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1.
J Rehabil Med Clin Commun ; 3: 1000037, 2020.
Article in English | MEDLINE | ID: covidwho-1197495

ABSTRACT

Respiratory and neurological complications in patients in various stages of COVID-19 emphasize the role of speech-language pathologists in the assessment and management of swallowing and communication deficits in these patients. The speech-language pathologist works within a multidisciplinary team to identify these deficits, and aims to improve swallowing, nutrition, hydration, speech, and quality of life in the medical settings. This paper describes the unique symptoms and complications associated with COVID-19 that require speech-language pathologist services in medical (acute care, inpatient, and outpatient rehabilitation) facilities. The speech-language pathologist is primarily responsible for dysphagia screening and diagnosis in the acute care units, dysphagia and tracheostomy management in the inpatient units, and swallowing, speech and voice rehabilitation and neurocognitive management in the outpatient units. This paper also discusses the current therapeutic services and the precautions that speech-language pathologists must take to reduce transmission of the virus.

2.
J Laryngol Otol ; : 1-4, 2020 Sep 28.
Article in English | MEDLINE | ID: covidwho-1072067

ABSTRACT

OBJECTIVE: The current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing. METHODS: Twenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield. RESULTS: A statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment. CONCLUSION: Use of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.

3.
J Acoust Soc Am ; 148(6): 3562, 2020 12.
Article in English | MEDLINE | ID: covidwho-1004074

ABSTRACT

Wearing face masks (alongside physical distancing) provides some protection against infection from COVID-19. Face masks can also change how people communicate and subsequently affect speech signal quality. This study investigated how three common face mask types (N95, surgical, and cloth) affected acoustic analysis of speech and perceived intelligibility in healthy subjects. Acoustic measures of timing, frequency, perturbation, and power spectral density were measured. Speech intelligibility and word and sentence accuracy were also examined using the Assessment of Intelligibility of Dysarthric Speech. Mask type impacted the power distribution in frequencies above 3 kHz for the N95 mask, and above 5 kHz in surgical and cloth masks. Measures of timing and spectral tilt mainly differed with N95 mask use. Cepstral and harmonics to noise ratios remained unchanged across mask type. No differences were observed across conditions for word or sentence intelligibility measures; however, accuracy of word and sentence translations were affected by all masks. Data presented in this study show that face masks change the speech signal, but some specific acoustic features remain largely unaffected (e.g., measures of voice quality) irrespective of mask type. Outcomes have bearing on how future speech studies are run when personal protective equipment is worn.


Subject(s)
COVID-19/prevention & control , Masks/adverse effects , Speech Acoustics , Speech Intelligibility , Adult , Female , Humans , Male , SARS-CoV-2 , Voice Quality , Young Adult
4.
S Afr Med J ; 110(12): 1172-1175, 2020 11 05.
Article in English | MEDLINE | ID: covidwho-994156

ABSTRACT

No one may be refused emergency medical treatment in South Africa (SA). Yet score-based categorical exclusions used in critical care triage guidelines disproportionately discriminate against older adults, the cognitively and physically impaired, and the disabled. Adults over the age of 60, who make up 9.1% of the SA population, are most likely to present with disabilities and comorbidities at triage. Score-based models, drawn from international precedents, deny these patients admission to an ICU when resources are constrained, such as during influenza and COVID-19 outbreaks. The Critical Care Society of Southern Africa and the South African Medical Association adopted the Clinical Frailty Scale, which progressively withholds admission to ICUs based on age, frailty and comorbidities in a manner that potentially contravenes constitutional and equality prohibitions against unfair discrimination. The legal implications for healthcare providers are extensive, ranging from personal liability to hate speech and crimes against humanity. COVID-19 guidelines and score-based triage protocols must be revised urgently to eliminate unlawful discrimination against legally protected categories of patients in SA, including the disabled and the elderly. That will ensure legal certainty for health practitioners, and secure the full protections of the law to which the health-vulnerable and those of advanced age are constitutionally entitled.


Subject(s)
Ageism/legislation & jurisprudence , COVID-19/therapy , Constitution and Bylaws , Critical Care/legislation & jurisprudence , Health Care Rationing/legislation & jurisprudence , Practice Guidelines as Topic , Triage/legislation & jurisprudence , Aged , Aged, 80 and over , Health Resources , Humans , Liability, Legal , Middle Aged , SARS-CoV-2 , South Africa
5.
Int J Telerehabil ; 12(2): 93-104, 2020 Dec 08.
Article in English | MEDLINE | ID: covidwho-993998

ABSTRACT

Telepractice facilitates services in exceptional settings and situations. The ongoing COVID-19 pandemic is certainly such a situation. Due to pandemic-related restrictions, speech-language pathologists (SLPs) needed to adopt new approaches to their professional functioning. The aim of the paper is to examine SLP professionals' perceptions and application of telepractice in SLP settings in Croatia during the COVID-19 pandemic. Two hundred and fifty-five SLPs completed an online survey. The results demonstrated that most SLPs had provided direct online therapy, mainly those employed in health care and private practice. The chief reasons for clients' refusal of therapy delivered via telepractice included the lack of equipment, insufficient independence, and doubts on the effectiveness of telepractice. Although only 3% of SLPs had acquired some formal knowledge of telepractice before the pandemic, over 70% expressed satisfaction with telepractice because it allowed them to provide undisturbed clinical services in an exceptional situation.

6.
JMIR Mhealth Uhealth ; 8(10): e22069, 2020 10 28.
Article in English | MEDLINE | ID: covidwho-930806

ABSTRACT

BACKGROUND: In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. OBJECTIVE: We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. METHODS: Family conferences comprised three phases designed according to telehealth implementation guidelines-the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: "team talk," "option talk," and "decision talk." The model has been implemented at a national cancer treatment center in Taiwan since February 2020. RESULTS: From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients' mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). CONCLUSIONS: Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic.


Subject(s)
Communication , Coronavirus Infections/epidemiology , Palliative Care/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Professional-Family Relations , Smartphone , Telemedicine/methods , Adult , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , Middle Aged , Pilot Projects
7.
J Speech Lang Hear Res ; 63(12): 3982-3990, 2020 12 14.
Article in English | MEDLINE | ID: covidwho-927154

ABSTRACT

Purpose There has been increased interest in using telepractice for involving more diverse children in research and clinical services, as well as when in-person assessment is challenging, such as during COVID-19. Little is known, however, about the feasibility, reliability, and validity of language samples when conducted via telepractice. Method Child language samples from parent-child play were recorded either in person in the laboratory or via video chat at home, using parents' preferred commercially available software on their own device. Samples were transcribed and analyzed using Systematic Analysis of Language Transcripts software. Analyses compared measures between-subjects for 46 dyads who completed video chat language samples versus 16 who completed in-person samples; within-subjects analyses were conducted for a subset of 13 dyads who completed both types. Groups did not differ significantly on child age, sex, or socioeconomic status. Results The number of usable samples and percent of utterances with intelligible audio signal did not differ significantly for in-person versus video chat language samples. Child speech and language characteristics (including mean length of utterance, type-token ratio, number of different words, grammatical errors/omissions, and child speech intelligibility) did not differ significantly between in-person and video chat methods. This was the case for between-group analyses and within-child comparisons. Furthermore, transcription reliability (conducted on a subset of samples) was high and did not differ between in-person and video chat methods. Conclusions This study demonstrates that child language samples collected via video chat are largely comparable to in-person samples in terms of key speech and language measures. Best practices for maximizing data quality for using video chat language samples are provided.


Subject(s)
COVID-19 , Language Disorders/diagnosis , Language Tests/standards , Speech Production Measurement/standards , Telemedicine/standards , Child Language , Child, Preschool , Feasibility Studies , Female , Humans , Infant , Longitudinal Studies , Male , Non-Randomized Controlled Trials as Topic , Reproducibility of Results , SARS-CoV-2 , Speech Intelligibility , Speech Production Measurement/methods , Telemedicine/methods
8.
Z Evid Fortbild Qual Gesundhwes ; 156-157: 1-8, 2020 Nov.
Article in German | MEDLINE | ID: covidwho-841442

ABSTRACT

INTRODUCTION: About 35,000 people in Germany suffered from stroke-related aphasia in 2019. One of the most frequent manifestations of aphasia are word finding disorders. In times of the COVID-19 pandemic, the temporary approval of video therapy enables the maintenance of speech therapy treatment. This leads to the necessity to investigate the effectiveness of screen-to-screen therapy via a video conferencing system compared to conventional face-to-face therapy of adult aphasia patients. METHODS: For this scoping review, a literature search in the databases Cochrane, Pubmed and Web of Science was conducted for the period February 2010 to 2020. We included German- and English-language studies comparing the effectiveness of a classic face-to-face therapy with a screen-to-screen therapy of adults with aphasia. The studies were selected using the PRISMA flowchart. RESULTS: A total of five studies were identified. Both face-to-face therapy and screen-to-screen therapy showed significant improvements in naming performance in an Italian crossover study, a Canadian randomized study and a quasi-randomized study conducted in the UK. No improvements were found for both forms of intervention in an Israeli crossover study. In a German comparative study, significant improvements in naming performance were found for face-to-face therapy, but the results did not differ significantly from the screen-to-screen therapy intervention group. DISCUSSION: In all included studies, screen-to-screen therapy and face-to-face therapy had a comparable effectiveness on naming performance. The results demonstrate the feasibility of a screen-to-screen therapy under everyday conditions. However, it is possible that this form of therapy cannot always be implemented. Barriers to screen-to-screen therapy can be the use of technologies and restrictions in the visual field due to a neglect. One limitation of the scoping review was that only the naming performance was considered as an outcome, another was the small number of studies included. CONCLUSION: For many patients screen-to-screen therapy is currently the only possibility to receive speech therapy treatment. Therefore it is a positive aspect that screen-to-screen therapy is as effective as face-to-face therapy. Screen-to-screen therapy can provide expanded access to health care and professional expertise in health services. In this way, speech therapy care during the COVID-19 pandemic can be largely maintained. Further research is needed on evidence-based treatment methods and user-oriented apps for video therapy.


Subject(s)
Aphasia , Coronavirus Infections , Pandemics , Pneumonia, Viral , Stroke , Telemedicine , Videoconferencing , Adult , Aphasia/therapy , Betacoronavirus , COVID-19 , Canada , Cross-Over Studies , Germany , Humans , Randomized Controlled Trials as Topic , SARS-CoV-2 , Stroke/complications , Stroke/therapy , User-Computer Interface
9.
Am J Speech Lang Pathol ; 29(4): 2242-2253, 2020 11 12.
Article in English | MEDLINE | ID: covidwho-786682

ABSTRACT

Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.


Subject(s)
Coronavirus Infections/complications , Deglutition Disorders/diagnosis , Deglutition Disorders/therapy , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Humans , Pandemics , Risk Assessment , SARS-CoV-2 , Speech-Language Pathology
10.
Am J Speech Lang Pathol ; 29(4): 1821-1832, 2020 11 12.
Article in English | MEDLINE | ID: covidwho-780038

ABSTRACT

Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors (https://www.coronavirus.jhu.edu/map.html). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials addressing other critical illnesses were also included to extend findings to potential cognitive communication outcomes following COVID-19. Results COVID-19 infection results in a combination of (a) respiratory infection with mechanical ventilation secondary to inadequate oxygenation, (b) inflammatory system reactivity, and (c) increased blood clotting factors. These affect central nervous system function incurring long-term cognitive communication impairment in a proportion of survivors. Diagnostic and intervention approaches for such impairments are discussed. Conclusions The existing literature on cognitive sequela of COVID-19 infection is small to date, but much can be learned from similar viral infections and disorders. Although COVID-19 is novel, the speech-language pathology approaches to evaluation and intervention of other populations of critical care patients are applicable. However, speech-language pathologists have not routinely been involved in these patients' acute care. As such, this is a call to action to speech-language pathologists to address the unprecedented numbers of patients who will need their services early in the disease process and throughout recovery.


Subject(s)
Cognitive Dysfunction/etiology , Communication Disorders/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Speech-Language Pathology , Betacoronavirus , COVID-19 , Cognitive Dysfunction/rehabilitation , Communication Disorders/rehabilitation , Delirium/etiology , Delirium/rehabilitation , Humans , Hypoxia/etiology , Pandemics , Professional Role , Respiration, Artificial/adverse effects , SARS-CoV-2 , Thrombophilia/etiology
11.
Arch Phys Med Rehabil ; 101(12): 2243-2249, 2020 12.
Article in English | MEDLINE | ID: covidwho-778404

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on the provision of medical care. As the curve progresses and patients are discharged, the rehabilitation wave brings a high number of postacute COVID-19 patients suffering from physical, mental, and cognitive impairments threatening their return to normal life. The complexity and severity of disease in patients recovering from severe COVID-19 infection require an approach that is implemented as early in the recovery phase as possible, in a concerted and systematic way. To address the rehabilitation wave, we describe a spectrum of interventions that start in the intensive care unit and continue through all the appropriate levels of care. This approach requires organized rehabilitation teams including physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists or neuropsychologists, and physiatrists collaborating with acute medical teams. Here, we also discuss administrative factors that influence the provision of care during the COVID-19 pandemic. The services that can be provided are described in detail to allow the reader to understand what services may be appropriate locally. We have been learning and adapting real time during this crisis and hope that sharing our experience facilitates the work of others as the pandemic evolves. It is our goal to help reduce the potentially long-lasting challenges faced by COVID-19 survivors.


Subject(s)
COVID-19/rehabilitation , Intensive Care Units/organization & administration , Physical and Rehabilitation Medicine/organization & administration , Survivors , Activities of Daily Living , Continuity of Patient Care/organization & administration , Disability Evaluation , Glasgow Coma Scale , Humans , Intensive Care Units/standards , Medicare/organization & administration , Pandemics , Physical and Rehabilitation Medicine/standards , SARS-CoV-2 , United States
13.
Cureus ; 12(8): e9638, 2020 Aug 10.
Article in English | MEDLINE | ID: covidwho-713297

ABSTRACT

Coronavirus Disease-19 (COVID-19) is a novel corona virus that started as an outbreak in the Hubei province of China in December 2019 and later became a pandemic affecting every continent on the planet. Patients with severe COVID-19 tend to develop acute thrombotic complications including myocardial infarction, pulmonary embolism, and ischemic stroke. We describe a case of a 75-year-old-female who presented with acute onset slurred speech and right sided facial droop. She was diagnosed with COVID-19 with acute ischemic stroke as the initial presentation. Stroke as the initial presentation of COVID-19 is rare and has not been described in the literature frequently. The purpose of this report is to raise awareness about this potential complication of COVID-19 as an initial presentation.

14.
Ren Replace Ther ; 6(1): 36, 2020.
Article in English | MEDLINE | ID: covidwho-704181

ABSTRACT

Background: Social frailty-the lack of a connection to society and infrequent social activities-has been reported to be associated with future declines in physical function in elderly individuals. This study aimed to evaluate both the association of social frailty with the physical function and the efficacy of intradialytic exercise as a therapy for social frailty among hemodialysis patients. Methods: All 16 outpatient hemodialysis patients in the hemodialysis department of a single medical center were enrolled in this single-center prospective single-arm interventional study. Patients received five questions which asked about going out infrequently, lack of visiting friends, feeling unhelpful to friends or family, living alone, and lack of talking with someone. Those to whom two or more of the above were applicable were categorized as socially frail. All patients were placed into exercise therapy to be performed during their thrice-weekly hemodialysis visits. Participants' physical function (walking speed), muscle strength (grip strength), muscle mass (appendicular skeletal muscle mass index), and social frailty were evaluated at baseline and after 3 months of therapy. Results: Four (25%) of the 16 participants (median age 71.5 years, 8 women) were categorized as being socially frail. In comparison to the non-socially frail group (non-SF), the socially frail group (SF) had a significantly lower walking speed (0.70 ± 0.12 m/s vs 1.15 ± 0.26 m/s, p = 0.005) and significantly worse performance on the Short Physical Performance Battery. Three months of intradialytic exercise therapy significantly improved their walking speed, from 1.04 ± 0.30 m/s to 1.16 ± 0.29 m/s (p = 0.003). intradialytic exercise therapy significantly improved walking speed in both the SF group and the non-SF group. The 2019 coronavirus disease pandemic unexpectedly occurred in the middle of the intervention period of this study, and although it was not statistically significant, the number of socially frail individuals among our participants increased to seven (43.8%, p = 0.248). Conclusions: Social frailty was associated with reduced physical function among hemodialysis patients. Intradialytic exercise therapy improved physical function regardless of the presence of social frailty. Trial registration: UMIN-CTR, UMIN-CTR000038313. Registered November 1, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043639.

15.
Am J Speech Lang Pathol ; 29(4): 1850-1865, 2020 11 12.
Article in English | MEDLINE | ID: covidwho-660125

ABSTRACT

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.


Subject(s)
Coronavirus Infections/rehabilitation , Pneumonia, Viral/rehabilitation , Speech-Language Pathology/organization & administration , Betacoronavirus , COVID-19 , Consensus , Coronavirus Infections/therapy , Humans , Pandemics , Pneumonia, Viral/therapy , SARS-CoV-2
16.
Int J Environ Res Public Health ; 17(13)2020 07 02.
Article in English | MEDLINE | ID: covidwho-635459

ABSTRACT

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.


Subject(s)
Coronavirus Infections/prevention & control , Dental Care/methods , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Dentists'/standards , Betacoronavirus , COVID-19 , Dental Care/standards , Dentists , Humans , Infection Control/standards , Mass Screening , Personal Protective Equipment , Professional Role , SARS-CoV-2
17.
Front Med (Lausanne) ; 7: 260, 2020.
Article in English | MEDLINE | ID: covidwho-612725

ABSTRACT

The main form of COVID-19 transmission is via "oral-respiratory droplet contamination" (droplet: very small drop of liquid) produced when individuals talk, sneeze, or cough. In hospitals, health-care workers wear facemasks as a minimum medical "droplet precaution" to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, for asymptomatic individuals, not wearing masks in public could easily cause the spread of COVID-19. The prevention of "environmental droplet contamination" (EnvDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote "public droplet safety," we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal "community droplet reduction solution" is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8 m, the minimum distance recommended for COVID-19 "social distancing." All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30 cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10 cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a "community droplet reduction solution" (i.e., face covers/scarfs/masks and surface covers) will reduce COVID-19 EnvDC and thus the risk of transmitting/acquiring COVID-19.

18.
J Stroke Cerebrovasc Dis ; 29(10): 105074, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-611370

ABSTRACT

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.


Subject(s)
Cerebral Small Vessel Diseases/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Betacoronavirus/pathogenicity , COVID-19 , Cerebral Small Vessel Diseases/diagnostic imaging , Cerebral Small Vessel Diseases/virology , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Host Microbial Interactions , Humans , Middle Aged , Nursing Staff, Hospital , Pandemics , Paresis/etiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Speech Disorders/etiology , Stroke/diagnostic imaging , Stroke/virology
19.
Am J Speech Lang Pathol ; 29(3): 1320-1334, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-594936

ABSTRACT

Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/therapy , Speech-Language Pathology/standards , Tracheostomy/standards , COVID-19 , Consensus , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Interdisciplinary Communication , International Cooperation , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , SARS-CoV-2
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