Successful single-word writing treatment: Experimental analyses of four cases

Background: Individuals with severe aphasia may fail to regain spoken language, so that treatment should target other communication modalities such as writing. There is relatively limited documentation of successful writing treatment, particularly in individuals with severe aphasia. Aims: The present study was designed to examine treatment outcomes in response to two writing treatment protocols intended to rebuild single-word vocabulary for written communication. Methods & Procedures: Writing treatments were implemented with four individuals who had significant aphasia and severe agraphia. Two participants received Anagram and Copy Treatment (ACT) which involved arrangement of component letters and repeated copying of target words, along with a homework programme called Copy and Recall Treatment (CART) that included copying and recall of target words. The other two participants received the homework-based CART only. Single-subject multiple-baseline designs were used with sets of words sequentially targeted for treatment. Outcomes & Results: All four participants responded positively to treatment. Three of the participants had severely limited spoken language, so that mastery of written words provided a much-needed means of communication. The fourth participant, who had adequate spoken language for face-to-face conversation, employed his improved spelling for written messages such as e-mail. Conclusions: Single-word writing abilities may improve with treatment despite long times post onset and persistent impairments to spoken language.     

Effect of familiar content on paragraph comprehension in aphasia

Background: Previous research has shown that context improves aphasic individuals' auditory comprehension. The specific contextual information that has been identified as beneficial includes semantic constraints, semantic plausibility, both predictive and non‐predictive information, and familiar topics. However, context can also include familiar content such as the names of relatives, friends, local schools, and local stores.

Aims: The purpose of the present study was to assess the influence of familiar content on comprehension in individuals with aphasia. Specifically, it assessed whether individuals with aphasia answer questions about paragraphs more accurately when the paragraphs contain familiar content than when they do not.

Methods & Procedures: Eleven participants with aphasia and eleven participants without brain damage listened to short paragraphs that differed in the familiarity of the content included. In half of the paragraphs, the people and places were generic and not known specifically by the participants. In the other half, the people and places were known by the participants (as provided by a spouse or other close individual). Approximately half of the subsequent questions asked of the participants related to this targeted information and half related to other, more generic, information in the paragraphs.

Outcomes & Results: The questions relating to the paragraphs with the familiar content were answered more accurately than were the questions relating to the paragraphs with neutral content. For the participants with aphasia, this result occurred for the questions relating to both the targeted (and thus familiar) information and the non‐targeted or neutral information. The extent to which each participant with aphasia benefited from the familiar content did not relate to age, education, time‐post‐onset, or comprehension and naming skills.

Conclusions: These results suggest that familiar content may be another type of context that enhances comprehension skills in individuals with aphasia. The results are interpreted with respect to attention and domain knowledge concepts.     

Pathway Home™ for High Utilizers of Psychiatric Inpatient Services: Impact on Inpatient Days and Outpatient Engagement

Community Mental Health Journal - This study examined the impact of Pathway Home™ (PH) transition services for high utilizers of psychiatric hospitalization on inpatient days and outpatient...     

Longitudinal Stability of Intellectual Functioning in Autism Spectrum Disorder: From Age 3 Through Mid-adulthood

Journal of Autism and Developmental Disorders - Intelligence (IQ) scores are used in educational and vocational planning for individuals with autism spectrum disorder (ASD) yet little is known...     

Sacral Neuromodulation for Bladder Dysfunction in Children: Indications,Results and Complications

Purpose of review

Sacral neuromodulation (SNM) is an approved treatment in adults. Despite multiple publications about its safety and efficacy in children, SNM has yet to be approved by the Food and Drug Administration for use in this population. We aim to review all the published literature on SNM in children.

Recent findings

A PUBMED® and MEDLINE® search was performed for scientific publications on “sacral neuromodulation” and “sacral nerve stimulation” in pediatric patients. A total of ten unique articles published between 2006 and 2016 were identified. Each of these publications was thoroughly reviewed and the results included in this article. Refractory bowel and bladder dysfunction (BBD) is the primary indication for SNM placement. The S3 nerve root is the most common anatomical location for lead placement and it is most commonly placed in two stages. The first stage is followed by a trial period to assess symptomatic improvement prior to the second stage when the implantable pulse generator is placed. Symptom improvement ranges across studies but generally improvement or resolution is seen in 60–90 % of patients when properly selected. Potential complications include infection, lead breakage or migration, pain at the insertion site, device erosion, and device failure. Such complications are rare and SNM placement is generally accepted as successful and safe.

Summary

Sacral neuromodulation is an effective intervention for refractory bowel and bladder dysfunction in the carefully selected child. This technology is not approved for use in children younger than 16 in the United States, but as the body of literature grows, it is feasible that its application in the pediatric population will become more widely accepted.

     

Defining a new diagnostic assessment parameter for wound care: Elevated protease activity,an indicator of nonhealing,for targeted protease‐modulating treatment

It is widely accepted that elevated protease activity (EPA) in chronic wounds impedes healing. However, little progress has occurred in quantifying the level of protease activity that is detrimental for healing. The aim of this study was to determine the relationship between inflammatory protease activity and wound healing status, and to establish the level of EPA above which human neutrophil‐derived elastase (HNE) and matrix metalloproteases (MMP) activities correlate with nonhealing wounds. Chronic wound swab samples (n = 290) were collected from four wound centers across the USA to measure HNE and MMP activity. Healing status was determined according to percentage reduction in wound area over the previous 2–4 weeks; this was available for 211 wounds. Association between protease activity and nonhealing wounds was determined by receiver operating characteristic analysis (ROC), a statistical technique used for visualizing and analyzing the performance of diagnostic tests. ROC analysis showed that area under the curve (AUC) for HNE were 0.69 for all wounds and 0.78 for wounds with the most reliable wound trajectory information, respectively. For MMP, the corresponding AUC values were 0.70 and 0.82. Analysis suggested that chronic wounds having values of HNE >5 and/or MMP ≥13, should be considered wound healing impaired. EPA is indicative of nonhealing wounds. Use of a diagnostic test to detect EPA in clinical practice could enable clinicians to identify wounds that are nonhealing, thus enabling targeted treatment with protease modulating therapies.     

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

Objective

To evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention.

Arsenic association with circulating oxidized low-density lipoprotein in a Native American community

More than 500 abandoned uranium (U) mines within the Navajo Nation contribute U, arsenic (As) and other metals to groundwater, soil and potentially air through airborne transport. The adverse cardiovascular health effects attributed to cumulative exposure to these metals remains uncertain. The aim of this study was to examine whether environmental exposure to these metals may promote or exacerbate the oxidation of low-density lipoprotein (LDL) cholesterol in this Native American population. The correlation of cardiovascular biomarkers (oxidized LDL (oxLDL) and C-reactive protein (CRP)) from a Navajo cohort (n = 252) with mean annual As and U intakes from water and urine metals was estimated using linear regression. Proof-of-concept assays were performed to investigate whether As and U directly oxidize human LDL. Mean annual As intake from water was positively and significantly associated with oxLDL, but not CRP in this study population, while U intake estimates were negatively associated with oxLDL. In an acellular system, As, but not U, directly oxidized the apolipoprotein B-100 component of purified human LDL. Neither metal promoted lipid peroxidation of the LDL particle. Both the population and lab results are consistent with the hypothesis that As promotes oxidation of LDL, a crucial step in vascular inflammation and chronic vascular disease. Conversely, for outcomes related to U, negative associations were observed between U intake and oxLDL, and U only minimally altered human LDL in direct exposure experiments. Only urine U was correlated with CRP, whereas no other metals in water or urine were apparently reliable predictors of this inflammatory marker.     

AAOMP case challenge: a pigmented lesion of the mandibular facial gingiva

A 55-year-old white male was referred by his dermatologist for evaluation of an asymptomatic dark brown lesion on the mandibular facial attached gingiva.