Association of COVID-19-Related Restrictions With Changes in Functional Skills of Adults With Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization.

Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.

A New Screening Tool for Rapid Diagnosis of Functional and Environmental Factors Influencing Adults with Intellectual Disabilities.

The dynamic nature of intellectual disability (ID) and its many comorbidities necessitate repeated screening and functional diagnosis. However, the existing scales are lengthy and expensive and cannot be implemented at all levels of ID. During phase one of this study (September 2019-September 2020), the functional screening tool (FST-ID) was validated for adults with ID and then used as a clinical tool to collect data for 76 participants from their direct service providers (DSP). Their age ranged from 21 to 71 years (mean = 37.63, SD ± 14.61), and they were diagnosed with severe/profound (N = 16) and moderate (N = 29), and mild (N = 31) levels of ID. The scale was found to hold high psychometric values. During phase two (September 2020-June 2022), the scale was found to be reliable as a continuous, clinical on-going screening tool, enabling the screening of functional and environmental changes experienced by adults with ID during acute times of the pandemic and regular times alike. All 76 adults experienced changes at the senior's daycare center mostly. The new scale may also help in the future to determine whether those changes only relate to post COVID-19 symptoms or other comorbidities as well.

Development and validation of a functional screening tool for adults with intellectual disabilities.

BACKGROUND: The dynamic nature of intellectual disability necessitates repeated screening. METHOD: The functional screening tool (FST-ID) for individuals with intellectual disabilities was carefully constructed. RESULTS: The FST-ID General Adaptive Composite score (GAC) runs between 0 and 68 points. Criterion validity-high-positive correlations were found between FST-ID and ABAS-II (Gold standard), and between the severity of the intellectual disability and the FST-ID (r = 0.78, p < .001). The scale holds high-internal consistency and intra- and inter-rater reliability values. The cut-off point between mild and moderate disability is 50.4 (Sensitivity: 87%, Specificity 86%, p < .001) and 29.4 between moderate to severe-profound (Sensitivity: 96%, Specificity 94%, p < .001). CONCLUSIONS: The FST-ID presents high-psychometric properties and requires less than 5 min to complete. Using this tool may support efficient screening practices and improved supports for adults with intellectual disability.

Using Vocal Production to Improve Long-Term Verbal Memory in Adults with Intellectual Disability.

Individuals with intellectual disability (ID) typically show weak long-term memory (LTM) skills. Understanding verbal LTM processes and searching for effective mnemonics in this population is important, to improve intervention programs. The current study aimed to assess verbal LTM abilities of adults with mild ID of mixed etiologies, and to offer a simple memorization technique based on vocal production. Participants (n = 55) learned lists of different study materials (images of familiar and unfamiliar objects, written words, and sentences) by vocal production (saying or reading aloud) or by no-production (looking, listening, or reading silently). Memory tests followed. Better memory was found for vocally produced images of familiar objects, written words, and sentences. The results show that adults with mild ID can benefit from the relative distinctiveness of items at study. Hence, vocalization may be used in educational and therapeutic contexts for this population, improving memory performance.

Isolated myoclonus of the vocal folds.

OBJECTIVE: Laryngeal manifestations of stroke play a significant role in the morbidity and mortality among affected patients. The objective of this article was to describe unique myoclonic vocal fold movement disorder, which is an unusual post-stroke manifestation. STUDY DESIGN: A retrospective case study. SETTING: The study group included post-stroke patients with dysphagia who were referred to the Swallowing Clinic at Edith Wolfson Medical Center. SUBJECTS AND METHODS: All patients underwent flexible laryngoscopy and flexible endoscopic evaluation of swallowing with sensory testing. The vocal fold movement was analyzed with the Sisson-Ammons video analysis system. RESULTS: Three post-pontine stroke patients presented with vocal fold myoclonus (VFM). The myoclonus was spontaneous, unintentional, and irregular (19-420 jerks per minute). Two patients presented with unilateral myoclonus, ipsilateral to the brainstem stroke. One patient, who experienced subsequent pontine strokes, presented with bilateral VFM. When patients were asked to swallow or phonate, the myoclonus disappeared. CONCLUSION: Isolated VFM is an unusual manifestation of pontine injury, resulting in a sudden, involuntary, and non-rhythmic vocal fold movement. This laryngeal pathology is not associated with either dyspnea or dysphonia and most likely not with inefficient swallowing.

Diagnostic clues for identification of nonorganic vs organic causes of food refusal and poor feeding.

OBJECTIVES: Food refusal, poor feeding, and somatic symptoms such as vomiting, gagging, irritability and failure to thrive (FTT) are commonly found in both infantile feeding disorders (IFD) and common treatable medical conditions. Present diagnostic classifications for diagnosing IFD are complex and difficult to apply in daily practice, leading to underdiagnosis and delay in diagnosis of IFD. We attempted to identify parental and infantile behaviour patterns or symptoms that could help distinguish between organic or behavioural causes for these symptoms. METHODS: We screened 226 children with poor feeding. After exclusion criteria, we divided the remaining 151 into 2 groups. The nonorganic group (n=83) included patients with onset of symptoms before age 2, persistent food aversion longer than 1 month, and a response to behavioural intervention. The second group consisted of children (n=68) presenting with similar characteristics, who responded to medical or nutritional therapy in which a final diagnosis of gastro-esophageal reflux disease, milk allergy, or idiopathic or nutritional FTT was made. RESULTS: Poor intake, poor weight gain, or vomiting did not discriminate between organic and nonorganic causes. Factors indicating the presence of a behavioural cause included food refusal, food fixation, abnormal parental feeding practices, onset after a specific trigger, and presence of anticipatory gagging (P<0.0001 for all). CONCLUSIONS: Integration of a few structured questions regarding infant behaviour, parental feeding practices, infant symptoms, and triggers for the onset of symptoms may help clinicians distinguish between organic and nonorganic causes for food refusal or low intake FTT.

Modified endoscopic swallowing test for improved diagnosis and prevention of aspiration.

Laryngopharyngeal sensation is important in the normal process of swallowing, it is often impaired after neurological events and it has been common practice in such an occurrence to order non-oral tube feeding to prevent aspiration. This study assesses a novel approach to the evaluation of the laryngopharyngeal sensation that allows for improved triage of aspiration risk and more lenience towards oral feeding. This is a case series with follow-up period ranging from 6 to 24 months. Forty patients with neurological deficiencies were tested by a modified laryngopharyngeal sensation study that included evaluation of both supra and infra-glottis. All patients had impaired supra glottic sensation but had good infra glottic sensation that enabled cough protection. All had received oral feeding. Main outcome measure is incident aspiration pneumonia. Twenty-two patients maintained oral feeding without any evidence of aspiration. Eighteen patients had some aspirations associated with cough, and were maintained on modified oral feeding. Out of these 18 patients, four patients (10% of the entire group) developed aspiration pneumonia. The presented procedure identified patients with impaired supraglottic sensation but preserved good infra glottic sensation. This observation enables safe oral feeding in most patients and therefore offers a better quality of life for these individuals.