Delayed Stimulus-Specific Improvements in Discourse Following Anomia Treatment Using an Intentional Gesture.

Purpose: In this study, the authors assessed how the addition of intentional left-hand gestures to an intensive treatment for anomia affects 2 types of discourse: picture description and responses to open-ended questions.Method: Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over 3 weeks.Seven subjects also incorporated intentional left-hand gestures into each treatment trial.Results: Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in Western Aphasia Battery­Aphasia Quotient(WAB­AQ; Kertesz, 1982) scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the gesture group produced more words at each assessment, whereas the no gesture group produced fewer words at each assessment. These patterns led to improvements in picture descriptions and minimal declines in question responses in the gesture group. In contrast, the no gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pretreatment levels.Conclusion: The intensive treatment protocol is a successful method for improving picture naming even of untrained items.Further, the authors conclude that the intentional left-hand gesture contributed significantly to the generalization of treatment to discourse.

Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program.

OBJECTIVE: To investigate functional and physiological changes in swallowing performance of adults with chronic dysphagia after an exercise-based dysphagia therapy. DESIGN: Intervention study: before-after trial with 3-month follow-up evaluation. SETTING: Outpatient clinic within a tertiary care academic health science center. PARTICIPANTS: Adults (N=9) with chronic (>12 mo) dysphagia after unsuccessful prior therapies. Subjects were identified from among patients referred to an outpatient dysphagia clinic. Subjects had dysphagia secondary to prior treatment for head/neck cancer or from neurologic injury. All subjects demonstrated clinical and fluoroscopic evidence of oropharyngeal dysphagia. No subject withdrew during the course of this study. INTERVENTIONS: All subjects completed 3 weeks of an intensive, exercise-based dysphagia therapy. Therapy was conducted daily for 1h/d, with additional activities completed by subjects each night between therapy sessions. MAIN OUTCOME MEASURES: Primary outcomes were clinical and functional change in swallowing performance with maintenance at 3 months after intervention. Secondary, exploratory outcomes included physiological change in swallow performance measured by hyolaryngeal elevation, lingual-palatal and pharyngeal manometric pressure, and surface electromyographic amplitude. RESULTS: Clinical and functional swallowing performances improved significantly and were maintained at the 3-month follow-up examination. Subject perspective (visual analog scale) on functional swallowing also improved. Four of 7 subjects who were initially feeding tube dependent progressed to total oral intake after 3 weeks of intervention. Physiological indices demonstrated increased swallowing effort after intervention. CONCLUSIONS: Significant clinical and functional improvement in swallowing performance followed a time-limited (3 wk) exercise-based intervention in a sample of subjects with chronic dysphagia. Physiological changes after therapy implicate improved neuromuscular functioning within the swallow mechanism.