The Efficacy of Voice Therapy via Hybrid Group Telepractice Program with Asynchronous Components for Primary School Teachers: A Pilot Study.

PURPOSE: To determine the efficacy of a hybrid group telepractice program in voice therapy for primary school teachers. METHOD: The participants, consisting of 12 teachers with voice disorders (three males and nine females), participated in 11 sessions of the telepractice program, divided into one training session on vocal hygiene, five practice sessions by themselves, and five group practice sessions in 5weeks. Data on the vocal handicap index (VHI) measure was obtained pre- and post-intervention. The voice analysis included fundamental frequency (local), jitter (local), shimmer (local), harmonic-to-noise ratio (local), and maximum phonation time assessed by Praat software. RESULT: The VHI assessment revealed a statistically significant difference (P < 0.05) in the emotional domain. There was no statistically significant difference (P > 0.05) in physical, functional, and total scores. Both males and females had no statistically significant difference (P > 0.05) in mean fundamental frequency. However, there was a statistically significant difference (P < 0.05) in jitter (local), shimmer (local), harmonics-to-noise ratio (local), and the maximum phonation time. CONCLUSION: The group telepractice program in voice therapy for primary school teachers was effective. It could be utilized for voice therapy to prevent voice disorder problems in teachers.

Epilepsy in patients with focal cortical dysplasia may be associated with autism spectrum disorder.

INTRODUCTION: Patients with epilepsy associated with focal cortical dysplasia (FCD) may be associated with autism spectrum disorder (ASD). Therefore, the purpose of this study was to compare surgically treated patients with epilepsy secondary to FCD and normal volunteers without epilepsy and to review the neuropathological findings of patients with FCD. METHODS: This study involved 38 patients with medically intractable focal onset epileptic seizures who underwent epilepsy surgery (Group 1). All patients had epilepsy associated with FCD. These patients and 38 normal volunteers without epilepsy (Group 2) were administered the autism spectrum quotient (AQ) test, and the groups were compared. RESULTS: The 38 patients in Group 1 included 16 females and 22 males (age range 20-60, mean age, 33.0; standard deviation (SD), 11.8 years). The normal volunteers in Group 2 included 22 females and 16 males (age range 20-57, mean age, 30.6 years; SD, 8.8 years). Total AQ scores were significantly higher in Group 1 than Group 2 (p = 0.027). Patients with FCD I showed a higher AQ score than those with FCD II in the AQ test (p ≤ 0.001). CONCLUSION: Patients with epilepsy secondary to FCD were associated with higher ASD score than normal volunteers. This tendency was seen more strongly in patients with FCD I than FCD II.

Nutritional Intervention Facilitates Food Intake after Epilepsy Surgery.

BACKGROUND: We investigated whether nutritional intervention affected food intake after epilepsy surgery and if intravenous infusions were required in patients with epilepsy. We hypothesized that postoperative food intake would be increased by nutritional intervention. The purpose of this study was to compare postoperative food intake in the periods before and after nutritional intervention. METHODS: Between September 2015 and October 2020, 124 epilepsy surgeries were performed. Of these, 65 patients who underwent subdural electrode placement followed by open cranial epilepsy surgery were studied. Postoperative total food intake, rate of maintenance of food intake, and total intravenous infusion were compared in the periods before and after nutritional intervention. RESULTS: A total of 26 females and 39 males (age range 3-60, mean 27.1, standard deviation (SD) 14.3, median 26 years) were enrolled. Of these, 18 females and 23 males (3-60, mean 28.2, SD 15.1, median 26 years) were in the pre-nutritional intervention period group, and eight females and 16 males (5-51, mean 25.2, SD 12.9, median 26.5 years) were in the post-nutritional intervention period group. The post-nutritional intervention period group showed significantly higher food intake (p = 0.015) and lower total infusion (p = 0.006) than the pre-nutritional intervention period group. CONCLUSION: The nutritional intervention increased food intake and also reduced the total amount of intravenous infusion. To identify the cut-off day to cease the intervention and to evaluate whether the intervention can reduce the complication rate, a multicenter study with a large number of patients is warranted.

Cortical activation during solid bolus swallowing.

Specific areas of cortical activity during solid bolus swallowing in humans are unknown. We tested the hypothesis that cortical representations of swallowing in humans may vary by bolus type. Twenty-one normal subjects swallowed three kinds of food: agar (solid), a capsule and water. We followed the same countdown method for identification of the cortical representations during swallowing performances as a previous study (Tanaka et al., 2006). Functional magnetic resonance imaging (fMRI) showed that the precentral gyrus, postcentral gyrus, medial temporal gyrus, superior temporal gyrus and cingulate gyrus were activated when swallowing an agar bolus (p<0.001). The subcortex was not activated. The cerebellum was activated only during capsule swallowing (P<0.001). Water bolus swallowing activations were similar to agar bolus swallowing. The cluster size of water swallowing was larger than the agar swallowing. We conclude that the cortical representations for swallowing are variable by food type.

Jaw opening and swallow triggering method for bilateral-brain-damaged patients: K-point stimulation.

The aim of this study was to confirm the response in patients stimulated at the trigger point (K-point). Since we have already clinically encountered patients with hyperactive bite reflexes who were able to open their mouth and swallow after stimulation of the trigger point, we investigated this response in other brain-damaged patients. The trigger point lies on the mucosa lateral to the palatoglossal arch and medial to the pterygomandibular fold at the height of the postretromolar pad. A total of 57 brain-damaged patients, including patients with pseudobulbar palsy due to bilateral upper motor neuron disease and bulbar palsy due to medulla oblongate. Other supratentorial brain-damaged patients and 20 non-brain-damaged subjects were also examined. The subjects were gently stimulated at the trigger point by a finger or a tongue depressor. We found that the pseudobulbar palsy patients with a hyperactive bite reflex responded by mouth opening and swallowing after a jaw movement similar to mastication elicited by the stimulation. The other pseudobulbar palsy patients, who did not have hyperactive bite reflexes and could open their mouth spontaneously, responded by swallowing with jaw movements similar to mastication after the stimulation. The bulbar palsy patients and the supratentorial brain-damaged patients showed no response to the stimulation. The non-brain-damaged subjects also did not respond, but all of the subjects reported a strange sensation after the stimulation. We concluded that stimulating the trigger point was useful for opening the mouth and facilitating swallowing in pseudobulbar palsy patients and that this technique may be of help in these patients in terms of oral health care and feeding.