DOCSLIB.ORG

Respiratory Therapy for Speech in Multiple Sclerosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Respiratory Therapy for Speech in Multiple Sclerosis Institute of Neurology University of London Respiratory Therapy for Speech in Multiple Sclerosis Ph.D. Thesis Kimberley Anne Mathieson Bradley April 1997 ProQuest Number: 10055444 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10055444 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT Respiratory Support for Speech In Multiple Sclerosis The dysarthria of multiple sclerosis is known to worsen as the disease progresses (Darley, Brown and Goldstein 1972). Thus as activities of daily life and opportunities for activity for the person with multiple sclerosis are curtailed by increasing disability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter and Bailey 1988). It is a hypothesis of this paper and others that disuse creates a discrepancy between the functional ability that is neurologically available and that which is characteristically used (Olgiati et al., 1988; Olgiati et al. 1986). It is this functional overlay that may be the target of speech therapy (Farmakides and Boone 1960). Five subjects with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improving functional speech performance. Intervention effects were demonstrated by introducing the therapy to different subjects at successive points in time. Therapy exercises targeted the respiratory system alone with no phonatory or articulatory components. Various measures including laryngographic analysis, clinical motor speech tasks and standardised dysarthria profiles were found to be unsuitable as baseline or repeat measures to show improvement in speech. Intelligibility was chosen as a global and objective repeat measure of functional speech performance and was established for each subject using the Yorkston Beukelman Test of the Intelligibility of Dysarthric Speech. Findings cautiously suggest that certain subjects can benefit from respiratory muscle exercises that improve speech performance as measured by intelligibility. A component of the dysarthria of MS may not be due to neuro-motor dysfunction but to atrophy based on fatigue and disuse of the system. This study suggests that this atrophy may be reversible. The objective measurement of intelligibility and the clinical use of a multiple baseline research format are also discussed. THE N/ for Paul, with thanks ACKNOWLEDGEMENTS To the five subjects in this study who gave unstintingly of their time, enthusiasm and concern I am greatly indebted. As well to the members of the North Surrey Group of the MS Society of Great Britain who welcomed me into their homes and let me tape their voices I am most grateful. I thank Dr. Keith Andrews of the Royal Hospital for Neuro-Disability, Putney and the members of the Speech Therapy Department at RHND in 1992, Julie Lepatourel, Joan Ellams, and Fiona Sugden for their assistance, suggestions and office space. I thank Sherwood Medical Supplies, Great Britain for supplying the Voldyne Inspiratory Spirometers used in the study and Sandra Robertson and Vincent McDonnell of the Speech Pathology Department of Manchester Metropolitan University for allowing me the use of the Respiratory Drive Indicator. Drs. Maggie Snowling, Frances McCurtain and Rosemary Morgan-Berry at the (then) National Hospitals College of Speech Sciences I thank for their input in the early stages of this project. I am grateful to Dr. Bill Wells of the Department of Human Communication Science, University College for his input into Round Two. To Dr. Jane Maxim, also of UCL, I am especially grateful for seeing the project to completion. Drs. Jamie Mathieson and John Lloyd of the Curry School of Education, University of Virginia I thank for their conflicting but helpful guide through the world of statistics and single case studies. I thank my parents who have always believed in me whatever I have attempted. I thank Charlotte and Georgia for being such sweethearts about letting Mum do her “fesis”. And finally I owe to my husband, Paul, infinite thanks for the emotional, financial, personal and practical support that he has always given me. I would not have done this without him. TABLE OF CONTENTS Page Abstract 2 Dedication 3 Acknowledgements 4 Table of Contents 5 Table of Figures 7 1 BACKGROUND TO THE RESEARCH QUESTION 9 1.1 Incidence Of Dysarthria In Multiple Sclerosis 11 1.2 Mixed Dysarthria Of Multiple Sclerosis As Distinct From 14 Paroxysmal Dysarthria 1.3 Language And Other Communication Problems In Multiple 17 Sclerosis 1.4 Acoustic Analysis Of Speech 23 1.5 Perceptual Analysis Of Speech 29 1.6 Treatment Of The Dysarthria In Multiple Sclerosis 36 1.7 Respiratory Function In Multiple Sclerosis 41 1.8 Respiratory Therapy In Multiple Sclerosis 48 1.9 Conclusion 49 2 METHODOLOGY 51 2.1 The Research Design 51 2.2 Subjects 52 2.2.1 Subjects - General 52 2.2.2 Subjects - Dysarthria 56 2.3 Research Procedure 60 2.3.2 Therapy 64 2.3.3 Judging 66 3 BACKGROUND TO THE METHODOLOGY 70 3.1 Case Study Methodology 70 3.2 Choice Of Repeat Measure 75 3.2.1 The Potential Of The Laryngograph As A Repeat Measure 79 3.2.2 Intelligibility Testing As A Repeat Measure 106 3.3 Respiration And Speech Therapy 124 3.4 Variables Controlled For In The Study 135 3.4.1 Diurnal Effects 135 3.4.2 Cyclical Effects 139 3.4.3 Location Of Session 140 3.4.4 Posture 142 3.5 Procedural Reliability 142 4 RESULTS 146 4.1 Multiple Baseline Study 146 4.2 Individual Responses To Therapy 148 4.3 Statistical Analysis 160 4.4 Reliability Testing 167 4.5 Error Analysis 172 4.6 Therapy Results 184 5 DISCUSSION 189 5.1 Statistical Analysis 189 5.2 Conclusions — The Research Question 194 5.3 Conclusions — Case Study Methodology 209 5.4 Conclusions — Measurement Of Intelligibility 215 6 RECOMMENDATIONS FOR FURTHER RESEARCH 220 7 BIBLIOGRAPHY 225 APPENDICES 243 A Upper And Lower Extremity Function Scales 244 B Dysarthria And Case History Assessment Form 246 C Standardised Reading Passages 253 D Multiple Baseline Therapy Results 255 E Consent Form 259 F Procedural Reliability Protocols 261 G Forms For The Yorkston Beukelman Assessment Of The 269 Intelligibility Of Dysarthric Speech H Diary Sheets 274 I Error Analysis Subjects VG And GF 278 J Subject Frenchay Dysarthria Assessment Profiles 299 TABLE OF FIGURES Figure 1 : Specific Speech Deviations Noted in a Group of Subjects with Multiple Sclerosis 31 Figure 2: Distribution of Speech, Breathing and Oral Diadochokinetic Rate Measures in Six Neurologic Groups of Subjects with Multiple Sclerosis* 33 Figure 3: Subject Details 55 Figure 4: Intelligibility Testing: Subjects, Settings and Procedures 63 Figure 5: Therapy Goals for Subjects 66 Figure 6: Normal Glottic Cycle 79 Figure 7: Laryngograph Study Participants Profile 82 Figure 8: Hillel’s Ranking of Speech in ALS (Hillel et al. 1989) 83 Figure 9: Laryngograph Study: Subjects’ Intelligibility Scores and Awareness of Speech Problem. 89 Figure 10: Laryngograph Study: Spontaneous Speaking Rate 91 Figure 11 : Laryngograph Study: Motor Speech Tasks Targeting Respiration 92 Figure 12: Laryngograph Study: Motor Speech Tasks Targeting Phonation 93 Figure 13: Laryngograph Study: Articulation Task - Diadochokinesis Data 95 Figure 14: Laryngograph Study: Articulation Tasks: Diadochokinesis 95 Figure 15: Laryngograph Study: L(jc) Traces 97 Figure 16: Laryngograph Study: Subject’s Report of Dysphagia 98 Figure 17: Laryngograph Study: Motor Speech Tasks Targeting Resonance and Multiple Levels in Speech Process 100 Figure 18: Laryngograph Study: Mean Results by Group 102 Figure 19: Laryngograph Study: ANOVA Group Difference Results 103 Figure 20: Intelligibility plotted against Sound Pressure Level 111 Figure 21 : Sherwood Voldyne 5000 Spirometer 134 Figure 22: Subjects and Control Times 138 Figure 23: Subject Session Location 141 Figure 24: Subject Posture 142 Figure 25: Multiple Baseline Study - The Effect of Respiratory Exercises on Speech Intelligibility as Measured by the YB Intelligibility Test 147 Figure 26: Intelligibility Scores by Week, Date and Session 149 Figure 27: VG Performance on Motor Speech Tasks - Summary 151 Figure 28: VG Intelligibility Scores, Repeated Listening 152 Figure 29: VG Intelligibility Scores 152 Figure 30: HP’s Performance on Motor Speech Tasks - Summary 154 Figure 31: RP Intelligibility Scores 154 Figure 32:GF’s Performance on Motor Speech Tasks - Summary 156 Figure 33: GF Intelligibility Scores 156 Figure 34: GF Intelligibility Scores 158 Figure 35: WR Intelligibility Scores 159 Figure 36: EB Intelligibility Scores 160 Figure 37: VG t-Test Statistics 162 Figure 38: GF t-Test Statistics 163 Figure 39: Mann Test Calculations for Subject GF 163 Figure 40: Summary of C Statistic Calculations for Subject VG 165 Figure 41 : Summary of C Statistic Calculations for Subject RP 165 Figure 42: Summary of C Statistic Calculations for Subject GF 166 Figure 43: Summary of Z Scores Results for Tryon’s C Statistic 166 Figure 44: Intrajudge
Load more

Recommended publications
  • About Pain Pharmacology: What Pain Physicians Should Know Kyung-Hoon Kim1, Hyo-Jung Seo1, Salahadin Abdi2, and Billy Huh2
    Korean J Pain 2020;33(2):108-120 https://doi.org/10.3344/kjp.2020.33.2.108 pISSN 2005-9159 eISSN 2093-0569 Review Article All about pain pharmacology: what pain physicians should know Kyung-Hoon Kim1, Hyo-Jung Seo1, Salahadin Abdi2, and Billy Huh2 1Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea 2Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Received February 8, 2020 Revised March 12, 2020 From the perspective of the definition of pain, pain can be divided into emotional Accepted March 13, 2020 and sensory components, which originate from potential and actual tissue dam- age, respectively. The pharmacologic treatment of the emotional pain component Correspondence includes antianxiety drugs, antidepressants, and antipsychotics. The anti-anxiety Kyung-Hoon Kim drugs have anti-anxious, sedative, and somnolent effects. The antipsychotics are Department of Anesthesia and Pain effective in patients with positive symptoms of psychosis. On the other hand, the Medicine, Pusan National University sensory pain component can be divided into nociceptive and neuropathic pain. Yangsan Hospital, 20 Geumo-ro, Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are usually applied for Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-1422 somatic and visceral nociceptive pain, respectively; anticonvulsants and antide- Fax: +82-55-360-2149 pressants are administered for the treatment of neuropathic pain with positive and E-mail: [email protected] negative symptoms, respectively. The NSAIDs, which inhibit the cyclo-oxygenase pathway, exhibit anti-inflammatory, antipyretic, and analgesic effects; however, they have a therapeutic ceiling.
    [Show full text]
  • Childhood Neurological Conditions and Disorders
    Childhood neurological conditions and disorders Please note: We do include rare conditions. If your one is not in the list below we will still consider your survey responses. Epilepsies Autosomal dominant epilepsy with auditory features (ADEAF) Autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE) Benign epilepsy with centrotemporal spikes (BECTS) Benign familial infantile epilepsy Benign familial neonatal epilepsy (BFNE) Benign infantile epilepsy Benign neonatal seizures (BNS) Childhood absence epilepsy (CAE) Cyclin Dependent Kinase-Like 5 (CDKL5) Deficiency Disorder Dravet syndrome Early myoclonic encephalopathy (EME) Epilepsy of infancy with migrating focal seizures Epilepsy with generalized tonic–clonic seizures alone Epilepsy with myoclonic absences Epilepsy with myoclonic atonic (previously astatic) seizures Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) Familial focal epilepsy with variable foci (childhood to adult) Febrile seizures (FS) Febrile seizures plus (FS+) (can start in infancy) Gelastic seizures with hypothalamic hamartoma Hemiconvulsion–hemiplegia–epilepsy Juvenile absence epilepsy (JAE) Juvenile myoclonic epilepsy (JME) Landau-Kleffner syndrome (LKS) Late onset childhood occipital epilepsy (Gastaut type) Lennox-Gastaut syndrome Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) Myoclonic epilepsy in infancy (MEI) Ohtahara syndrome Panayiotopoulos syndrome Photosensitive absence epilepsies including Jeavons syndrome, Sunflower syndrome Progressive myoclonus epilepsies
    [Show full text]
  • 1 July 2008.Pmd
    Bangladesh Journal of Neuroscience 2008; Vol. 24 (1) : 9-16 Initial Neurologic Symptoms Among Bangladeshi Multiple Sclerosis Patients MD BAHADUR ALI MIAH1, ABDUL KADER SHEIKH1, AKHLAQUE HOSAIN KHAN2, MD RAFIQUL ISLAM3, AKM ANWAR ULLAH4, QUAZI DEEN MOHAMMAD5, ANISUL HAQUE4 Abstract vision (optic nerve involvement, 64%), motor This study was undertaken in the weakness (92%), sphincteric disturbances Department of Neurology, Bangabandhu (92%) and a lower rate of brainstem and Sheikh Mujib Medical University (BSMMU), cerebellar involvement. Painful tonic Dhaka, from January 2002 to December spasm was a prominent feature among 2003. The objective of this study was to Bangladeshi patients with multiple sclerosis determine the initial neurologic symptoms (8 out of 25, 32%). of multiple sclerosis among Bangladeshi Out of 25 patients, one (4%) expired due patients. to aspiration pneumonia. Twenty four (96%) A total of 25 respondents of multiple survived. Among them 9 (36%) has sclerosis patients as cases selected by restricted activity, 7 (28%) were bedridden, McDonald et al. (2001) diagnostic criteria 5 (20%) were chairbound, 2 (8%) had minor disability and were in work and 1 (4%) was for multiple sclerosis were enlisted during completely normal. the study period. The clinical details, investigations of the respondents were Introduction reviewed. Data were recorded in Multiple sclerosis (MS) is an inflammatory predesigned data collection sheet. Out of demyelinating disease of central nervous 25 cases, male patients were 12 (48%) and system (CNS) causing significant morbidity females were 13 (52%), ratio being 1:1.08. with a variable course, thought to result from Majority of the patients presented at immune response to myelin sheath with second, third and fourth decades of life.
    [Show full text]
  • London Journtal of Medicine
    Lond J Med: first published as 10.1136/bmj.s2-1.7.601 on 3 July 1849. Downloaded from LONDON JOURNTAL OF MEDICINE, A MONTHLY 3Ietortof tte lItbfial *(fences. i5i L JULY 1849.-No. VII. ORIGINAL COMMUNICATIONS. THE CLIMACTERIC DISEASE IN WOMEN; A PAROXYSMAL AFFECTION OCCURRING AT THE DECLINE OF THE CATAXENIA. By W. TYLER SMITH, M.D. Lond.; ectturet on Midwifery and the Diseases of Womeu in the Hunterian School of Medicine. THE Climacteric Disease has received much attention, since the appear- ance of the valuable Essay on the subject ly Sir Henry Halford, in the fourth volume of the Transactions of the College of Physicians. The Climacteric Disorder there described, consists of a sudden decline of the vital or biotic powers in advanced life, and is chiefly met with, in http://www.bmj.com/ the male sex, from the age of sixty-five and upwards, the female being comparatively exempt from its attacks. Periodicity is, however, more indelibly marked upon the female than upon the male constitution; and periodic tendencies are as distinctlv seen in the diseases, as in the functions, of the female economy. With reference to the sex, the most important climacteric or-periodic epoch, of the catamenia. This is is that of the decline epoch generally a time on 30 September 2021 by guest. Protected copyright. of anxiety, both to patients and professional men; and much care has been bestowed on the study of the access and exacerbations of organic diseases, especially of the uterine system, at this time. Still, it ap- pears to me, the specual disorder of this period, from which a variety of secondary disorders arise, has never been noticed with sufficient accu- racy, either for the purposes of diagnosis or of practice.
    [Show full text]
  • P-Wave Dispersion and Left Atrial Indices As
    The Egyptian Heart Journal (2014) xxx, xxx–xxx Egyptian Society of Cardiology The Egyptian Heart Journal www.elsevier.com/locate/ehj www.sciencedirect.com ORIGINAL ARTICLE P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients with non hemorrhagic cerebrovascular strokes and transient ischemic attacks Mohamed Elansary, Mohamed Hamdi, Hanan Zaghla, Dalia Ragab * Critical Care Medicine Department, Cairo University, Egypt Received 13 September 2013; accepted 20 October 2013 KEYWORDS Abstract Background: One-third of stroke and Transient Ischemic Attack (TIA) are cryptogenic P-wave dispersion; requiring additional investigation and intervention. Occult Paroxysmal Atrial Fibrillation (PAF) LA volume; has been suggested as a possible cause for these cryptogenic strokes. Paroxysmal AF Objective: The aim of our study is to evaluate the role of simple ECG & bedside echocardiographic parameters for prediction of PAF in patients presenting with stroke or TIAs. Patients & methods: The study included 60 patients with non hemorrhagic stroke. During 1 week of continuous ICU monitoring, 30% of patients had PAF (group 1), the remaining 42 patients did not develop PAF (group 2). All patients were subjected to detailed history taking, thorough clinical examination including NIHSS, serial ECGs for calculation of maximum and minimum P wave duration (Pmax, and Pmin) & P wave dispersion (Pdis), and transthoracic echocardiography for cal- culation of left atrial volume (LAV), and left atrial volume index (LAVI). Results: It was found that Pmax &Pdis were significantly higher in group 1 in comparison to group 2 (147.7 ± 9.6 mm vs 114.3 ± 9 mm, P: <0.001) and (54.1 ± 7.5 mm vs 30.2 ± 7 mm, P: <0.001), respectively.
    [Show full text]
  • Trigeminal Neuralgia After Bromocriptine Therapy in a Stroke Patient - a Case Report
    J Korean Acad Rehab Med 2010; 34: 777-780 Case Report Trigeminal Neuralgia after Bromocriptine Therapy in a Stroke Patient - A Case Report - Joo Hyun Park, M.D., Ph.D.2, Geun Young Park, M.D., Ph.D.1, Sun Im, M.D.1, Soon Hei Yoo, M.D.2, Jin Jun, M.D.2, Jin Ook Kwon, M.D.1, Sung Hee Jung, M.D.2, Hee Chan Jung, M.D.2 Department of Rehabilitation Medicine, 1Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon 420-717, 2Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-040, Korea Rare side effects of bromocriptine, such as, trigermial neuralgia, have been reported in patients with pituitary adenoma but no such case has been reported in post-stroke patients. This case reports on a stroke patient who developed trigeminal neuralgia after bromocriptine therapy. A 48-year-old man, diagnosed with left middle cerebral artery territory infarction and transcortical motor aphasia, was prescribed with 2.5 mg of bromocriptine. After two days, he complained of pain in the right trigeminal nerve distribution. Brain MRI, facial EMG, blink reflex, revealed no abnormalities. His pain showed no relief to various pharmacological agents. However, pain disappeared with discontinuation of bromocriptine and recurred again with readministration. In addition, pain intensity correlated with increase of bromocriptine dosage. Based on these findings, we concluded that patient’s trigerminal neuralgia was related to bromocriptine administration. An antidote, which consisted of a dopamine antagonist was prescribed together with bromocriptine and the patient subsequently showed relief of pain and improvement of aphasia.
    [Show full text]
  • A Study of Selected Cases of Nervous Diseases With
    A STUDY OF SELECTED CASES OF NERVOUS DISEASES WITH SPECIAL REFERENCE TO DISSEMINATED SCLEROSIS AND SYPHILIS AMD THE VALUE OF THE COLLOIDAL GOLD REACTION AS AN AID TO EARLY DIAGNOSIS. by Douglas KlnoM n Adame. -----------__oOo—--------- - ProQuest Number: 27555675 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27555675 Published by ProQuest LLO (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLO. ProQuest LLO. 789 East Eisenhower Parkway P.Q. Box 1346 Ann Arbor, Ml 48106- 1346 A STUDY OF SELECTED CASES OF NERVOUS DISEASES WITH SPECIAL REFERENCE TO DISSEMINATED SCLEROSIS AND SYPHILIS AND THE VALUE OF THE COLLOIDAL GOLD REACTION AS AN AID TO EARLY DIAGNOSIS. The following research, was undertaken on behalf of the Medical Research Council and its primary object was to attempt an investigation into the aetiology of disseminated sclerosis. It was recognized at the outset that the morbid histology of the disease had been studied in great ( 1 ) detail, notably by Dawson, that opportunities of obtaining pathological material were likely rarely to arise and that the chief hope of future advance in the investigation of this disease would appear to lie rather along bacteriological, serological and experimental lines.
    [Show full text]
  • Neurally Mediated Syncope Manifesting During Atrial Fibrillation a Case Report
    Circ J 2002; 66: 866–868 Neurally Mediated Syncope Manifesting During Atrial Fibrillation A Case Report Takeshi Shirayama, MD; Keiji Inoue, MD; Takashi Sakamoto, MD; Midori Yamamura, MD; Hiroki Mani, MD; Akiko Yoshida, MD; Hiroto Imai, MD; Yayoi Matoba, MD; Masao Nakagawa, MD A 64-year-old male was admitted to hospital because of repeated episodes of syncope and palpitation. Ambulatory monitoring revealed paroxysmal atrial fibrillation (AF) as the cause of palpitation; he did not have structural heart disease. The induction of AF by rapid pacing (50Hz for 1s) in an upright position provoked syncope with a vasodepressor response. Atropine sulfate blocked the induction of syncope. The possible etiology was neurally mediated syncope that manifested only during AF, which suggests that the abnormal vagal activity during AF in this case exaggerated the vasodepessor response while upright. (Circ J 2002; 66: 866–868) Key Words: Atrial fibrillation; Head-up tilt; Neurally mediated syncope; Vagal nerve yncope is often encountered in an emergency room, Laboratory tests revealed hyperlipidemia (triglyceride, but its etiology is not always clear. Neurally medi- 240mg/dl; total cholesterol, 208mg/dl) and hyperuricemia S ated syncope, which is characterized by abnormal (8.6 mg/dl). Liver enzymes (aspartate aminotransferase, vagal reflex, has been recently recognized as a major cause alanine aminotransferase,γ-glutamyl transpeptidase) were of syncopal episodes,1–3 and it can be provoked repeatedly normal. Blood pressure was 132/70mmHg, and heart rate by the head-up tilt test with fairly good sensitivity.2,4 A was regular at 85beats/min. The ECG was normal, as was paroxysmal attack of atrial fibrillation (AF) is another ultrasonic echocardiography.
    [Show full text]
  • P-Wave Dispersion and Left Atrial Indices As Predictors of Paroxysmal
    The Egyptian Heart Journal (2014) 66, 369–374 HOSTED BY Egyptian Society of Cardiology The Egyptian Heart Journal www.elsevier.com/locate/ehj www.sciencedirect.com ORIGINAL ARTICLE P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients with non hemorrhagic cerebrovascular strokes and transient ischemic attacks Mohamed Elansary, Mohamed Hamdi, Hanan Zaghla, Dalia Ragab * Critical Care Medicine Department, Cairo University, Egypt Received 13 September 2013; accepted 20 October 2013 Available online 14 February 2014 KEYWORDS Abstract Background: One-third of stroke and Transient Ischemic Attack (TIA) are cryptogenic P-wave dispersion; requiring additional investigation and intervention. Occult Paroxysmal Atrial Fibrillation (PAF) LA volume; has been suggested as a possible cause for these cryptogenic strokes. Paroxysmal AF Objective: The aim of our study is to evaluate the role of simple ECG & bedside echocardiographic parameters for prediction of PAF in patients presenting with stroke or TIAs. Patients & methods: The study included 60 patients with non hemorrhagic stroke. During 1 week of continuous ICU monitoring, 30% of patients had PAF (group 1), the remaining 42 patients did not develop PAF (group 2). All patients were subjected to detailed history taking, thorough clinical examination including NIHSS, serial ECGs for calculation of maximum and minimum P wave duration (Pmax, and Pmin) & P wave dispersion (Pdis), and transthoracic echocardiography for cal- culation of left atrial volume (LAV), and left atrial volume index (LAVI). Results: It was found that Pmax &Pdis were significantly higher in group 1 in comparison to group 2 (147.7 ± 9.6 mm vs 114.3 ± 9 mm, P: <0.001) and (54.1 ± 7.5 mm vs 30.2 ± 7 mm, P: <0.001), respectively.
    [Show full text]
  • Medical Terminology Made Incredibly Easy Third Edition
    845500FM.qxd 8/19/08 7:17 PM Page i Medical Terminology made IncrediblyIncredibly® EaEasy!sy! 845500FM.qxd 8/19/08 7:17 PM Page ii Staff The clinical treatments described and recommended in this pub- lication are based on research and consultation with nursing, Executive Publisher medical, and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Neverthe- Judith A. Schilling McCann, RN, MSN less, they can’t be considered absolute and universal recom- Editorial Director mendations. For individual applications, all recommendations David Moreau must be considered in light of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light Clinical Director of the latest package-insert information. The authors and pub- Joan M. Robinson, RN, MSN lisher disclaim any responsibility for any adverse effects result- Art Director ing from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text. Mary Ludwicki Electronic Project Manager © 2009 by Lippincott Williams & Wilkins. All rights reserved. This John Macalino book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any Senior Managing Editor means—electronic, mechanical, photocopy, recording, or other- Jaime Stockslager Buss, MSPH, ELS wise—without prior written permission of the publisher, except Clinical Project Manager for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by the publisher to in- Lorraine M. Hallowell, RN, BSN, RVS structors whose schools have adopted its accompanying text- Editors book.
    [Show full text]
  • 2.14 Neuropsychiatry of Neurometabolic and Neuroendocrine Disorders 655
    2.14 Neuropsychiatry of Neurometabolic and Neuroendocrine Disorders 655 Ware AL, Glass L, Crocker N, et al. Effects of prenatal alcohol exposure and attention- metabolic disorders have been described, and only a very limited deficit/hyperactivity disorder on adaptive functioning. Alcohol Clin Exp Res. 2014; 38:1439–1447. number of these are screened for in the neonatal period (usually less Ware AL, O’Brien JW, Crocker N, et al. The effects of prenatal alcohol exposure and than ten in most centers). This may provide the clinician with a false attention-deficit/hyperactivity disorder on psychopathology and behavior. Alcohol assurance that any significant and/or serious metabolic disorders will Clin Exp Res. 2013;37:507–516. already have been detected. This situation is further complicated by the fact that the age of onset and presentation, in addition to disease expression, vary greatly across and within these disorders, and dis- orders that present later or in a less severe form are often missed by ▲▲ 2.14 Neuropsychiatry screening processes during the neonatal and childhood periods. Those metabolic disorders that present initially, or predominantly, of Neurometabolic and with neuropsychiatric syndromes generally have their onset in the period of the life cycle associated with the onset of the majority of Neuroendocrine Disorders psychiatric illnesses, that is, adolescence or early adulthood. The dis- orders that present in this stage will commonly be inborn errors of MARK WALTERFANG, PH.D., FRANZCP, RAMON MOCELLIN, metabolism, affecting cellular function in the CNS. A wide range OLIVIER BONNOT, M.D. PH.D., AND DENNIS VELAKOULIS, of phenotype–genotype correlations occur in such disorders, as dif- DMEDSCI, FRANZCP fering mutations in the gene for the protein serving a key function in metabolism will result in different structural or conformational changes to the protein product and differential metabolic effects.
    [Show full text]
  • Nurses' Alumnae Association Bulletin - Volume 5 Number 8
    Thomas Jefferson University Jefferson Digital Commons Nursing Alumni Bulletins Jefferson Nursing 5-1947 Nurses' Alumnae Association Bulletin - Volume 5 Number 8 Margaret M. Jackson Kathryn M. Prendergast Martha E. Riland Thelma Showers Morris Maudie Dunigan See next page for additional authors Follow this and additional works at: https://jdc.jefferson.edu/nursing_alumni_bulletin Part of the Nursing Commons Let us know how access to this document benefits ouy Recommended Citation Jackson, Margaret M.; Prendergast, Kathryn M.; Riland, Martha E.; Morris, Thelma Showers; Dunigan, Maudie; Smith, Austin T.; Rehfuss, Martin E.; Schutt, Barbara; Spruance, Henrietta Fitzgerald; Flack, Herbert L.; Rice, Mrs. Willard M.; Barth, Alice S.; and Ellwanger, A. E., "Nurses' Alumnae Association Bulletin - Volume 5 Number 8" (1947). Nursing Alumni Bulletins. Paper 13. https://jdc.jefferson.edu/nursing_alumni_bulletin/13 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Nursing Alumni Bulletins by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Authors Margaret M. Jackson, Kathryn M. Prendergast, Martha E. Riland, Thelma Showers Morris, Maudie Dunigan, Austin T. Smith, Martin E. Rehfuss, Barbara Schutt, Henrietta Fitzgerald Spruance, Herbert L.
    [Show full text]