Systematic Review of Variables Related to Instruction in Augmentative and Alternative Communication Implementation: Group and Single-Case Design.

PURPOSE: This article provides a systematic review and analysis of group and single-case studies addressing augmentative and alternative communication (AAC) intervention with school-aged persons having autism spectrum disorder (ASD) and/or intellectual/developmental disabilities resulting in complex communication needs (CCNs). Specifically, we examined participant characteristics in group-design studies reporting AAC intervention outcomes and how these compared to those reported in single-case experimental designs (SCEDs). In addition, we compared the status of intervention features reported in group and SCED studies with respect to instructional strategies utilized. PARTICIPANTS: Participants included school-aged individuals with CCNs who also experienced ASD or ASD with an intellectual delay who utilized aided or unaided AAC. METHOD: A systematic review using descriptive statistics and effect sizes was implemented. RESULTS: Findings revealed that participant features such as race, ethnicity, and home language continue to be underreported in both SCED and group-design studies. Participants in SCED investigations more frequently used multiple communication modes when compared to participants in group studies. The status of pivotal skills such as imitation was sparsely reported in both types of studies. With respect to instructional features, group-design studies were more apt to utilize clinical rather than educational or home settings when compared with SCED studies. In addition, SCED studies were more apt to utilize instructional methods that closely adhered to instructional features more typically characterized as being associated with behavioral approaches. CONCLUSION: The authors discuss future research needs, practice implications, and a more detailed specification of treatment intensity parameters for future research.

Participant characteristics predicting communication outcomes in AAC implementation for individuals with ASD and IDD: a systematic review and meta-analysis.

This meta-analysis examined communication outcomes in single-case design studies of augmentative and alternative communication (AAC) interventions and their relationship to participant characteristics. Variables addressed included chronological age, pre-intervention communication mode, productive repertoire, and pre-intervention imitation skills. Investigators identified 114 single-case design studies that implemented AAC interventions with school-aged individuals with autism spectrum disorder and/or intellectual disability. Two complementary effect size indices, Tau(AB) and the log response ratio, were applied to synthesize findings. Both indices showed positive effects on average, but also exhibited a high degree of heterogeneity. Moderator analyses detected few differences in effectiveness when comparing across diagnoses, age, the number and type of communication modes, participant's productive repertoires, and imitation skills to intervention. A PRISMA-compliant abstract is available: https://bit.ly/30BzbLv.

Coaching Parents of Children With Developmental Disabilities to Implement a Modified Dialogic Reading Intervention Using Low Technology via Telepractice.

Purpose Storybook reading provides a naturalistic context to promote bonding and increase oral communication between the reader and child. This study investigated the impact of modified dialogic reading procedures, which included a prompting component on the language skills of children with autism spectrum disorder and Down syndrome in the children's homes. Method A multiple-probe-across-participants design was used to investigate the efficacy of the intervention for this population. Parent training and coaching were provided via telepractice. Maintenance and generalization sessions were also conducted. Results A functional relation was observed between parent implementation and telepractice coaching. Conclusion While the child responses to comprehension questions did not change, changes in the parent implementation of modified dialogic reading procedures in response to coaching via telepractice were noted in this study. Supplemental Material https://doi.org/10.23641/asha.13382831.

Image velocimetry and spectral analysis enable quantitative characterization of larval zebrafish gut motility.

BACKGROUND: Normal gut function requires rhythmic and coordinated movements that are affected by developmental processes, physical and chemical stimuli, and many debilitating diseases. The imaging and characterization of gut motility, especially regarding periodic, propagative contractions driving material transport, are therefore critical goals. Previous image analysis approaches have successfully extracted properties related to the temporal frequency of motility modes, but robust measures of contraction magnitude, especially from in vivo image data, remain challenging to obtain. METHODS: We developed a new image analysis method based on image velocimetry and spectral analysis that reveals temporal characteristics such as frequency and wave propagation speed, while also providing quantitative measures of the amplitude of gut motion. KEY RESULTS: We validate this approach using several challenges to larval zebrafish, imaged with differential interference contrast microscopy. Both acetylcholine exposure and feeding increase frequency and amplitude of motility. Larvae lacking enteric nervous system gut innervation show the same average motility frequency, but reduced and less variable amplitude compared to wild types. CONCLUSIONS & INFERENCES: Our image analysis approach enables insights into gut dynamics in a wide variety of developmental and physiological contexts and can also be extended to analyze other types of cell movements.

Zebrafish as a model for understanding enteric nervous system interactions in the developing intestinal tract.

The enteric nervous system (ENS) forms intimate connections with many other intestinal cell types, including immune cells and bacterial consortia resident in the intestinal lumen. In this review, we highlight contributions of the zebrafish model to understanding interactions among these cells. Zebrafish is a powerful model for forward genetic screens, several of which have uncovered genes previously unknown to be important for ENS development. More recently, zebrafish has emerged as a model for testing functions of genes identified in human patients or large-scale human susceptibility screens. In several cases, zebrafish studies have revealed mechanisms connecting intestinal symptoms with other, seemingly unrelated disease phenotypes. Importantly, chemical library screens in zebrafish have provided startling new insights into potential effects of common drugs on ENS development. A key feature of the zebrafish model is the ability to rear large numbers of animals germ free or in association with only specific bacterial species. Studies utilizing these approaches have demonstrated the importance of bacterial signals for normal intestinal development. These types of studies also show how luminal bacteria and the immune system can contribute to inflammatory processes that can feedback to influence ENS development. The excellent optical properties of zebrafish embryos and larvae, coupled with the ease of generating genetically marked cells of both the host and its resident bacteria, allow visualization of multiple intestinal cell types in living larvae and should promote a more in-depth understanding of intestinal cell interactions, especially interactions between other intestinal cell types and the ENS.

Glomus jugulare tumours: certain clinical and radiological aspects observed following Gamma Knife radiosurgery.

INTRODUCTION: Glomus jugulare tumours represent a great therapeutic challenge. Previous papers have documented good results from Gamma Knife surgery (GKS) with these tumours. However, the relationship between clinical improvement and tumour shrinkage has never been assessed. MATERIALS AND METHODS: There were 14 patients, 9 women and 5 men. The mean follow-up period was 28 months (range 6 to 60 months). All the tumours except one were Fisch type D and the mean volume was 14.2 cm(3) (range 3.7-28.4 cm(3)). The mean prescription dose was 13.6 Gy (range 12-16 Gy). RESULTS: None of the tumours have continued to grow. Eight are smaller and 6 unchanged in volume. Two patients with bruit have had no improvement in their symptoms. Among the other 12 patients, 5 have had symptomatic improvement of dysphagia, 4 in dysphonia, 3 in facial numbness, 3 in ataxia and 2 in tinnitus. Individual patients have experienced improvement in vomiting, vertigo, tongue fasciculation, hearing, headache, facial palsy and accessory paresis. One patient developed a transient facial palsy. Symptomatic improvement commonly began before any reduction in tumour volume could be detected. The mean time to clinical improvement was 6.5 months whereas the mean time to shrinkage was 13.5 months. CONCLUSIONS: Gamma Knife treatment of glomus jugulare tumours is associated with a high incidence of clinical improvement with few complications, using the dosimetry recorded here. Clinical improvement would seem to be a more sensitive early indicator of therapeutic success than radiological volume reduction. Further follow-up will be needed.

Adverse radiation effects after Gamma Knife Surgery in relation to dose and volume.

INTRODUCTION: The relationship between target volume and adverse radiation effects (AREs) at low prescription doses requires elucidation. The development of AREs in three series of patients treated in the Gamma Knife is analysed in relation to prescription dose and target volume. MATERIALS AND METHODS: There were three groups. In group 1, there were of 275 patients with meningiomas; in group 2, 132 patients with vestibular schwannomas; and in group 3, 107 patients with arteriovenous malformations (AVMs). The minimum follow-up for each group was more than 24 months. All patients were followed up at six monthly intervals. The patients with tumours received a prescription dose of 12 Gy, which was varied to protect normal structures but not in relation to tumour volume per se. The desired AVM prescription dose was 25 Gy, but this was also reduced to protect normal structures and to keep the total dose within certain pre-defined limits. All AREs refer to intra-parenchymal increased perilesional T2 signal on MR irrespective of clinical correlation. RESULTS: There was no relationship between tumour volume and the development of ARE in the tumour groups. There was a highly significant relationship between target volume and the development of ARE for the AVMs with their much higher dose. Radiation-induced clinical trigeminal and facial nerve deficits with both vestibular schwannomas and meningiomas were always associated with an increased T2 signal in the neighbouring brainstem parenchyma. CONCLUSIONS: The relationship between target volume and the risk of adverse radiation effects may not apply with lower prescription doses. Individual radiosensitivity may explain why a minority suffer AREs unrelated to target volume. It is possible that radiation-induced brainstem parenchymal damage with concomitant cranial nerve deficits may be commoner after radiosurgery than is usually thought. If tumour control with lower doses is adequate, radiosurgery could be safely considered for larger targets associated with a high risk from microsurgery.

Gamma Knife surgery of large meningiomas: early response to treatment.

PURPOSE: Gamma Knife treatment is traditionally limited to tumours with a diameter not exceeding 3-3.5 cm. The current paper presents 97 patients with meningiomas with a minimum volume of 10 cm(3), treated with a prescription dose of 12 Gy (or sometimes less to protect neighbouring structures). The post-treatment assessment of these patients, the early response to treatment and the complications of treatment are presented. METHODS: There were 97 patients, 70 females and 27 males. The mean age was 48.1 years (range 20.4-87.2 years). The mean follow-up was 54 months (range 25-86 months). All tumours had a volume of 10 cm(3) or more. The mean volume was 15.9 cm(3) (range 10.0-43.2 cm(3)). Post-treatment follow-up used quantitative and qualitative assessments, which are described. RESULTS: No tumour continued to grow. Twenty-seven were smaller and 72 unchanged in volume. Three patients suffered adverse radiation effects (defined as a new post-treatment oedema detected on the magnetic resonance image with or without contrast leakage). In one case this was silent. In two cases the clinical and radiological effects were temporary and resolved completely. CONCLUSIONS: It is suggested on the basis of this material that the dosimetry used here permits the safe Gamma Knife treatment of larger meningiomas within the range reported. The early radiological response is encouraging, but further follow-up is needed to check long term tumour control. A qualitative method of tumour volume assessment is presented. It seems to be a simpler and more reliable way of assessing tumour volume changes than other methods currently in routine use.

Relationship of clinical presentation and calcification of culprit coronary artery stenoses.

Coronary artery calcification is increased in the presence of atherosclerosis. However, there is great variability in the calcification of individual coronary stenoses, and the clinical significance of this finding remains unknown. We tested the hypothesis that culprit lesions associated with myocardial infarction or unstable angina are less calcified than are stenoses associated with stable angina. The study consisted of 78 patients who underwent intravascular ultrasound imaging of culprit stenoses after the placement of a stent. Seventeen patients presented with stable angina; 43, with unstable angina; and 18, with myocardial infarction. The extent of coronary calcification was measured by the angle of its arc and was quantified with a computer-based protractor. The arc of calcium was measured in the stented area at the point of maximal calcification and also as an average of the calcification found at proximal, middle, and distal stent segments. The maximal arc of calcium decreased progressively from patients with stable angina (91+/-10 degrees ) to those with unstable angina (59+/-8 degrees ) and to those with myocardial infarction (49+/-11 degrees, P=0.014). Similarly, the average arc of calcium was greatest (32+/-7 degrees ) in patients with stable angina, less (15+/-4 degrees ) in patients with unstable angina, and least (10+/-5 degrees ) in patients with acute myocardial infarction (P=0.014). These associations remained significant after adjustment for other factors that potentially affect arterial calcification. Acute coronary syndromes are associated with a relative lack of calcium in the culprit stenoses compared with stenoses of patients with stable angina. These findings have implications for the understanding of the biology of acute coronary syndromes as well as for the identification of coronary stenoses by methods that rely solely on the presence of calcium.

A six year experience with the postoperative radiosurgical management of pituitary adenomas.

Since April 1992, 73 consecutive patients with pituitary adenomas were treated with radiosurgery. There were 31 hormonally inactive adenomas and 42 hormonally active adenomas. All but three patients had been subjected to one or more surgical procedures prior to radiosurgery. Three patients had received fractionated radiotherapy. In the inactive adenoma group, the mean target volume was 4.4 ¿ 3 cm3 and the mean prescription dose was 13.8¿1.5 Gy. In the prolactinoma patients, the mean target volume was 6.7 ¿ 9 cm3 and the mean prescription dose was 14.2 ¿4 Gy. In the acromegalic patients, the mean target volume was 2.9¿2.5 cm3 and the mean prescription dose was 16¿4 Gy. ACTH secreting adenomas had a mean target volume of 3.6 ¿ 5.5 cm3 with a mean prescription dose of 17 ¿4.8 Gy. The mean follow-up time was 28.9 ¿ 21.5 months. Follow-up data was available in 83.6% of the patients. Tumor control was achieved in 98.3% and the endocrinological cure rate was 57%. Pituitary function deteriorated in 19.2%. No patient suffered from radiation induced visual damage. It would seem that postoperative radiosurgery for residual or recurrent pituitary adenomas may be a safe technique that can increase the frequency of therapeutic success.

Cavernous sinus meningiomas--what is the strategy: upfront or adjuvant gamma knife surgery?

43 patients with meningiomas of the cavernous sinus form the basis of this study. Two patients were treated with microsurgery alone, 17 patients were treated by Gamma Knife radiosurgery (GKRS) as a primary treatment modality, and 24 patients underwent a combined treatment of microsurgery followed by GKRS. Therefore, in 17 patients the diagnosis rested on clinical and radiological criteria alone. Cranial nerve disorders (CND) related to open surgical treatment were infrequent in this material (3 of 13 patients) due to deliberate strategies of partial or subtotal resection aimed at sparing cranial nerves from surgical maneuvers. In contrast, 6 of 11 patients, admitted for GKRS from other institutions suffered from considerable CND after open surgery and showed only partial improvement after GKRS. In all GKRS cases, no radiation-related complications were seen after a follow-up of 18-62 months (mean 39 months). Moreover, in all cases tumor control was obtained with a stable tumor volume in 63%, reduction of volume in 34.5% and a disappearance of tumor in 2.5%. GKRS is not only an additional treatment for meningiomas involving the cavernous sinus, but may be offered to the patient as an alternative primary treatment.

Stereotactic radiosurgery of skull base meningiomas.

Between April 1992 and February 1996, 97 patients with skull base meningiomas were treated at our department. The age of these patients ranged from 10 to 80 years. The male/female ratio was 1/2. Fifty-three of these patients had primary open surgery for partial removal or recurrent growth and subsequent radiosurgical treatment. Radiosurgery was performed as a primary treatment in 44 patients. The mean tumor volume was 13.7 cm3 (range: 0.8-82 cm3). These tumor volumes could be covered by mean isodose volumes of 45% (range: 20-70%) and were treated by a mean dose of 13.8 Gy (range: 7-25 Gy) at the tumor border. Six patients underwent radiosurgery with a staged treatment protocol with 4.6-6 months interval. In 78 patients, a total of 102 follow-up scans were available. The remaining 19 patients have not been included in the post-radiosurgical evaluation since the observation time was either too short or the patients were lost for follow-up. The mean interval between gamma knife treatment and last follow-up scan was 18.5 months, with a range from 6 to 46 months. Follow-up imaging (CT, MRI or both) revealed a decreased volume of the tumor in 31 cases (40%). In 44 cases (56%), tumor progression was stopped, and in 3 cases (4%) increased tumor volumes could be observed. In 8 cases marked central tumor necrosis was seen. Neurological follow-up examinations in 76 patients showed a stable neurological status in 71%, ameliorated status in 24% and worsening in 5% of the patients.

Acoustic neurinomas with macrocysts treated with Gamma Knife radiosurgery.

Six cases of acoustic neurinomas with macrocystic components are presented. In three cases the cystic portion was within the tumor, while in the other three, the cyst was peritumoral, in the form of a cul-de-sac within the arachnoid, in other words it was not a true tumor cyst. The six tumors are from a series of 74 acoustic neurinomas treated by radiosurgery with a minimum follow-up of 18 months. In all cases, enlargement of the associated cyst was observed as early as 4 months after radiosurgery. Clinical signs and symptoms such as facial weakness, trigeminal symptoms, vertigo and dizziness and coordination disorders developed between 4 and 8 months. In three cases (two intramural cysts and one combined peri- and intramural cyst), subacute microsurgery was performed to treat the progression of neurological symptoms. One case had spontaneous rupture of an intramural cyst, one case of a peritumoral cyst, after progression showed a slow spontaneous size decrease after 2 years, and one case is still under observation. In the reported series, the dose at the tumor margin ranged between 11 and 17 Gy (mean 13.8 +/- 2.5 [SD] Gy) and the maximal dose between 24 and 40 Gy (mean 30.6 +/- 6.2 Gy). In view of the findings in this study, one should perhaps be cautious in advising radiosurgery for this subgroup of acoustic tumors.

Radiation-induced edema after Gamma Knife treatment for meningiomas.

A retrospective study was performed to analyze some parameters in a consecutive series of 35 Gamma Knife treatments in 34 patients with benign meningiomas. The minimum dose to the tumors was never less than 12 Gy. The follow-up period was from 1 to 3 years. A semiquantitative method of tumor volume assessment was used to measure the tumor response to treatment. The presence and clinical significance of postradiation edema were noted. Even in this short follow-up period, 11 of the 35 tumors were reduced in volume. No tumors increased in size. Edema developed preferentially in nonbasal tumors, especially those around the midline and sagittal sinus. In all but one case where radiation-induced edema was observed was the margin tumor dose 18 Gy or more. It is suggested that doses of 18 Gy or more should probably be avoided in the Gamma Knife treatment of meningiomas and that the greatest care should be taken in selecting non-skull base tumors for this form of treatment.

Tumour volume reduction following gamma knife radiosurgery: the relationship between X-ray and histological findings.

The case histories of two young ladies with Cushing's disease are described. Both patients were treated first with Gamma Knife radiosurgery and subsequently by microsurgery. The radiosurgery caused a marked reduction in tumour volume but only a partial relief of the endocrinopathy. Comparison of the histological findings with the radiological findings following radiosurgery indicates that confluent necrosis is not a prerequisite for a reduction in tumour volume. It seems more likely that the reduction in tumour volume is related to changes in cellular dynamics.

Radiosurgical treatment of gliomas of the diencephalon.

The results of Leksell Gamma Knife treatment of diencephalic gliomas are presented. Eight tumours in seven patients form the basis of this report. 7 patients, 4 males and 3 females. The age range was 7.5 to 33 years with a mean of 18 years. Mean follow-up was 21 +/- 12 months. In 4 patients the tumour had been reduced in volume by an open internal decompression procedure. The location of the tumour will determine the risks of treatment. With anterior lesions there is risk of endocrinological and visual pathway damage. With a pineal region lesion there is a risk of diplopia. In this series no tumour has increased in volume. Four have decreased and one has disappeared. Two patients suffered temporary diplopia. No visual disturbance has been observed to date. No hypothalamic disturbance has been observed yet. These tumours are dangerous not so much because of their biological nature as because of their location. However, the biological nature of the tumours, with the close concordance between the radiological and actual extent make them appropriate targets for radiosurgery as a primary treatment. The present study gives preliminary support to this line of treatment.

Changes in intracranial morphology, regional cerebral water content and vital physiological variables during epidural bleeding. An experimental MR study in dogs.

Epidural bleeding was produced in 8 anaesthetised and heparinised dogs by an artificial system. Changes in vital physiological variables were related to intracranial shifts and tissue water content assessed with MR imaging. Six animals survived while 2 succumbed. In the surviving animals intracranial shifts and compressions remained unchanged from an early stage. The cerebral perfusion pressure was reduced from between 80 and 110 mm Hg to between 40 and 60 mm Hg. Some increase in supratentorial white matter tissue water was observed. In the lethal experiments cerebral perfusion pressure fell to less than 40 mm Hg. Moreover, secondary delayed anatomical changes were seen including hydrocephalus. Increase in cerebral tissue water was more intense and widespread than in the survivors. These findings indicate that the outcome of epidural bleeding is related to cerebral perfusion pressure with secondary deterioration resulting from additional volume loading from increased tissue water and hydrocephalus.