The WHO (World Health Organization) is expecting 20 million people to be struck by a stroke on a yearly base. More women than men will in the future have the risk on having a stroke.
Although stroke is seen in every age, 70% of the people having a stroke is older than 65. Dysphagia resulting from stroke is concerning scientists because of the risk for possible death, extra costs for special care and quality of life after the stroke. If not identified and managed well, it can lead to poor nutrition, pneumonia and increased disability, increased numbers for mortality. The possibility to predict a consisting and remaining dysphagia after a stroke is the focus of research nowadays.
Dysphagia occurs when there is a problem with any part of the swallowing process. When we see dysphagia after a stroke, problems include: not being able to start the swallowing reflex (because of the stroke or nervous system disorder. People with these problems are unable to begin the muscle movements that allow food to move from the mouth to the stomach.
Aspiration is a common problem for people with dysphagia and occurs when material a person is swallowing enters their airway and lungs, and pneumonia may develop. When the throat muscles are too weak they may not be able to prevent fluids or food from entering the airway or lungs. Aspiration causes choking, pneumonia and even death from asphyxiation.
Normally, aspiration would cause a violent cough, but a stroke can reduce sensation. After a stroke, food or liquid could enter the airway/lungs without someone being aware of it, called silent aspiration.
After a stroke many people have dysphagia. Dysphagia can affect up to 65 percent of stroke survivors, and is a serious problem that can cause potentially life threatening complications. That is an amount that needs consideration.
Dysphagia is influencing the quality of life and may lead to aspiration (causing pneumonia), malnutrition or dehydration, specifically in older patients. Mortality rates will rise when not recognizing dysphagia in time. Therefore it is necessary to focus on predictors of possible presence of dysphagia after stroke and the period this problem could stay.
In normal swallowing the pharynx has to be prepared on the volume of the coming bolus and, as said, gets information about sense and viscosity. Impulses will go to the Brainstem.
Patients with stroke located in the Brainstem will show a high risk of lacking the swallowing reflex. Size and exact location of the lesion are directly related to the prognosis for remaining dysphagia.
Having neurological damage caused by stroke, aspiration is a unexpected risk, as well as delayed first swallowing reflex, less control over the tongue muscles and control. A swallowing apraxia caused by stroke will show incorrect motor functions. When having a hemi-paralysis of the pharynx, there will also be high risk caused by unnoticed remaining residue after swallowing (Logemann, 2000).
In more recent research the relations between clinical variables and consequences for screening and treatment are considered. For example, Terré and Mearin (2006) show us that here are clear relations between clinical variables being age, intubation, velopharyngeal disorders and a cough when swallowing, changes in quality of voice, etiology and location of the lesion. Their study shows us that a clear correlation is proved between location of the lesion (posterior vascular area) and the changes in quality of the voice after the swallowing and aspiration. A disturbed vomiting reflex, coughing when swallowing as a reflex and also changes in quality of the voice really are the predictors of the high risk of aspiration, because the safety in the whole process has been lost.
The Royal Adelaide Prognostic Index for Dysphagic Stroke (RAPIDS) (Broadley S. et al., 2005) is the most recent index based on clinical and X-ray findings, that claims to be predictive about dysphagia and aspiration after stroke and also combines prediction with the grade of possible risk (Barthel index).
So there are possible predictors in the field of giving a prognoses for dysphagia and aspiration or prolonged dysphagia after stroke. An important issue for the patient as well as the medical staff and caregivers, insurance companies and revalidation therapists. Unfortunately, international guidelines in this field have not been developed yet.
No validated screening is used yet in the acute phase after stroke to give exact predictions about the recovery or risks after a stroke in the area of dysphagia and the life threatening extra risk of aspiration. Research is needed for confirming the best possible combination of tests and assessment leading to better screening in predicting consequences of stroke in the field of swallowing difficulties. Also, the best therapy and aimed evidence-based revalidation can be evaluated and formulated and linked to the screening procedure when available.
Written by M. Coppens
Thursday, 18 September 2008
About Hearing and Learning a Second Language
It is known that the first language of a person influences the way a second language is heard and how this person experiences speech sounds.
When learning a language the specific sounds (phonemes) from the first language are ‘programmed’ in the hearing system of a baby. Sounds that are not used (also: frequencies, prosodic elements) will be inactive until re-activated or even completely disappear (Groenen & Crul, 1998).
This is also known as the ‘Aangeboren Taal-Magneettheorie van Kuhl’. This theory states (in short) that new-borns are capable of discriminating contrasts of all possible phonemes, but when a child reaches the age of one year the possibility of discriminating phonemic contrasts from different languages than used in his first language will decrease.
This relates directly to the speech production. From the moment that a child is one year old the utterances will become specific for the first language only (Simkens, 1998).
After the age of twelve it has become very difficult to create changes in the active hearing of phonemes. The second language learner has to train the possibility of hearing and recognizing the ‘new’ sounds.
About the influence of hearing-skills and the relation with pronunciation it is known that the direct connection is very important for language development. (Koopmans- van Beinum, Clement & van der Stelt, 1998).
As said by Groenen and Crul (1998): when we think about causality: speechperception and speechproduction are influencing each other in one direct process and this underlines the important role of auditory skills in a language learning process.
In adults we see ‘perceptual assimilation’. This is the process of hearing a similar phoneme that exists in the first language of an adult listener, not being the right phoneme in the new language. The heard phoneme relates with the sound that is meant, but is not the exact phoneme.
The right phoneme will therefore not be produced as well. It is very difficult for adults to hear differences in relating phonemes (Groenen & Crul, 1998).
Re-activating can be done when an adult learns a second language that has different phonemes, prosody or frequencies used. The theory is now that a speech training, where pronunciation is learned in a way that is specifically aiming at already known problems that are to be expected for a native speaker of a certain language (being for example the not known sounds, frequencies, prosodic elements), can be of great help in learning a better pronunciation.
Feedback in speech-lessons given by a native speaker is therefore an important help in learning to hear the sounds to learn (Groenen & Crul, 1998).
Written by M. Coppens
When learning a language the specific sounds (phonemes) from the first language are ‘programmed’ in the hearing system of a baby. Sounds that are not used (also: frequencies, prosodic elements) will be inactive until re-activated or even completely disappear (Groenen & Crul, 1998).
This is also known as the ‘Aangeboren Taal-Magneettheorie van Kuhl’. This theory states (in short) that new-borns are capable of discriminating contrasts of all possible phonemes, but when a child reaches the age of one year the possibility of discriminating phonemic contrasts from different languages than used in his first language will decrease.
This relates directly to the speech production. From the moment that a child is one year old the utterances will become specific for the first language only (Simkens, 1998).
After the age of twelve it has become very difficult to create changes in the active hearing of phonemes. The second language learner has to train the possibility of hearing and recognizing the ‘new’ sounds.
About the influence of hearing-skills and the relation with pronunciation it is known that the direct connection is very important for language development. (Koopmans- van Beinum, Clement & van der Stelt, 1998).
As said by Groenen and Crul (1998): when we think about causality: speechperception and speechproduction are influencing each other in one direct process and this underlines the important role of auditory skills in a language learning process.
In adults we see ‘perceptual assimilation’. This is the process of hearing a similar phoneme that exists in the first language of an adult listener, not being the right phoneme in the new language. The heard phoneme relates with the sound that is meant, but is not the exact phoneme.
The right phoneme will therefore not be produced as well. It is very difficult for adults to hear differences in relating phonemes (Groenen & Crul, 1998).
Re-activating can be done when an adult learns a second language that has different phonemes, prosody or frequencies used. The theory is now that a speech training, where pronunciation is learned in a way that is specifically aiming at already known problems that are to be expected for a native speaker of a certain language (being for example the not known sounds, frequencies, prosodic elements), can be of great help in learning a better pronunciation.
Feedback in speech-lessons given by a native speaker is therefore an important help in learning to hear the sounds to learn (Groenen & Crul, 1998).
Written by M. Coppens
A New Researchproject
The American Association of Mental Retardation discussed the naming Mental Retardation for a long time and decided that this naming is inappropriate, therefore changing the name to Intellectual and Developmental Disabilities - IDD.
The association also recently changed its name to the American Association On Intellectual And Developmental Disabilities (AAIDD) .
In this new definition we can find the new way of thinking about creating the best possible help for a group of very different people.
When a person cannot react in a way we would like him to react (because it fits in our logical thinking), how can we translate or learn to see what this person really experiences?
Evidence-based measures can help us as well as evidence-based interventions given, as long as we base this on desired goals.
Nowadays the medical care is highly improving. Prenatal, natal, postnatal guidance are in better quality than ever. Medical and educational care are constantly improving and financial systems are maintained so that every living person can receive the best care needed.
Consequence is that people get older. And more people having mental retardation will live a longer life. A lot of thinking is done about the aspect if a longer life will lead to better quality of life. With the changing situation also treatments are changing, taking consideration of the dimension of aging in therapy.
Mostly people with mental retardation are classified according to their level of cognitive and adaptive impairment. Nowadays a tendency is seen to divide these people by their needs for environmental supports (AAMR, 1992).
Important will be to know how effective interventions are that are based on knowing these needs. When utilizing characteristic (behavioural) profiles we could develop an instrument to detect needs in people that we think they might improve when given the right therapy available.
With known signals to observe, it should be possible to develop targeted, evidence-based effective interventions.
Research aiming for improvement of aspects of the communication process is most important. Communication is one of the essential contributors in quality of life.
In new research we aim for improvement in hearing and listening, leading to a better possibility for auditory processing and speech perception, and improvement of speech and speech production, leading to better intelligibility and understanding.
Improvements we are searching for are those who lead to a better quality of life by changing conditions needed for optimal communication and taking a look at the possibility for keeping the improvements in communication on a certain level, for example by interventions and repeated assessment and implementing all possible help permanently.
A new researchproject on this subject started a year ago, in the Netherlands.
When you would like to hear more about this researchproject or information related to this researchfield, please leave a message.
Written by M. Coppens
The association also recently changed its name to the American Association On Intellectual And Developmental Disabilities (AAIDD) .
In this new definition we can find the new way of thinking about creating the best possible help for a group of very different people.
When a person cannot react in a way we would like him to react (because it fits in our logical thinking), how can we translate or learn to see what this person really experiences?
Evidence-based measures can help us as well as evidence-based interventions given, as long as we base this on desired goals.
Nowadays the medical care is highly improving. Prenatal, natal, postnatal guidance are in better quality than ever. Medical and educational care are constantly improving and financial systems are maintained so that every living person can receive the best care needed.
Consequence is that people get older. And more people having mental retardation will live a longer life. A lot of thinking is done about the aspect if a longer life will lead to better quality of life. With the changing situation also treatments are changing, taking consideration of the dimension of aging in therapy.
Mostly people with mental retardation are classified according to their level of cognitive and adaptive impairment. Nowadays a tendency is seen to divide these people by their needs for environmental supports (AAMR, 1992).
Important will be to know how effective interventions are that are based on knowing these needs. When utilizing characteristic (behavioural) profiles we could develop an instrument to detect needs in people that we think they might improve when given the right therapy available.
With known signals to observe, it should be possible to develop targeted, evidence-based effective interventions.
Research aiming for improvement of aspects of the communication process is most important. Communication is one of the essential contributors in quality of life.
In new research we aim for improvement in hearing and listening, leading to a better possibility for auditory processing and speech perception, and improvement of speech and speech production, leading to better intelligibility and understanding.
Improvements we are searching for are those who lead to a better quality of life by changing conditions needed for optimal communication and taking a look at the possibility for keeping the improvements in communication on a certain level, for example by interventions and repeated assessment and implementing all possible help permanently.
A new researchproject on this subject started a year ago, in the Netherlands.
When you would like to hear more about this researchproject or information related to this researchfield, please leave a message.
Written by M. Coppens
Wednesday, 17 September 2008
Thinking about basic needs or possibilities
Discoveries in human genetics led to forthcoming diseases and forthcoming syndromes and more knowledge about mental retardation. The advances of the developing knowledge about syndromes and consequences are promoting new ways of looking at a variety of human disorders and permanently changing the field as a result.
The improvements and research results in knowing more about certain syndromes lead to new understanding of and interventions for people who have mental retardation.
Causes, prevalence and basic physical characteristics help us understand the behavioural issues that are considered when developing interventions aiming for improving quality of life.
In life, every person has the basic right for getting the best possible help and guidance available.
This counts for all people in our world. So let's not think from the perspective of what persons with mental retardation are short of….a new perspective will be that all people are a collection of biochemical processes leading to certain (partly predictable) behaviour and experience. Given that there also is an environment that influences the development of each person in a different way, we should think of ways to learn to see what question for help persons with mental retardation could have in stead of thinking in terms of retardation or handicap.
In research in the field of mental retardation, we find several different cultures sharing a common interest. There are Psychology researchers looking at the complex measurements in competence and behaviour, and we find Biomedical researchers looking at causes and genetics. But all researchers in this field are interested in the behaviour of people with mental retardation.
Disorders of mental retardation influence cognition, language and behaviour, and therefore influence reactions of people in the environment of people with mental retardation.
The choices caretakers have to make in the field of educational and psychological (or other) interventions are relative.
Therapies are told to be only effective when improvement is seen according to the view of the people in the direct environment of the person with Mental Retardation. But the main aim will always be the improving of quality of life from the person with mental retardation.
The difficulty is not only to think from this different view, it is most complex to get to know what will be the best reachable quality of life for a person. Especially when you cannot ask these persons themselves.
Improvement can be achieved by changing conditions for communication, so improving all basic needs for being able to communicate. Will this in the experience of the person in question lead to improvement of life-quality, or to an easier way of living? Who can decide if it is the best help?
Written by M. Coppens
The improvements and research results in knowing more about certain syndromes lead to new understanding of and interventions for people who have mental retardation.
Causes, prevalence and basic physical characteristics help us understand the behavioural issues that are considered when developing interventions aiming for improving quality of life.
In life, every person has the basic right for getting the best possible help and guidance available.
This counts for all people in our world. So let's not think from the perspective of what persons with mental retardation are short of….a new perspective will be that all people are a collection of biochemical processes leading to certain (partly predictable) behaviour and experience. Given that there also is an environment that influences the development of each person in a different way, we should think of ways to learn to see what question for help persons with mental retardation could have in stead of thinking in terms of retardation or handicap.
In research in the field of mental retardation, we find several different cultures sharing a common interest. There are Psychology researchers looking at the complex measurements in competence and behaviour, and we find Biomedical researchers looking at causes and genetics. But all researchers in this field are interested in the behaviour of people with mental retardation.
Disorders of mental retardation influence cognition, language and behaviour, and therefore influence reactions of people in the environment of people with mental retardation.
The choices caretakers have to make in the field of educational and psychological (or other) interventions are relative.
Therapies are told to be only effective when improvement is seen according to the view of the people in the direct environment of the person with Mental Retardation. But the main aim will always be the improving of quality of life from the person with mental retardation.
The difficulty is not only to think from this different view, it is most complex to get to know what will be the best reachable quality of life for a person. Especially when you cannot ask these persons themselves.
Improvement can be achieved by changing conditions for communication, so improving all basic needs for being able to communicate. Will this in the experience of the person in question lead to improvement of life-quality, or to an easier way of living? Who can decide if it is the best help?
Written by M. Coppens
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