June 1, 2013 Departments

From the Journals: June 2013

Visual Analog Scales Reveal Reductions in Tinnitus Severity

Visual analog scales of loudness and annoyance are valid and sensitive measurements for capturing changes in tinnitus severity in patients with chronic tinnitus, according to a study in the December 2012 issue of the American Journal of Audiology.

Developing interventions for chronic tinnitus requires sensitive and clinically responsive tools to measure treatment-induced changes in tinnitus loudness and annoyance. In this study, the authors evaluated the psychometric properties of patient-reported visual analog scales for measuring these subjectively perceived changes.

Researchers analyzed data from a single-blind, randomized, placebo-controlled study of acoustic coordinated reset neuromodulation in 63 German patients with chronic tinnitus. The goal was to assess the reliability, validity and minimally clinically identifiable difference—the smallest difference in a score that is considered to be important, relevant or worthwhile—of the visual analog scales of loudness and annoyance. Subjects completed these scales at screening, at baseline and during five visits during the clinical study's 16 weeks.

Visual analog scales of loudness and annoyance showed good test-retest reliability of .8 and .79, respectively. In terms of convergent validity, VAS loudness and VAS annoyance correlated well with the tinnitus questionnaire at all clinical visits. Minimally clinically identifiable difference estimates clustered between 10 and 15 points.

Seizures Decrease Children's Language Performance Over Time

Continued seizures—or prolonged exposure to the medications used to control them—may produce decrements in children's language performance over time, according to a study in the March-April 2013 International Journal of Language and Communication Disorders. The authors strongly recommend a greater awareness of seizure disorder among speech-language pathologists, as well as baseline testing at first diagnosis so changes over time can be documented reliably (see "Baseline Benefits").

Researchers sought to compare the language skills of 25 children with epilepsy—some with recent onset seizures and some with chronic seizure activity for more than three years—using a mix of standardized tests, analysis of elicited narratives and listener judgments of the children's narratives. They divided the children into two groups (recent and chronic) and age-matched them to 25 typically functioning peers. In addition to completing standardized IQ and language testing, children produced narratives to accompany the book "Frog, Where Are You?" Researchers analyzed their narratives for syntax, vocabulary and narrative components. Forty-five adult listeners each blindly rated nine narratives to create a large pool of listener judgments.

Children with chronic epilepsy showed the greatest differences in language skill and listener judgments from their unaffected peers. Differences were smaller for children whose epilepsy was of more recent onset and for their matched peers.

Chronic Seizures Associated With Decreased Language Skills

Children with epilepsy may be more disfluent overall than their typically developing peers, according to a study in press for the Journal of Fluency Disorders. The study adds to emerging literature charting poorer language skills and listener perceptions of verbal ability in children with chronic seizure activity, and bolsters the literature suggesting that disfluency during spoken language tasks may be a subtle marker of expressive language impairment.

Researchers assessed the relationship between fluency and language demand in children with epilepsy, a group that typically demonstrates depressed language skills. Then the researchers analyzed 52 children's disfluency types and frequencies using their elicited narratives. Half of the children had localization-related epilepsy, and the rest were age- and gender-matched typically developing peers.

During narrative productions, children with localization-related epilepsy were found to be significantly more disfluent overall than their matched, typically developing peers, and they demonstrated a higher proportion of stutter-like disfluencies, particularly prolongations.

Alzheimer's Disease Prevention Moves a Step Closer

A new drug to prevent the early stages of Alzheimer's disease could enter clinical trials in a few years, according to a study published Jan. 31, 2013, in the journal PLOS ONE. The drug needs to be tested for safety before it can enter human trials, but if it passes this hurdle the aim would be to give the drug to people with mild symptoms of memory loss before they develop the illness.

Alzheimer's is the most common type of dementia, which affects 820,000 people in the United Kingdom. One in three people older than 65 will die with dementia. The disease begins when a protein called amyloid-ß starts to clump together in senile plaques in the brain, damaging nerve cells and leading to memory loss and confusion.

David Allsop and Mark Taylor at Lancaster University have created a new drug that can reduce the number of senile plaques by one-third, and can double the number of new nerve cells in a particular region of the brain associated with memory. It also markedly reduced the amount of brain inflammation and oxidative damage associated with the disease.

The researchers tested the drug on transgenic mice containing two mutant human genes linked to inherited forms of Alzheimer's, so that they would develop some of the changes associated with the illness. The drug is designed to cross the blood-brain barrier and prevent amyloid-ß molecules from sticking together to form plaques.

Number of Americans With Alzheimer's May Triple by 2050

The number of people with Alzheimer's disease in the United States is projected to triple in the next 40 years, according to a study published in the February 2013 online issue of Neurology.

"This increase is due to an aging baby boom generation. It will place a huge burden on society, disabling more people who develop the disease, challenging their caregivers, and straining medical and social safety nets," said co-author Jennifer Weuve, assistant professor of medicine at the Rush Institute for Healthy Aging at Rush University Medical Center in Chicago. "Our study draws attention to an urgent need for more research, treatments and preventive strategies to reduce this epidemic."

Researchers analyzed information from 10,802 African American and Caucasian people living in Chicago, ages 65 and older, between 1993 and 2011. The researchers interviewed and assessed the participants for dementia every three years, factoring in age, race and education level. They combined data with U.S. death rates, education, and current and future population estimates from the U.S. Census Bureau.

The study found that the total number of people with Alzheimer's dementia in 2050 is projected to be 13.8 million, up from 4.7 million in 2010. About 7 million of those with the disease would be age 85 or older in 2050. "Our detailed projections use the most up-to-date data, but they are similar to projections made years and decades ago. All of these projections anticipate a future with a dramatic increase in the number of people with Alzheimer's and should compel us to prepare for it," Weuve said.

Robot-Delivered Speech and Physical Therapy a Success

In one of the earliest experiments using a humanoid robot to deliver speech and physical therapy to a stroke patient, researchers at the University of Massachusetts Amherst saw notable speech and physical therapy gains and significant improvement in quality of life, according to a study in the March 2013 issue of Aphasiology.

Researchers aimed to assess how interventions in one domain (speech treatment) affected interventions in another (physical therapy) in two different delivery scenarios. Despite the importance of working with other professionals, the authors point out, until now it has been "largely unknown how interventions by one type of therapy affect progress in others."

One client—with aphasia and hemiparesis—completed a robot-mediated program of only speech-language treatment for five weeks, followed by only physical therapy for five weeks in the sole condition. For the sequential condition, the client attended back-to-back speech treatment and physical therapy sessions for five weeks.

Over the course of the experiment, the client made "notable gains in the frequency and range of the upper-limb movements," the authors say. He also made positive gains in verbal expression. Interestingly, his improvements in speech and physical function were much greater when he engaged in only one therapy than when the two therapies were paired in sessions immediately following each other. The authors theorize that in such a sequential schedule "speech and physical functions seemed to compete for limited resources" in the brain.

Although some may object to robots delivering therapy, the authors point out the need is great and not being met now, especially in rural areas. They hope to augment human-to-human interaction, so a robot could take a clinician's place temporarily.

 


  

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