Voice recognition and aphasia: can computers understand aphasic speech?

Purpose : This preliminary investigation of the use of voice recognition software by people with aphasia presents a new method of training the software, which allows the aphasic user to by-pass the linguistically demanding standard training. It examines how accurately voice recognition software performed with aphasic speech and language as compared to that of control subjects.

Method : Five non-impaired controls and six participants with aphasia used a vocabulary of 50 words and 24 phrases to train the software over a maximum of five sessions. For the people with aphasia baseline assessments provided a profile of speech and language impairment. Measures of software accuracy were taken for all subjects at baseline and after four subsequent training sessions, for both single word and phrase level dictation.

Results : Word level production resulted in similar accuracy levels for both groups. Phrase level production showed greater accuracy levels than single word level production for both aphasics and controls, but participants with greater speech difficulties had lower software accuracy scores.

Conclusions : Training the software on a specific vocabulary allows people to access it whose speech and language difficulties would otherwise have prevented them. Findings are discussed in relation to use of the software as a dictation tool and as an input device to therapy software.     

Hands-free communication technology: a benefit for nursing?

The introduction of mobile communication devices (MCDs) has dramatically altered how nurses communicate. It is critical to assess whether these technologies contribute to stress and complicate the work of the nurse or if the devices are perceived as assisting in the provision of efficient and higher-quality patient care. The authors discuss a study that assessed the perceptions of nurses on a medical unit after MCDs were implemented.     

Amantadine for traumatic brain injury: does it improve cognition and reduce agitation?

OBJECTIVE: To review the available literature pertaining to amantadine as therapy for improving cognition and reducing agitation following a non-penetrating traumatic brain injury (TBI). DATA SOURCES: Clinical literature was accessed through MEDLINE (from 1966 to February 2004) and bibliographic searches. Key search terms included 'amantadine', 'traumatic brain injury', 'cognition', and 'agitation'. DATA SYNTHESIS: Amantadine is primarily used for treatment and prophylaxis of influenza A. Its ability to improve mentation and motor function in patients with head injury remains questionable. An evaluation of five clinical trials, two case reports, and one case series is conducted focusing on the use of amantadine following TBI. Patients in clinical trials were assessed using a variety of neuropsychological tools aimed at, among other things, assessing cognition and agitation. Although individual patient results varied, the majority of patients studied showed improved neuropsychological test scores. Similar observations are noted in the case reports and case series. Improvement in cognition and reduced agitation seems to occur with post-injury amantadine therapy. CONCLUSIONS: Amantadine is a reasonable option for improving cognition and reducing agitation following a TBI but confirmatory evidence of the efficacy the drug is necessary.     

Acute pancreatitis: a possible role for activated protein C?

Acute pancreatitis results from a sequence of events that involve the systemic inflammatory response. Activated C has multiple anti-inflammatory activities and may attenuate the degree of pancreatic injury and systemic organ dysfunction when infused early in pancreatitis     

Apraxia of speech: how reliable are speech and language therapists' diagnoses?

OBJECTIVE: To discover how reliably speech and language therapists could diagnose apraxia of speech using their clinical judgement, by measuring whether they were consistent (intra-rater reliability), and whether their diagnoses agreed (inter-rater reliability). DESIGN: Video clips of people with communication difficulties following stroke were rated by four speech and language therapists who were given no definition of apraxia of speech, no training, and no opportunity for conferring. SETTINGS: Videos were made of people following stroke in their homes. Ratings of the videos were carried out in the university lab under controlled conditions. SUBJECTS: Forty-two people with communication difficulties such as aphasia, apraxia of speech and dysarthria took part, and four specialist speech and language therapists acted as raters. MAIN MEASURE: Speech and language therapists' ratings of the presence and severity of apraxia of speech using videos. RESULTS: Intra-rater reliability was high for diagnosing (1) the presence of apraxia of speech (Cohen's kappas ranging from 0.90 to 1.00; 0.93 overall), and (2) the severity of apraxia of speech (kappa 0.84 to 0.92; 0.90 overall). The inter-rater reliability was also high for both the presence of apraxia of speech (kappa 0.86) and severity of apraxia of speech (0.74). CONCLUSION: Despite controversy over its nature and existence, specialist speech and language therapists show high levels of agreement on the diagnosis of apraxia of speech using their clinical judgement.     

Enterovirus infection--a possible trigger for Graves' disease?

Viruses are potential environmental factors in autoimmune disease. Some evidence suggests a relationship between enteroviral infection (especially Coxsackie B virus) and autoimmunity. We investigated 21 individuals with recent onset of Graves' hyperthyroidism in regard of (subclinical) enterovirus infection. Thyrotoxic symptoms had started about two months before blood sample collection. The patients were from Upper Austria and mainly female (17/21). Their mean free thyroxin levels in blood were twice the maximum normal value and the majority achieved a euthyroid state 1 1/2 years later, after antithyroid medication. We employed a nested PCR reaction with primers of the enterovirus genome on blood samples. All were negative for RNA of the enterovirus group. Coxsackie and related viruses were not identified as a trigger factor in autoimmune thyrotoxic disease.     

Using helicopters for secondary transfer--does the patient benefit?

In common with many expensive, high-technology devices, helicopters have been introduced into medical practice without the systematic assessment of benefit (if any). The civilian use of helicopters has evolved from a military role in evacuating casualties and is now increasingly directed towards secondary transfer of patients between hospitals as well as primary retrieval from the community. Whilst cost restraints have delayed the development of such services in the UK they have become increasingly available in the last decade. Helicopters are fast, once airborne, have a high profile and generate considerable enthusiasm, but they carry the disadvantages of increased response time, increased time at scene, space restriction, noise, lower safety margins, weather and daylight dependence, and high cost. When considering secondary transfer, it is highly unlikely that the advantage of speed in the air outweighs these disadvantages. Although studies are limited, none has shown any advantage for helicopter against road transport in either primary or secondary transport. The money required to run a helicopter service would be far better spent on establishing properly-equipped and trained road-based retrieval teams who can stabilise the patient on site and then continue treatment in transit, particularly as it has actually been shown that this approach can be used to transfer critically-ill patients without significant deterioration.     

Speech pathology services for people with aphasia: what is the current practice in Singapore?

Abstract

Purpose: This study reports on current provision of aphasia services by speech pathologists in Singapore. Method: A 44-item web-based survey was conducted looking into areas of service delivery, assessment, cultural and linguistic adaptations, clinical approaches, education of clients, recovery, goal setting and discharge as well as scope and challenges to practice. Results: A total of 36 surveys were completed representing approximately 86% of the potential target population. The intensity of aphasia services provided was well below that recommended by the literature. Participants reported embracing approaches to aphasia rehabilitation that spanned across the ICF domains. Numerous challenges were reported in providing aphasia services. These included the lack of locally relevant resources for aphasia, lack of family support and patient motivation, manpower shortages as well as barriers such as transport and cost restricting access to services. Conclusions: This research reveals several findings with considerable implications for practice planning and future direction in aphasia rehabilitation. There is a need for the development of locally relevant aphasia resources to enable comprehensive provision of aphasia services. In addition, further investigation is required to tackle the resource challenges faced by the profession and improve community support for people with aphasia.

• Implications for Rehabilitation

• Speech pathology services for aphasia in Singapore

• This article has identified the challenges of providing aphasia services in the Singapore context.

• Further investigation is required to address the key issues to improve aphasia services in Singapore.

• This includes developing locally relevant resources, looking at means like telerehabilition to tackle resource challenges, and improving community support for people with aphasia.

     

Developmental language disorders and adolescent risk: A public-health advocacy role for speech pathologists?

Within the multi-disciplinary team concerned with child and adolescent development, speech pathologists are uniquely positioned to understand the nature and overall developmental significance of language acquisition in childhood and adolescence. Other disciplines contribute valuable insights about psychosocial development during the childhood and adolescent years. The field of developmental psychology, for example provides a large and convincing body of evidence about the role of academic success as a protective factor against a range of psychosocial harms, in particular substance misuse, truancy, early school leaving, and juvenile offending. In this paper, we argue that juvenile offending embodies the notion of "adolescent risk", but in Australia in particular, has been under-investigated with respect to possible associations with developmental language disorders and subsequent academic failure. We present findings pertaining to a sample of 30 male juvenile offenders completing community based orders. Performance on a range of oral language processing and production skills was poorer than that of a demographically similar comparison group. Our results confirm the need to conceptualize language within a broader risk and protective framework. We therefore emphasize the public health importance of early language competence, by virtue of the psychosocial protection it confers on young people with respect to the development of prosocial skills, transition to literacy and overall academic achievement. We argue that speech pathologists are best positioned to advocate at a policy level about the broader public health importance of oral language competence.     

Biofeedback-assisted relaxation training for essential hypertension: who is most likely to benefit?

The main purpose of this study was to develop a way to predict which persons with essential hypertension would benefit most from biofeedback-assisted relaxation (BFAR) training. Second, the authors evaluated the effect of BFAR on blood pressure (BP) reduction, which was measured in the clinic and outside the clinic using an ambulatory BP monitor. Fifty-four adults with stage 1 or 2 hypertension (78% taking BP medications) received 8 weeks of relaxation training coupled with thermal, electromyographic, and respiratory sinus arrhythmia biofeedback. Blood pressure was measured in the clinic and over 24 hours using an ambulatory BP monitor pretraining and posttraining. Systolic BP dropped from 135.0 +/- 9.8 mmHg pretraining to 132.2 +/- 10.5 mmHg posttraining (F = 6.139, P = .017). Diastolic BP dropped from 80.4 +/- 8.1 mmHg pretraining to 78.5 +/- 10.0 mmHg posttraining (F = 4.441, P = .041). Data from 37 participants with baseline BP of 130/85 mmHg or greater were used to develop a prediction model. Regression showed that those who were able to lower their SBP 5 mm Hg or more were (1) not taking antihypertensive medication, (2) had lowest starting finger temperature, (3) had the smallest standard deviation in daytime mean arterial pressure, and (4) the lowest score on the Multidimensional Health Locus of Control-internal scale. Since these types of persons are most likely to benefit from BFAR, they should be offered BFAR prior to starting hypertensive medications.     

Trials stopped early for benefit? Not so fast!

Citation

Montori VM, Devereaux PJ, Adhikari NK, Burns KE, Eggert CH, Briel M, Lacchetti C, Leung TW, Darling E, Bryant DM, Bucher HC, Schunemann HJ, Meade MO, Cook DJ, Erwin PJ, Sood A, Sood R, Lo B, Thompson CA, Zhou Q, Mills E, Guyatt GH: Randomized trials stopped early for benefit: a systematic review. JAMA 2005, 294:2203–2209 [1].

Background

Randomized clinical trials (RCTs) that stop earlier than planned because of apparent benefit often receive great attention and affect clinical practice. Their prevalence, the magnitude and plausibility of their treatment effects, and the extent to which they report information about how investigators decided to stop early are, however, unknown.

Methods

Objective

To evaluate the epidemiology and reporting quality of RCTs involving interventions stopped early for benefit.

Design

Systematic review up to November 2004 of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify RCTs stopped early for benefit.

Study selection

Randomized clinical trials of any intervention reported as having stopped early because of results favoring the intervention. There were no exclusion criteria.

Data extraction

Twelve reviewers working independently and in duplicate abstracted data on content area and type of intervention tested, reporting of funding, type of end point driving study termination, treatment effect, length of follow-up, estimated sample size and total sample studied, role of a data and safety monitoring board in stopping the study, number of interim analyses planned and conducted, and existence and type of monitoring methods, statistical boundaries, and adjustment procedures for interim analyses and early stopping.

Data synthesis

Of 143 RCTs stopped early for benefit, the majority (92) were published in 5 high-impact medical journals. Typically, these were industry-funded drug trials in cardiology, cancer, and human immunodeficiency virus/AIDS. The proportion of all RCTs published in high-impact journals that were stopped early for benefit increased from 0.5% in 1990–1994 to 1.2% in 2000–2004 (P < .001 for trend). On average, RCTs recruited 63% (SD, 25%) of the planned sample and stopped after a median of 13 (interquartile range [IQR], 3–25) months of follow-up, 1 interim analysis, and when a median of 66 (IQR, 23–195) patients had experienced the end point driving study termination (event). The median risk ratio among truncated RCTs was 0.53 (IQR, 0.28–0.66). One hundred thirty-five (94%) of the 143 RCTs did not report at least 1 of the following: the planned sample size (n = 28), the interim analysis after which the trial was stopped (n = 45), whether a stopping rule informed the decision (n = 48), or an adjusted analysis accounting for interim monitoring and truncation (n = 129). Trials with fewer events yielded greater treatment effects (odds ratio, 28; 95% confidence interval, 11–73).

Conclusion

RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism.     

Systematic screening for urinary incontinence in older women: Who could benefit from it?

Objective

To identify women who are suffering from urinary incontinence but do not consult a physician and to identify reasons for this.

Design

Survey study as part of a randomized controlled trial that investigates the effects of a standardized assessment and evidence-based treatment on urinary incontinence in older women, the URINO project.

Setting

Female patients from general practices in the Northern part of the Netherlands.

Patients

A total of 225 women of 55 years and older suffering from urinary incontinence.

Main outcome measures

Number of patients with urinary incontinence who are not registered by their GP as suffering from this, factors associated with help-seeking behaviour, and reasons for not seeking help.

Results

Of the 225 patients, 143 (64%) were not registered by their GP as suffering from urinary incontinence. These women were more often younger and had lower levels of distress due to their urogynaecological symptoms. The most common reason for not consulting a GP was that patients considered their symptoms not to be serious enough.

Conclusion

The prevalence of older women with urinary incontinence who do not seek help is high. Help-seeking behaviour is associated with increasing age and higher levels of distress caused by the symptoms. Younger patients more often hesitate to consult their GP if they perceive their symptoms to be relatively mild.Key Words: Family practice, female, patient acceptance of health care, primary health care, urinary incontinence