Success of recommending oral diets in acute stroke patients based on passing a 90-cc water swallow challenge protocol.

PURPOSE: This study investigated the success of recommending specific oral diets following an acute stroke based on passing a 90-cc water swallow challenge protocol. METHOD: The study was a single group consecutively referred case series design. The study took place in a large, urban, tertiary care teaching hospital and involved 75 acute adult stroke inpatients in a 90-cc water swallow challenge. The volume (in cc) of liquid ingested, percent of meal eaten, and specific diet recommendations made 12 to 24 hours after passing a 90-cc water swallow challenge were accessed electronically from routine oral intake information entered by nursing staff on each participant's daily flow sheets. Nurses were blinded to the study's purpose. RESULTS: All 75 participants were drinking thin liquids and eating food successfully 12 to 24 hours after passing a 90-cc water swallow challenge. The mean volume of liquid ingested was 385.4 cc and percent of diet eaten ranged from 10% to 100%. Flow sheets indicated that specific diet recommendations were followed with 100% accuracy. CONCLUSIONS: Successfully recommending specific oral diets to acute stroke patients based on passing a 90-cc water swallow challenge protocol was supported. A 90-cc challenge is an easily administered, highly reliable, cost-effective, and validated clinical assessment that can be used by a variety of qualified health care professionals to identify aspiration risk. When a 90-cc challenge protocol is passed, specific diet recommendations can be made safely and confidently without the need for further objective dysphagia testing.

Atypical lexical/semantic processing in high-functioning autism spectrum disorders without early language delay.

Although autism is associated with impaired language functions, the nature of semantic processing in high-functioning pervasive developmental disorders (HFPDD) without a history of early language delay has been debated. In this study, we aimed to examine whether the automatic lexical/semantic aspect of language is impaired or intact in these population. Eleven individuals with Asperger's Disorder (AS) or HFPDD-Not Otherwise Specified (NOS) and age-, IQ-, and gender-matched typically developing individuals performed a semantic decision task in four conditions using an indirect priming paradigm. Semantic priming effects were found for near-semantically related word pairs in the controls, whereas this was not the case in the AS or HFPDDNOS participants. This finding suggests similarities in the underlying semantic processing of language across PDD subtypes.

Differentiation of speech and nonspeech processing within primary auditory cortex.

Primary auditory cortex (PAC), located in Heschl's gyrus (HG), is the earliest cortical level at which sounds are processed. Standard theories of speech perception assume that signal components are given a representation in PAC which are then matched to speech templates in auditory association cortex. An alternative holds that speech activates a specialized system in cortex that does not use the primitives of PAC. Functional magnetic resonance imaging revealed different brain activation patterns in listening to speech and nonspeech sounds across different levels of complexity. Sensitivity to speech was observed in association cortex, as expected. Further, activation in HG increased with increasing levels of complexity with added fundamentals for both nonspeech and speech stimuli, but only for nonspeech when separate sources (release bursts/fricative noises or their nonspeech analogs) were added. These results are consistent with the existence of a specialized speech system which bypasses more typical processes at the earliest cortical level.

Relationships of naming skills to reading, memory, and receptive vocabulary: evidence for imprecise phonological representations of words by poor readers.

The main hypotheses addressed in the research were (1) whether imprecision in the phonological representations of lexical items underlies the impaired expressive naming abilities of disabled readers, and (2) whether weak verbal memory might mediate the relationship between naming and reading skills. From samples of 93 first graders and 67 fourth graders, extreme groups of good and poor readers were identified and compared on measures of receptive vocabulary, expressive naming, acceptability judgments for variants of object names, imitation and correction of naming errors by another speaker, pseudoword repetition, and long-term memory. Performance was generally better by older than younger students and by good than poor readers at each age, with little interaction between grade and reader group. The results indicated that for both good and poor readers, imprecise phonological knowledge, especially about long words, contributed to children's difficulties on all naming tasks. Memory differences, however, appeared to play only a minor role in explaining the strong association between naming and reading.