1/10. Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
2/10. Life-threatening dystonia-dyskinesias in a child: successful treatment with bilateral pallidal stimulation.We report a 13-year-old boy who developed severe, refractory dystonia-dyskinesias as an abrupt worsening of a previously nonprogressive movement disorder. The movements became continuous, requiring artificial respiration and continuous sedation in the intensive-care unit. Various drugs and drug combinations failed to achieve control. The child was then treated successfully with bilateral pallidal (GPi) stimulation as shown in the videotape. Four months later and without medication, the boy regained autonomous gait and audible speech; his neurologic condition continues to improve.- - - - - - - - - - ranking = 0.34849707442306keywords = respiration (Clic here for more details about this article) |
3/10. Obstructive sleep apnea syndrome in a patient with medulloblastoma.We present one adult patient with medulloblastoma who developed polysomnographically documented obstructive sleep apnea after posterior fossa surgery. The sleep apnea worsened in conjunction with clinical and imaging-confirmed neoplastic progression and clinically improved after craniospinal radiation therapy. medulloblastoma or its surgical treatment has never before been implicated in a sleep-related breathing disorder. We discuss possible mechanisms for its occurrence and management implications.- - - - - - - - - - ranking = 0.090909090909091keywords = breathing (Clic here for more details about this article) |
4/10. dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.- - - - - - - - - - ranking = 0.34849707442306keywords = respiration (Clic here for more details about this article) |
5/10. Long-term treatment of severe dysarthria: a case study.This case study describes the long-term treatment and changing symptoms in a single subject with dysarthria secondary to basilar artery thrombosis. Initially, the subject was anarthric. Treatment efforts thereafter were directed toward modifying speech respiration, velopharyngeal function, articulatory precision, speech intensity, and speech intelligibility. A variety of treatment and measurement techniques are illustrated. The behavioral change resulting from each of the treatments was small. However, when combined, these small gains in conjunction with some neurological recovery resulted in significantly improved communication and quality of life for this subject. Implications for management of similar subjects are discussed.- - - - - - - - - - ranking = 0.34849707442306keywords = respiration (Clic here for more details about this article) |
6/10. dysarthria after large doses of intravenous diazepam.This is a description of a 34-month-old girl with dysarthria after a dosage of 37.5 mg/15 hours of intravenous diazepam (DZP). dysarthria lasted 180 hours after the final dose. However, her respiration and blood pressure were normal, and disturbance of consciousness was mild and normalized at 77 hours. The clinical correlations of the concentrations of DZP and its active metabolite are discussed.- - - - - - - - - - ranking = 0.34849707442306keywords = respiration (Clic here for more details about this article) |
7/10. Modification of breath patterning to increase naturalness of a mildly dysarthric speaker.The case of a 20-year-old, closed head injured male with mild dysarthria is presented. The decreased naturalness of speech was related to short, uniform breath groups, inhalation during every pause, and restricted fundamental frequency. Data related to patterns of breathing and pausing during samples of connected speech along with measures of respiratory control are presented in order to illustrate techniques for assessing and training speech naturalness.- - - - - - - - - - ranking = 0.090909090909091keywords = breathing (Clic here for more details about this article) |
8/10. Neurogenic dysphonia.Disorders of phonation and resonation subsequent to damage to the central or peripheral nervous system (neurogenic dysphonia) typically occur with alterations in other aspects of motor speech: articulation, prosody, and respiration. Deficits in voice initiation or coordination of resonation with speech that occur without significant neuromuscular impairment following a lesion to Broca's area are compatible with a motor speech programming disorder, or apraxia of speech. Conversely, damage to upper or lower motor neurons subserving motor speech results in a group of neuromuscular speech disorders, the dysarthrias, which have signs including aberrations of phonation and resonation which can be differentiated. The neuropathologic and perceptual characteristics of neurogenic dysphonia are elucidated, and suggestions are provided for their identification and differentiation.- - - - - - - - - - ranking = 0.34849707442306keywords = respiration (Clic here for more details about this article) |
9/10. Physiological and perceptual features of dysarthria in Moebius syndrome: directions for treatment.The functioning of the major subsystems of the speech production apparatus of a 12 year old female with Moebius syndrome was investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included: The Assessment of Intelligibility of Dysarthric Speech; the Frenchay dysarthria Assessment; and a perceptual analysis of a speech sample based on a reading of the Grandfather Passage. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic and aerodynamic evaluation of laryngeal function; nasometric assessment of velopharyngeal function; and evaluation of lip and tongue function using a variety of strain-gauge and pressure transducers. Consistent with the pathophysiological basis of Moebius syndrome, the major dysfunctions of the speech production mechanism were found at the level of the articulatory valve. Somewhat unexpectedly, however, impaired function was also identified at the level of the velopharyngeal and laryngeal valves by both the perceptual and instrumental assessments and at the level of the respiratory system by the physiological analysis alone. The results are discussed with reference to the neurological basis and clinical features of Moebius syndrome. The implications of the findings for the treatment of congenital dysarthria associated with Moebius syndrome are also discussed. The advantage of instrumental analysis over perceptual assessments in defining treatment goals for children with congenital dysarthria is highlighted.- - - - - - - - - - ranking = 0.090909090909091keywords = breathing (Clic here for more details about this article) |
10/10. Motor speech impairment in a case of childhood basilar artery stroke: treatment directions derived from physiological and perceptual assessment.The perceptual and physiological characteristics of the speech of a nine year old child who suffered a basilar artery stroke at the age of five years were investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included the Frenchay dysarthria Assessment, a perceptual analysis of a speech sample based on a reading of the Grandfather Passage and a phonetic intelligibility test. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic evaluation of laryngeal function, nasometric assessment of velopharyngeal function and evaluation of lip and tongue function using pressure transducers. Physiological assessment indicated the most severe deficits to be in the respiratory and velopharyngeal sub-systems with significant deficits in the articulatory sub-system, all of which resulted in severely reduced intelligibility. These results were compared and contrasted with the subject's performance on the perceptual assessment battery. In a number of instances the physiological assessments were able to identify deficits in the functioning of components of the speech production apparatus either not evidenced by the perceptual assessments or where the findings of the various perceptual assessments were contradictory. The resulting comprehensive profile of the child's dysarthria demonstrated the value of using an assessment battery comprised of both physiological and perceptual methods. In particular, the need to include instrumental analysis of the functioning of the various subcomponents of the speech production apparatus in the assessment battery when defining the treatment priorities for children with acquired dysarthria is highlighted. Treatment priorities determined on the basis of both the perceptual and physiological assessments for the present CVA case are discussed.- - - - - - - - - - ranking = 0.090909090909091keywords = breathing (Clic here for more details about this article) |
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