Comparing monitoring and production based approaches to the treatment of phonological assembly difficulties in aphasia

Background: Waldron, Whitworth, and Howard (2011 Waldron, H., Whitworth, A. and Howard, D. 2011. Therapy for phonological assembly difficulties: A case series. Aphasiology, 25(4): 434–455. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) replicated the auditory and monitoring therapy reported in a single case by Franklin, Buerk, and Howard (2002 Franklin, S., Buerk, F. and Howard, D. 2002. Generalised improvement in speech production for a subject with reproduction conduction aphasia. Aphasiology, 16(10/11): 1087–1114. [Taylor & Francis Online] , [Google Scholar]) with four participants with phonological assembly difficulties. No participant responded in the same way as Franklin et al.’s client MB and, notably, all improvements seen were item-specific, in contrast to MB who had shown generalised improvements in naming, repetition, and reading aloud. Waldron et al. attributed this difference to the combination of underlying impairments in their participants, in particular additional lexical deficits; it remains unknown whether Franklin et al.’s results would be replicated in someone with a more pure phonological assembly difficulty. It is also unknown whether a more direct therapy approach, targeting a reduction in the production of phonological errors, rather than improving monitoring, might also be effective with this client group.

Aims: The current study aimed to compare the effectiveness of the auditory and monitoring therapy reported by Franklin et al. (2002 Franklin, S., Buerk, F. and Howard, D. 2002. Generalised improvement in speech production for a subject with reproduction conduction aphasia. Aphasiology, 16(10/11): 1087–1114. [Taylor & Francis Online] , [Google Scholar]) with a production-focused therapy based on the articulatory kinematic treatment of apraxia of speech (AOS), in a single participant with phonological assembly difficulties.

Methods & Procedures: Participant RE received three consecutive therapy phases: Franklin et al.’s auditory therapy, followed by a new production therapy involving a hierarchy of articulatory kinematic cues and the production of minimal contrast pairs, and finally Franklin et al.’s monitoring therapy. As RE's linguistic profile was similar to that of Franklin et al.’s client, it was predicted that he would make similar gains, i.e., generalised improvement in the production of treated and untreated words, following all three therapy types.

Outcomes & Results: RE's naming of treated items improved significantly after both the production therapy and the monitoring therapy, but naming of untreated items did not improve and there were no naming improvements following the auditory therapy.

Conclusions: Two possible reasons why RE did not respond as predicted are discussed. First, that RE may have had additional lexical retrieval difficulties, in which case therapy could have improved the link between semantics and lexical phonology; and second, that RE may have had additional mild AOS, in which case therapy may have resulted in improved motor planning abilities. Neither of these hypotheses could fully account for all of RE's results. Nonetheless, the production therapy was shown to be an effective alternative approach for clients with phonological assembly difficulties, when a direct focus on speech production is needed.     

Bouveret's syndrome--a rare presentation of gallstone ileus

We present the case of an elderly Irish male with Bouveret's syndrome--a very unusual cause of gallstone ileus, where a large gallstone occludes the gastric outlet or duodenum causing obstruction. Management of this condition is often controversial. We discuss the various medical, radiological and surgical therapies available for treatment of this rare entity. Bouveret's Syndrome--A Rare Presentation of Gallstone Ileus     

The Impact of Traumatic Experiences on Risky Sexual Behaviors in Black and White Young Adult Women

Background

Trauma exposure has been linked to risky sexual behavior (RSB), but few studies have examined the impact of distinct trauma types on RSB in one model or how the association with trauma and RSB may differ across race.

Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID‐19) pandemic: Wuhan and Toronto experience

The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID‐19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.