Effectiveness of postural control techniques to compensate for oropharyngeal dysphagia have been recommended and used by several clinicians. However, the inter-rater reliability of these techniques is not well understood. The purpose of this study was to clarify the ambiguity of postural control techniques using statistical analyses. A total of 50 clinicians involved in dysphagia treatment participated in this study, where a healthy male served as the simulated patient. The following clinically used postures were measured by two investigators on two separate days: chin down, right/left incline, and right/left rotation. Postural angles were measured twice by two investigators on each day. Data obtained for the angle of each posture were visually displayed. Data from both investigators were assessed for each posture using the Youden plot, which analyzes data variability for systematic errors and accidental errors separately. The correlation coefficient for examining the measurement error between investigators was calculated. The results showed considerable variation between clinicians regarding the postures used, and significant differences were noted each day. The correlation coefficient for a total of four measurements was more often lower on Day 2 than that on Day 1. The details of the instructions provided by clinicians were not fixed, and the same specified posture was not reproduced even when instructions were provided to the same subject. These findings suggest poor inter-rater reliability because of the variability of selected postures when using statistical analyses. Therefore, standardized postures need to be developed that can be easily measured and reproduced.
Summary This research was designed to investigate the acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia. Forty‐nine patients with complaints of swallow difficulty received a videofluorographic ( VF ) examination. They were divided into three groups: nine who did not have any apparent disease ( G roup N ), 22 patients with head and neck cancer ( G roup H&N ) and 18 patients with other diseases including cerebrovascular disease ( G roup OD ). After liquid barium swallows, they exhaled voluntarily without voicing. Videofluorographic findings were classified into four groups: normal ( N ormal), acceptable swallow (Acceptable), swallow with residue (Resid) and swallows with penetration or aspiration (Pen/Asp). The duration of expiratory sounds was measured on the time waveform. Frequency characteristics of expiratory sounds were obtained using one‐third octave band analysis ranging from 62·5 to 2000·0 Hz of central frequency. The averaged level of the 1000·0‐Hz band was chosen as the reference band level ( RB level). The revised averaged level of each band was obtained by subtracting the RB level from the averaged level of each band. Zero decibel of the revised magnitude of the 125·0‐Hz band was set as the critical value to differentiate dysphagia ( R esid or Pen/Asp) from no dysphagia ( N ormal or A cceptable). Comparison of this assessment with VF findings showed a significant percentage agreement (85·4%). These results suggest that frequency characteristics of post‐swallow expiratory sounds can differentiate dysphagia from no dysphagia among multiple dysphagic patient groups.
Circadian rhythms are a system integrated into almost every organism that lives on Earth.Clock genes are responsible for circadian oscillations.In mammals, four kinds of major clock genes(products) , namely BMAL1, CLOCK, PER, and CRY, form a negative feedback loop consisting of transcription and translation of transcription factors, and there is an oscillating 24-h rhythm in almost all cells or organs in the body.Clock genes not only oscillate circadian rhythms, but also provide rhythmic periods of approximately 24 h in the expression of various factors through fluctuations in transcriptional activity of the clock genes around a 24-h cycle.Studies of clock gene-knockout mice have revealed that some genes(Per1, Per2, and Cry1) have an active rhythmic cycle that is shorter than that of wild-type genes, genes(Clock and Cry2) , that become longer, or genes(Bmal1) whose rhythm disappears.Because clock genes control the rhythmic expression of factors functioning in various cells and organs of an organism, mutations in clock genes not only cause abnormalities in sleep / behavior rhythms, but also dyslipidemias and tumors, and are involved in the pathogenesis of various diseases.In addition, clock genes control daily uctuations in drug targets, metabolic enzymes, and transporters, indicating that they are also involved in the daily uctuations in the effects of drugs and their side effects.Thus, the roles of clock genes are also drawing attention from these perspectives.
Electropalatography (EPG) has been used in the past 50 years for studying the patterns of contact between the tongue and the palate during speech production in typical speakers and those with speech disorders due to different causes. At the 7th EPG Symposium in Japan that was held online on 24 January 2021 (see: https://epg-research.sakura.ne.jp/), a panel of invited experts discussed their views regarding further developments and application of the technique. This paper provides a summary of this discussion. EPG offers information on articulation which cannot be replaced by other instrumental measures of speech. Identified areas for further hardware development are thinner EPG plates, better dental and palatal coverage, wireless connectivity, and sensors that provide additional articulatory information (e.g. tongue pressure, tongue-palate distance). EPG can serve as a resource for teaching speech disorders and phonetics. Furthermore, EPG therapy can be combined with telepractice in the speech therapy of clients with speech disorders.
Abstract Background At the 7th Electropalatography Symposium in Japan, held online on the 24 January 2021, a few speakers were invited to talk about how the COVID‐19 pandemic had impacted their research and/or speech therapy that involved the use of electropalatography (EPG) as well as the procedures adopted in order to continue their work in a safe manner. The information on protective measures when using instrumental techniques in speech research and therapy may be useful for colleagues in research and the clinic. Aims The primary aims are: (1) to find out whether there are any published recommendations regarding protective measures for using EPG in research and clinic settings; (2) to discuss the impact of the pandemic and the corresponding restrictions and general protective measures directed (or advised) by local government and professional bodies at each stage of EPG work; and (3) to share experiences in using modified procedures for face‐to‐face EPG therapy sessions and combined EPG teletherapy. In addition, a brief overview of EPG and a summary of EPG research and clinical activities in Japan presented by one of the symposium organizers at the symposium are included. Methods & Procedures A review of the literature regarding protective measures recommended for using EPG for speech assessment and treatment or research, supplemented by a discussion of our own experiences. Main Contribution The literature review showed that there are no guidelines regarding protective measures for using EPG, but there is some advice regarding speech recording using microphones. Most published articles related to speech and language therapy (SLT) service during COVID‐19 are about telepractice or general clinical guidelines for face‐to‐face speech therapy sessions. The protective measures for using EPG developed based on the general guidelines recommended by local government and professional bodies (e.g., using visors, transparent acrylic board) were described. Using EPG in telepractice was discussed as well. Conclusions It has been challenging to continue EPG research and therapy during the pandemic. In order to deal with this crisis, available knowledge regarding infection control and recommendations from local government and professional bodies were applied to design methods and procedures that allowed EPG research and therapy to continue. What this paper adds What is already known on the subject There are general protective measures recommended by local government and professional bodies regarding speech therapy sessions (e.g., using personal protective equipment (PPE), social distancing), but little is known about the measures for using instrumental techniques in speech research and therapy, particularly EPG. The equipment of each instrumental technique is different, so measures that are appropriate for one may not be suitable for others. Hence, specific recommendations are needed for EPG. What this paper adds to existing knowledge This paper provides pointers to information about recommendations regarding protective measures for speech research and therapy, supplemented with suggestions specific to EPG provided by experienced users based on actual experience. What are the potential or actual clinical implications of this work? In evaluating the impact of the COVID‐19 pandemic on EPG research and therapy, an analytical approach was taken to break down the steps involved in carrying out those activities, and the challenges we faced and the possible alternatives for completing the tasks were discussed. A similar approach can be applied to evaluate other aspects of speech therapy service.
Abstract Aim Lateral misarticulation (LM) is a speech sound disorder in which air escapes laterally during speech. In LM speech therapy, errors often remain in conversational speech, even when single syllables are produced correctly. However, previous studies have used syllables, words, and phrases as speech samples and have not analyzed conversational speech. In this study, electropalatography (EPG) was used to observe tongue–palate contact patterns in a sentence that is similar to conversational speech and thereby clarify the articulatory dynamics of LM in connected speech. Methods The participants included 30 patients with LM and 10 typical speakers. Tongue–palate contact patterns were recorded simultaneously with speech sounds. A global pattern (GP) for each participant was created by accumulating all the EPG patterns during the sentence production. The contact rates of cumulative global patterns (CGP) for each group were examined. Results The GP for each participant revealed that typical speakers displayed continuous contact in the bilateral posterolateral region and less contact in the central region, whereas patients with LM exhibited less contact in the posterolateral region and more contact in the central region. The CGP for each group indicated that the LM group tended to have a lower contact rate in the posterolateral region and a higher contact rate in the anterior‐central region than the typical group. Conclusion Lateral bracing in the posterolateral region and groove formation in the central region are important for patients with LM to consistently produce correct sounds in connected speech.
