Low-alcohol doses reduce common 10- to 15-Hz input to bilateral leg muscles during quiet standing.

The effects of low doses of alcohol on neural synchronization in muscular activity were investigated in ten participants during quiet standing with eyes open or closed. We focused on changes in common input to bilateral motor unit pools as evident in surface electromyographic (EMG) recordings of lower leg extensor and flexor muscles. The extensor muscles exhibited bilateral synchronization in two distinct frequency bands (i.e., 0-5 and 10-15 Hz), whereas synchronization between flexor muscles was minimal. As expected, alcohol ingestion affected postural sway, yielding increased sway at higher blood-alcohol levels. Whereas vision affected bilateral synchronization only at 0-5 Hz, alcohol ingestion resulted in a progressive decrease of synchronization at 10-15 Hz between the EMG activities of the extensor muscles. The decrease in common bilateral input is most likely related to reduced reticulospinal activity with alcohol ingestion.

Telemedicine and the diagnosis of speech and language disorders.

OBJECTIVE: To summarize results of telemedicine evaluations of speech and language disorders in patients in a small, rural hospital and in large multidisciplinary medical practices. MATERIALS AND METHODS: Eight patients underwent assessment as part of experiments with the National Aeronautics and Space Administration-launched Advanced Communications Technology Satellite. A second clinician was on-site with patients to assess the reliability of satellite observations. Twenty-four previously videotaped samples of speech disorders were also transmitted to assess agreement with original face-to-face clinical diagnoses. In addition, results of 150 telemedicine evaluations among Mayo Clinic practices in Minnesota, Arizona, and Florida were examined retrospectively. RESULTS: Evaluations were reliable, and patient satisfaction was good. Diagnoses were consistent with lesion localization and medical diagnosis when they were known, and they frequently had implications for lesion localization and medical diagnosis and management when they were previously unknown. The frequency of uncertain diagnosis (13%) for evaluation among the Mayo practices was only slightly higher than that encountered in face-to-face practice. Face-to-face evaluations were considered necessary for only 6 of the 150 patients (4%). CONCLUSION: Telemedicine evaluations can be reliable, beneficial, and acceptable to patients with a variety of acquired speech and language disorders, both in rural settings and within large multidisciplinary medical settings.

Social competence and head injury: a practical approach.

Social competence assessment and training has long focused on specific skills within the clinical setting. In addition, emphasis has been placed on identifying deficits relative to an arbitrary, often idiosyncratic metric. In this article, we discuss the importance of the principles that underlie communication and which are reflected in the range of behaviours described as 'social competence'. We review methods we have found productive in the training of these principles with persons who have suffered traumatic brain injuries.

Social competence and head injury: a new emphasis.

In the push for quantifiable outcome-based rehabilitation programmes, sensitivity to the integrity and uniqueness of the individual has been moved to the background. This has been particularly noticeable in the area of social skills therapy for persons who have suffered a traumatic head injury. We review some of the patterns of normal communication, with particular reference to roles, communicative relationships and individual differences, in order to clarify the difficulties in making clinical judgements about these skills. We propose a shift in focus to establishing a symmetrical therapeutic relationship in which communication is based on respect rather than structure and control. We utilize the clients' insights into their own social communication problems to enable them to be primary managers of their activities. The clinician's responsibility is not only to be a resource but also to be actively involved in the therapeutic process by reviewing his or her own social communication patterns in and outside of the therapy sessions. We argue that, with this perspective, activities can focus on principles of communication rather than specific skills, resulting in improved generalization and long-term outcome.

Perspectives on the male speech-language pathologist.

Although many professions are reporting greater gender neutrality, the opposite appears to be the case in speech-language pathology and audiology. The number of men in speech-language pathology and audiology has always been small. In 1925, 40% of the original members of the American Academy of Speech Correction were male (Bender, 1989). Each subsequent decade has seen the gender gap between male and female professionals widen (see chart illustrating the steady decline of male ASHA members between the years 1968 and 1992). When one considers only speech-language pathology, the gap between numbers of males and of females is even greater. According to ASHA's membership database, in December 1993 only 6.0% of ASHA-certified speech-language pathologists were men (ASHA, 1993).