ABSTRACT
OBJECTIVE: We developed a clinical sign that improves the sensitivity, specificity, and predictive values of the Head Impulse Paradigm (HIMP) Test by adding the Suppression Head Impulse Paradigm (SHIMP) Test using a diagnostic headband. METHODS: Prospective and descriptive study analyzing the function of 1,255 horizontal semicircular canals of subjects with differing vestibulo-ocular reflex (VOR) gains who showed-up with symptoms related to neurotology (Montevideo, Uruguay, March 2017 to March 2019). The clinical HIMP and SHIMP tests were assessed and the amplitudes of overt saccades were compared to each other. Clinical findings were contrasted against vHIT gains. CONCLUSION: The HIMP and SHIMP combined test using the H/S headband has high specificity and low sensibility. This test association can identify healthy individuals among individuals typically misdiagnosed as ill by the conventional HIT or HIMP maneuver of the HIMP test, as originally described by Halmagyi and Curthoys. Therefore, we recommend using the headband assisted HIMP/SHIMP test, instead of exclusively relying on positive HIMP results.
Subject(s)
Head Impulse Test , Reflex, Vestibulo-Ocular , Head Impulse Test/methods , Humans , Prospective Studies , Saccades , Semicircular CanalsABSTRACT
El bullying es un fenómeno definido como una forma de agresión intencional que incluye actos verbales, físicos o psicológicos que ocurren en una relación con otras personas de manera reiterada, sistemática y sostenida en el tiempo. La mayor parte de los estudios se concentran en el bullying y las consecuencias en población escolar normotípica, sin embargo, existe poca exploración en el bullying que es resultado de un trastorno comunicativo. Es por ello que la labor de los fonoaudiólogos insertos en ámbitos educativos no es clara en explicitar los lineamientos de acciones terapéuticas que favorezcan la prevención de este fenómeno. El propósito de esta investigación es conocer las principales concepciones que los fonoaudiólogos tienen sobre el bullying en personas con trastornos de la comunicación en edad escolar. Con este objetivo, se realizó una investigación con métodos cuantitativos y cualitativos, mediados por encuestas y entrevistas en profundidad respectivamente. Se encontró que más del 65% del bullying entre personas dentro de los establecimientos educacionales se relaciona con niños de entre 9 y 12 años de edad con trastornos de la comunicación. En cuanto a la autopercepción del rol fonoaudiológico en el tema de la prevención e/o intervención en temas de bullying, emergen los conceptos de favorecer los aspectos del lenguaje y/o del habla en los niños que tienen dificultad, la sensibilización de los actores involucrados, el refuerzo del autoestima y el trabajo en equipo interdisciplinario. Finalizando el tratamiento analítico de las entrevistas, se establece que la Fonoaudiología cumpliría un papel fundamental en el abordaje del bullying en poblaciones con trastornos de la comunicación, siendo el profesional que actúa directamente sobre la salud comunicativa.
Bullying is a phenomenon defined as a form of intentional aggression that includes verbal, physical or psychological acts that occur in a relationship with other people in a repeated, systematic and sustained manner over time. Most of the studies focus on bullying and its consequences in the normal school population, however, there is little exploration of bullying that is the result of a communication disorder. This is why the work of speech therapists inserted in educational settings is not clear in explaining the guidelines for therapeutic actions that favor the prevention of this phenomenon. The purpose of this research is to know the main conceptions that speech-language pathologists have about bullying in people with communication disorders at school age. With this objective, an investigation was carried out with quantitative and qualitative methods, mediated by surveys and in-depth interviews, respectively. It was found that more than 65% of bullying between people within educational establishments is related to children between 9 and 12 years of age with communication disorders. Regarding the self-perception of the speech-language pathology role in the issue of prevention and/or intervention in bullying issues, the concepts of favoring aspects of language and/or speech in children who have difficulty emerge, raising awareness of the actors involved, the reinforcement of self-esteem and interdisciplinary teamwork. Completing the analytical treatment of the interviews, it is established that speech therapy would play a fundamental role in addressing bullying in populations with communication disorders, being the professional who acts directly on communicative health.
Subject(s)
Humans , Child , Communication Disorders , Speech, Language and Hearing Sciences , Bullying/prevention & control , Mainstreaming, Education , Surveys and QuestionnairesABSTRACT
Introduction/Objective: Anterior canalithiasis is an uncommon and challenging diagnosis. This is due in part to the difficulty of defining the affected side, the extreme positioning required to carry out described therapeutic maneuvers, and the infrequent use of specific maneuvers. Our objective is to present a new treatment alternative for anterior canalithiasis which is based on the well-known canalith repositioning procedure (CRP) described by Epley and which is used routinely in the treatment of both posterior and anterior canalithiasis. Analysis of the standard CRP for anterior canalithiasis with a biomechanical model validates that this new maneuver is an enhanced treatment option for anterior canalithiasis. We call the new maneuver the "short CRP." Methods: A previously published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze the conventional CRP in the treatment of anterior canalithiasis. The expected position of free otoliths near the anterior ampulla of the anterior semicircular duct was followed while recreating the sequential positions of the CRP. Although the standard CRP was possibly effective, certain enhancements were evident that could increase successful repositioning. These enhancements were incorporated into the modification of the CRP presented here as the "short CRP" for anterior canalithiasis. Results: The traditional CRP used for posterior canalithiasis can also be used for anterior canalithiasis. Although in the traditional CRP the head hangs 30° below horizontal, our simulation shows that a 40° head-hang below horizontal is an enhancement and may ensure progression of anterior otolith debris. Elimination of Position 4 of the classic CRP, in which the face is turned 45° toward the floor, was also seen as an enhancement as this position is predicted to cause retrograde movement of otoliths back into the anterior canal if the patient tucks the chin in position 4 or when sitting up. Conclusion: A modification of the CRP called the "short CRP" can be used to treat anterior canalithiasis. Model analysis predicts possible increased efficacy over the standard CRP. Model analysis of existing BPPV treatments is a valuable exercise for examination and can lead to realistic enhancements in patient care.
