scholarly journals Treatment for Pediatric Aphasia: A Critical Review

2020 ◽  
Author(s):  
K. L. Cox ◽  
L. O. Froeschke ◽  
R. E. Schumacher ◽  
Brenda Gorman
Keyword(s):  
Critical Review ◽  
Observational Studies ◽  
Language Intervention ◽  
Clinical Implications ◽  
Functional Communication ◽  
Language Outcomes ◽  
Adequate Description ◽  
Current State ◽  
Rising Incidence ◽  
Aphasia Recovery

Objective: The primary aim of this study was to summarize the current state-of-science for principles and practices of intervention in acquired pediatric aphasia (APA). A secondary aim was to identify gaps in research regarding interventional frameworks, and to identify key areas of future inquiry to optimize language outcomes. Conclusions: Although epidemiologic data indicate rising incidence in  APA, limited research on recovery and intervention exists. Results suggest that language intervention supports aphasia recovery; however, available data lack adequate description of methodologies to make crosscomparisons and dosage recommendations possible. Evidence from observational studies suggests that a) pediatric recovery is not necessarily more rapid nor complete than adult recovery; b) principles of neuroplasticity may be applied to pediatric aphasia; however prognostication may be affected by developmental stage and presence of immature language networks; and, c) aphasia symptoms related to literacy may extend into adulthood, even after functional communication has been established. Clinical implications as well as recommendations for research are discussed in light of evidence.

scholarly journals Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Marian C. Brady ◽  
Myzoon Ali ◽  
Kathryn VandenBerg ◽  
Linda J. Williams ◽  
Louise R. Williams ◽  
...  
Keyword(s):  
Outcome Measurement ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Functional Communication ◽  
Clinical Services ◽  
Language Outcomes ◽  
Home Practice ◽  
Language Therapy ◽  
Post Intervention ◽  
Individual Participant

Background and Purpose: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Methods: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Results: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Conclusions: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018110947.

Platelets: New Understanding of Platelet Glycoproteins and Their Role in Disease

Hematology ◽  
2000 ◽  
Vol 2000 (1) ◽  
pp. 222-240 ◽  
Author(s):  
James B. Bussel ◽  
Thomas J. Kunicki ◽  
Alan D. Michelson
Keyword(s):  
Point Of View ◽  
Platelet Glycoprotein ◽  
Clinical Implications ◽  
New Developments ◽  
Advantages And Disadvantages ◽  
Current State ◽  
Platelet Antigen ◽  
Low Platelet Count ◽  
Case Presentations ◽  
Alloimmune Thrombocytopenia

Abstract This review covers new developments and their clinical implications in three areas: platelet antigen polymorphisms, inhibition of platelet glycoprotein IIb-IIIa, and autoimmune thrombocytopenia (ITP). In Section I, Dr. Kunicki reviews platelet polymorphisms and their clinical implications. A current tabulation of the numerous platelet antigens, both those that are platelet specific and not platelet specific, are summarized. The immunogenic clinical implications of these polymorphisms are considered, including fetal and neonatal alloimmune thrombocytopenia, post transfusion purpura, and refractoriness to platelet transfusion. The functional relationship to hemostasis and thrombosis is also discussed, in particular whether one haplotype of the PIA1/PIA2 (HPA-1a/1b) polymorphism predisposes to myocardial infarction. Finally, novel investigations of polymorphisms will be considered, including hormonal induction of certain polymorphisms. In Section II, Dr. Michelson reviews the newest generation of platelet inhibitors, those blocking glycoprotein IIB/IIIA, from the point of view of the hematologist who might be consulted about a patient receiving this form of treatment. The current use of available IIb-IIIa inhibitors and those in trial and the accepted and possible future indications for their use are addressed. The mechanism of action and actual and theoretical advantages and disadvantages of each inhibitor are explored. Scenarios that prompt consultation with a hematologist are presented, including management of bleeding, thrombocytopenia, and management of the patient requiring emergency surgery. In Section III, Dr. Bussel reviews controversies in ITP, looking at both the current state of the art and the potential for the future. Case presentations are used to illustrate the issues in both children and adults. Three primary areas are addressed: 1) the diagnosis of ITP, 2) when and for which patient to recommend splenectomy, and 3) the management of the refractory splenectomized patient who still has a low platelet count and bleeding symptoms.

Anticoagulant effects of statins and their clinical implications

2014 ◽  
Vol 111 (03) ◽  
pp. 392-400 ◽  
Author(s):  
Kathleen Brummel-Ziedins ◽  
Kenneth Mann ◽  
Anetta Undas
Keyword(s):  
Factor Xiii ◽  
Observational Studies ◽  
Protein C ◽  
Thrombin Generation ◽  
Clinical Implications ◽  
Factor V ◽  
Reductase Inhibitors ◽  
Factor Va ◽  
Factor Expression ◽  
Antithrombotic Effects

SummaryThere is evidence indicating that statins (3-hydroxy-methylglutaryl coenzyme A reductase inhibitors) may produce several cholesterol-independent antithrombotic effects. In this review, we provide an update on the current understanding of the interactions between statins and blood coagulation and their potential relevance to the prevention of venous thromboembolism (VTE). Anticoagulant properties of statins reported in experimental and clinical studies involve decreased tissue factor expression resulting in reduced thrombin generation and attenuation of pro-coagulant reactions catalysed by thrombin, such as fibrinogen cleavage, factor V and factor XIII activation, as well as enhanced endothelial thrombomodulin expression, resulting in increased protein C activation and factor Va inactivation. Observational studies and one randomized trial have shown reduced VTE risk in subjects receiving statins, although their findings still generate much controversy and suggest that the most potent statin rosuvastatin exerts the largest effect.

scholarly journals A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia

2017 ◽  
Vol 60 (7) ◽  
pp. 2031-2046 ◽  
Author(s):  
Anthony Pak-Hin Kong ◽  
Sam-Po Law ◽  
Gigi Wan-Chi Chak
Keyword(s):  
Language Intervention ◽  
Multimedia Data ◽  
Minor Role ◽  
Lexical Retrieval ◽  
Clinical Implications ◽  
Culturally Specific ◽  
Nonfluent Aphasia ◽  
Fluent Aphasia ◽  
A Minor ◽  
The Relationship

Purpose Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia. Method Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio. Results Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia. Conclusions The current results supported the sketch model of language–gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.

scholarly journals Use of Blended Learning for Effective Implementation of English-Medium Instruction in a Non-English Higher Education Context

2015 ◽  
Vol 8 (11) ◽  
pp. 1 ◽  
Author(s):  
Jin-Hyouk Im ◽  
Jeongyeon Kim
Keyword(s):  
Higher Education ◽  
College Students ◽  
Blended Learning ◽  
Critical Review ◽  
Critical Factors ◽  
Policy Makers ◽  
Course Content ◽  
Effective Implementation ◽  
Current State ◽  
English Medium Instruction

<p class="apa">Although researchers agree with the strengths of an English-medium instruction (EMI) in addressing internationalization of a non-English higher education (HE) context, its implementation in classrooms has been widely criticized, mostly because of ineffective delivery of course content and a lack of evidence of English improvement. Grounded upon a critical review of the current state of internationalization of Korean HE and the subsequent examination of supplementary interview data from 15 college students who have taken EMI courses, this study proposes a model which integrates critical factors of EMI into one framework. This model aims at guiding the EMI policy from initiation to implementation. A major feature of this model is blended learning as a strategy to address the shortcomings of current EMI in this context and to facilitate the allocation of diverse online materials to scaffold EMI instruction. The benefits of the approach are presented from the perspectives both of policy-makers and of classroom participants.</p>

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