(s): To determine impact of Covid- 19 on the total number of admissions of stroke patients, compare ischemic stroke standard of care and outcome before and during Covid-19 pandemic. Methodology: A retrospective record review study. Data of patients with radiologically and - /or clinically confirmed AIS in HUSM who were diagnosed from 1st March 2019-28th February 2021 were recorded. Those who fulfilled the criteria were included in the study. Result(s): 229 patients were involved in this study;114 (49.8%) patients in the pre-Covid-19 period, and 115 (50.2%) patients during Covid-19 period. NIHSS score was similar, 5.3 +/- (4.18) in 2019 and 5.9 +/- (4.42) in 2020. There was no difference in terms of onset to door time between the two groups. However, we noticed a significant delay of onset to door time in both groups: 1875.2 min (31.25) hours in pre- Covid-19 vs. 1827.1 (30.45) hours during Covid-19 group (t. test 0.17, p = 0.863). The waiting time to see an ED (in minutes) dropped from 25.3 (30.21) during pre -Covid-19 period vs. 22.6 (16.48) in Covid- 19 group (t. test 0.48, p = 0.402). Door to CT brain time was 83.8 (58.91) vs 92.4 (120.20) during pre-Covid and Covid group (t. test -0.69, p = 0.493). There was a sharp decrease in patients who seek thrombolytic therapy from 7(6.1%) during pre-covid-19 to 4 (3.5%) during Covid-19 period (p = 0.354). As physiotherapy, occupational therapy, speech therapy assessment, the results are as follows;(77.2% vs. 81.7% p = 0.372), (76.3% vs. 81.7% p = 0.334), (50% vs. 59.1% p = 0.185), (43.9% vs. 45.2% p = 0.894) respectively. The duration of hospital stay was (6.4 +/- 4.5 vs. 7.5 +/- 6.74 (t. test -1.36, p = 0.175). MRS score at discharge was [2.8 (1.38) vs 2.9 (1.49)] (t. test -0.33 p = 0.742) for pre-Covid-19 and during Covid-19 group. Conclusion(s): The Covid-19 pandemic had no significant impact on stroke management and neurological outcomes for patients seeking treatment in HUSM.Copyright © 2023

Using technology and telepractice to evaluate discourse after traumatic brain injury

Technology plays an increasing role in everyday communication. People regularly use technology in their daily lives for a range of spoken discourse tasks, including monologic discourse and conversational discourse. Written discourse is also commonly supported through technology as part of text messaging, email, and communication on social media. In addition to the increasing use of technology for communication in daily life, technology is also employed in the clinical assessment of discourse impairments after a traumatic brain injury (TBI). During the COVID-19 pandemic, clinicians embraced technology in serving people with TBI as traditional in-person clinical services presented hazards. Technology can also provide the means to collect data about discourse in different contexts, including phone conversations with different communication partners, video conferencing to capture conversations in the home environment, or virtual reality to evaluate discourse in a range of real-life situations, all without leaving the clinical setting. This chapter provides an overview of the use of telepractice in discourse assessment, implementation of technology to support the analysis of discourse, and future directions in evaluating discourse via the application of new and emerging technologies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Examining Use and Effectiveness of Teletherapy for Patients with Dysphonia.

OBJECTIVE(S)/HYPOTHESIS: Virtual therapy (teletherapy) for patients with dysphonia has become ubiquitous in the COVID-19 era. However, barriers to widespread implementation are evident, including unpredictable insurance coverage attributed to limited evidence supporting this approach. In our single-institution cohort, our objective was to show strong evidence for use and effectiveness of teletherapy for patients with dysphonia. STUDY DESIGN: Single institution, retrospective cohort study. MATERIAL AND METHODS: This was an analysis of all patients referred for speech therapy with dysphonia as primary diagnosis from 4/1/2020 to 7/1/2021 and in whom all therapy sessions were delivered in a teletherapy format. We collated and analyzed demographics and clinical characteristics and adherence to the teletherapy program. We assessed changes in perceptual assessments and vocal capabilities (GRBAS, MPT), patient-reported outcomes (V-RQOL), and metrics of session outcomes (complexity of vocal tasks, carry-over of target voice) pre- and post-teletherapy using student's t test and chi-square test. RESULTS: Our cohort included 234 patients (mean [SD] age 52 [20] years) residing a mean (SD) distance of 51.3 (67.1) miles from our institution. The most common referral diagnosis was muscle tension dysphonia (n = 145, 62.0% patients). Patients attended a mean (SD) of 4.2 (3.0) sessions; 68.0% (n = 159) of patients completed four or more sessions and/or were deemed appropriate for discharge from teletherapy program. Statistically significant improvements were seen in complexity and consistency of vocal tasks with consistent gains in carry-over of target voice for isolated tasks and connected speech. CONCLUSIONS: Teletherapy is a versatile and effective approach for treatment of patients with dysphonia of varying age, geography, and diagnoses.

Parent's Perspective on Teletherapy of Pediatric Population with Speech and Language Disorder During Covid-19 Lockdown in India.

Aim: The pandemic COVID-19 led to the sudden imposition of lockdown and travel restrictions worldwide, that made tele practice one of the most viable options for various hospitals and healthcare centres. The present study aimed at exploring the parental perspective on teletherapy, for children having speech and language delay, during the covid-19 pandemic lockdown. Material & method: A total of 100 parents with children with speech and language delays and who have undergone a minimum of five teletherapy sessions at a tertiary care hospital during the COVID-19 pandemic lockdown were recruited. A questionnaire with 12 close-ended questions was administered over the phone call to know the parent's perspective on the impact of teletherapy and its benefits. The responses obtained were tabulated and calculated for percentage response to each question. Result: Around 95% of parents reported improved motivation for speech-language therapy for their child due to teletherapy during the COVID-19 pandemic lockdown, and 96% of parents were satisfied with receiving teletherapy services during the COVID-19 pandemic lockdown. Furthermore, 90% of parents found teletherapy is more cost-effective than in-person therapy, but 88% believe face-to-face consultation is also required after some time (approx. after six months). Conclusion: The overall result suggested that parents had a positive attitude towards the teletherapy sessions. They reported the therapy sessions to be very effective and compliant, and it can be an efficient alternative with more structured implementation. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03310-y.

Factors affecting telepractice use in COVID-19

Background: The use of telepractice as an alternate method of delivering healthcare to people increased significantly after COVID-19 became a global pandemic. Objective(s): This study aimed to identify factors contributing to the accelerated adoption of telepractice during COVID-19 in Singapore. It also sought to examine whether there are differences in the perspectives of staff in nursing facilities and caregivers in personal homes towards telepractice. Method(s): A cross-sectional mixed method design was used. A survey with 20 items was adapted from the Telehealth Usability Questionnaire and translated into Mandarin. Anonymous responses were obtained from 70 patients and caregivers who had received speech therapy services via telepractice from a restructured hospital before and/or during Singapore's Circuit Breaker period. Analyses were conducted using descriptive statistics and content analysis. Result(s): Sociodemographic variables of age, gender, education level and language preference did not impact user satisfaction and the likelihood of using telepractice again. Service-related factors were more influential. Participants chose to use telepractice as it saved travelling time (24.0%), was easy to use (19.3%), improved healthcare access (17.5%) and reduced waiting time (17.5%). Although all respondents expressed satisfaction in telepractice, 35.5% from personal homes and 37.5% from nursing facilities were not keen to use it again. Amongst caregivers, 26.7% from personal homes and 37.5% from nursing facilities preferred not to continue telepractice use. Technical and logistical disruptions and the lack of 'personal touch' were contributing factors. Conclusion(s): Improving technological infrastructure, providing training for users and developing guidelines would help sustain telepractice as a form of service delivery beyond COVID-19. Copyright © The Author(s) 2022.

Rehabilitation of intubated COVID-19 patients in a Singapore regional hospital with early intensive care unit and sustained post-intensive care unit rehabilitation

Background: A proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients. Objective(s): To describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation. Method(s): Retrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database. Result(s): Most patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation. Conclusion(s): Early ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients. Copyright © The Author(s) 2022.

The headache of diagnosing cerebellitis

Case Report:We describe a case of a non-verbal 5-yearold patient with autism and global developmental delay who presented with headache, nausea, vomiting, and decreased oral intake and found to have acute cerebellar syndrome/cerebellitis secondary to COVID-19 infection. Method(s): Chart Review. Summary of Results: A 5-year-old male with autism spectrum disorder and global developmental delay presented with one week history of headache, nausea, and non-bilious, non-bloody emesis. Despite intravenous fluid resuscitation and anti-emetic treatment, the patient continued to have persistent emesis with decreased oral intake and urine output. Physical exam findings were notable for aniscoria with right pupil larger than left, fixed upward gaze deviation, horizontal nystagmus, and nuchal rigidity. Patient was able to move all extremities spontaneously with normal tone and without rigidity or hyperreflexia. A complete blood cell count was consistent with the following: WBC 17.29 K/uL, hemoglobin level 12.8 g/dL, hematocrit 38.9%, and platelet count 482 K/ uL. C-reactive protein <4.0 mg/L and procalcitonin 0.12 ng/mL. CT Head on hospital day one showed no acute intracranial abnormality. Due to the patient's acute neurological changes, MRI brain was obtained and revealed patchy areas of hyperintensity in both the cerebellar hemispheres with moderate swelling of the cerebellum causing narrowing of the posterior fossa extra-axial cerebrospinal fluid (CSF) spaces. In addition, there was obstruction of the cerebral aqueduct due to extrinsic mass effect by the swollen cerebellum. CSF studies were notable for the following: 148 total nucleated cells with 75% lymphocytes and 17% monocytes and 2 red blood cells, protein was elevated at 113 mg/dL, and glucose was normal at 52 mg/dL. Meningitis and encephalitis panel was without any acute findings. Other laboratory testing was negative for tuberculosis, syphilis, chlamydia, HIV, and EBV. The patient tested positive for COVID-19 virus about one month prior to the onset of symptoms. Imaging and laboratory results in the setting of obstructive hydrocephalus with associated symptoms of nausea, emesis, headache, and upward gaze deviation are consistent with acute cerebellar syndrome, or cerebellitis. Due to obstructive hydrocephalus and inflammation of the cerebellum, patient was started on high-dose steroids, and neurosurgery placed external ventricular drain (EVD). The patient worked closely with physical medicine and rehabilitation as well as speech therapy, physical therapy, and occupational therapy to make a full recovery following this illness. Conclusion(s): Headache, nausea, and vomiting are often seen as benign findings;however, it is important to obtain specific details regarding the timing of symptoms, especially in the setting of a non-verbal patient. Because inflammation of the cerebellum can lead to hydrocephalus and potential herniation, prompt diagnosis is crucial to prevent long term effects of cerebellitis. Copyright © 2023 Southern Society for Clinical Investigation.

Systematic Synthetic Phonics: Case Studies from Sounds-Write Practitioners

Sounds-Write is a systematic synthetic phonics approach that has been successfully used to teach students to read and spell for the last two decades. This volume brings together twelve case studies -- written by practitioners -- of implementation of the Sounds-Write programme in different settings and geographical contexts (Europe, US, Australia). Through them, the authors share their experiences and evidence-based evaluations of the programme, as well as recommendations on how to make the most of what Sounds-Write has to offer. [This content is provided in the format of an e-book. Individual chapters are indexed in ERIC.]

Analysis of the face-to-face and online application of dialogic reading for people with intellectual disabili- ties and recommendations for its implementation

The COVID-19 crisis has led to an increase in the use of videoconferencing for educational inclusion. One of the practices to be carried out with people with intellectual disabilities through videoconferencing is dialogic reading, characterised by simultaneous reading aloud and group reading using interactive techniques. This study aims to analyse the process of applying dialogic reading with people with mild intellectual disabilities (MID), with two modalities: both face-to-face and virtual, and to assess the differences between the two. A multiple case study is used with a mixed methodology. Ten adults with Mild Intellectual Disability (MID) participated in 5 face-to-face and 5 online dialogic reading sessions. Video recordings of sessions, Mean Length of Utterance (MLU), percentage of com-municative interaction and an ad hoc Likert questionnaire, filled in at the end of face-to-face and online dialogic reading, were used. Results: both modalities are satisfactory, but in the face-to-face sessions: the self-perception of improvement, the amount of personal opinions expressed and the initiative of the participants are higher;in the virtual sessions, the MLU and the percentage of communica-tive interaction of the speech therapist are higher. Finally, recommendations are made for online dialogic reading sessions with adults with MID.

TELEPRACTICE IN PROVIDING SPEECH THERAPY FOR CHILDREN: SPEECH THERAPISTS' VIEW AND EXPERIENCES

The article analyses speech therapists' view and experiences in providing speech therapy using telepractice in the context of the COVID-19 situation. The performed quantitative and qualitative analysis of the research data revealed how the country's speech therapists perceived telepractice, the types of applied telepractice, the advantages and limitations of applying this practice, the opportunities to provide (in) direct support to children who had various speech, language and swallowing disorders, and the opportunities to perform professional quality functions from a distance. The study revealed that telepractice in the speech therapist's work, although challenging due to the need to apply it in unforeseen circumstances and without proper preparation, had many advantages and could be successfully applied when combined with normal, traditional, in-person support. © 2022, Specialusis Ugdymas. All Rights Reserved.

Bridging the Access Gap: The Telepractice Experience of Speech Therapists and Audiologists at a Public Health Care Facility in South Africa

South Africa is a low to middle income country (LMIC) with a population of 60 million people. The public health sector serves more than 80% of the population. Chris Hani Baragwanath Academic Hospital is a central level public health care facility situated in Gauteng. The Speech Therapy and Audiology Department provides insight into their telepractice services through a qualitative approach. The onset of the COVID-19 pandemic resulted in therapists exploring telepractice as a sustainable model of service delivery. Therapists and patients encountered many challenges to the implementation of telepractice, however, the commitment of therapists ensured that creative solutions were developed. A comprehensive needs analysis at public health institutions is required to ensure the sustainability of telepractice. A hybrid model (telepractice and in-person consults) holds the potential to reduce the financial burden on patients and increase access to quality patient-centered care.