This document provides an overview of communication and swallowing issues in multiple sclerosis (MS), including characteristics, identification, and interventions. It summarizes that speech and swallowing changes are common in MS, affecting over 30% of patients, and are more likely with increased disease severity and progression. A variety of screening tools and assessments are available to identify speech and swallowing issues. Interventions can target impairment, compensation, and participation, and involve speech language therapy as well as a multidisciplinary approach. Early intervention may provide benefits, though evidence for treatments is still limited.
Communication and swallowing impairment in MS: 'a view from everyday clinical...MS Trust
Aims:
Increase knowledge base of swallowing mechanics and impairment
Understand SLT’s scope of practice and interventions
Consider impact of interventions
Gain practical advice for patients
Experience for yourself texture modification
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Communication and swallowing impairment in MS: 'a view from everyday clinical...MS Trust
Aims:
Increase knowledge base of swallowing mechanics and impairment
Understand SLT’s scope of practice and interventions
Consider impact of interventions
Gain practical advice for patients
Experience for yourself texture modification
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Structural and Functional foot problems in the elderly tanvi Pathania
Foot problems are commonly seen and overlooked in elderly which can cause impaired physical functioning and pain. There are many common conditions seen in the aged population. Few are discussed in the slide.
Manual and physical therapists use a postural-structural-biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions.
The most important question is consistently being ignored is can a person’s physical shape/posture/structure/biomechanics be the cause of pain in spine
A biopsychosocial approach to stroke physiotherapy. This is a move to integrate the personal and environmental factors to the standing biomedical understanding of the disease for a tailor-made treatment.
Practical bowel management in MS - Maureen CoggraveMS Trust
Aims:
- Understand concept of neurogenic bowel dysfunction (NBD) as seen in people with MS
- Appreciate impact of NBD on quality of life
- Understand the importance of case finding
- Be aware of assessment methods in NBD
- Be aware of potential methods of management, particularly conservative interventions
- Be aware of resources to support management
Structural and Functional foot problems in the elderly tanvi Pathania
Foot problems are commonly seen and overlooked in elderly which can cause impaired physical functioning and pain. There are many common conditions seen in the aged population. Few are discussed in the slide.
Manual and physical therapists use a postural-structural-biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions.
The most important question is consistently being ignored is can a person’s physical shape/posture/structure/biomechanics be the cause of pain in spine
A biopsychosocial approach to stroke physiotherapy. This is a move to integrate the personal and environmental factors to the standing biomedical understanding of the disease for a tailor-made treatment.
Practical bowel management in MS - Maureen CoggraveMS Trust
Aims:
- Understand concept of neurogenic bowel dysfunction (NBD) as seen in people with MS
- Appreciate impact of NBD on quality of life
- Understand the importance of case finding
- Be aware of assessment methods in NBD
- Be aware of potential methods of management, particularly conservative interventions
- Be aware of resources to support management
This presentation from Pam Bostock & Heidi Cleary explores therapy tips for MS nurses. It was presented at the MS Trust Annual Conference in November 2013.
Making Best Use of Speech-Language Therapy: When to Refer and What to ExpectBilinguistics
In this presentation, we discuss speech and language in school-age youth, identify when referral for Speech-Language Evaluation and Therapy would benefit the patient, and explain utilization of Alternative and Augmentative Communication (AAC).
Managing Respiratory Symptoms in Advanced MS - Practical by Rachael MosesMS Trust
Practical guide to managing respiratory symptoms in Advanced MS presented at the MS Trust Annual Conference 2016 buy Consultant Physiotherapist Rachael Moses
This presentation is submitted to Myanmar Dental Association Continuing Medical Education Program. It aims to introduced this new subject to our professional. Thanks to all primary authors.
Feinberg School of Medicine, Northwestern University, Chicago USA.
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Daniel Lee, M.D., of UC San Diego Owen Clinic, presents "Update from the 15th International Workshop on Co-Morbidities and Adverse Drug Reactions in HIV"
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This invited presentation was part of the 2020 6th Annual Interior Region Eating Disorder (Virtual) Forum, September 2020. The presentation addresses recent research, community and clinical experiences of men with eating disorders to deepen our understanding to improve caring. Stories, stats, questions, video clips and polls were included to seek input from those participating.
For example: Do males comprise 33-40% of those we are caring for? If NO, WHY NOT?
You may find use for some of these in future presentations or team discussions.
Tips to Improve Caring include:
*Team based interest/working groups to plan better for
males; include cross site/jurisdiction knowledge
exchange/peer support for clinicians/mentorship
*Include male former patients/MWED in planning/advising
*Include males in research AND disseminate this research to honor their contribution
rather than “the number of males were insufficient to report on”
*Include retrospective reviews on past males for quality improvement
*Review non-published findings on males in your own research
*Demonstrate that you’re informed/comfortable working with MWED
*Know the literature/resources & limits of both for males with eating disorders
*Use your creativity & planning to consider all-male therapeutic groups including online therapeutic or support groups?
*Schedule male appointments back to back/same time. Males see they are not the only male in treatment/care
*Seize the moment to engage the person who is seeking support (hope, optimism and repeat check-in)
A take away team or self-reflection exercise asks:
What are we doing in our own practice or setting to__
-Demonstrate a “male friendly” welcoming environment for
boys/men with Eating Disorders?
-Better understand… boys/men with Eating Disorders?
-Better support/treat/demonstrate caring … boys/men with
Eating Disorders?
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
6. What can speech sound like
Most common: mixed spastic-
ataxic (Hartelius et al 2000)
• Aesthenic voice
• Strained voice
• Disrupted prosody
• Imprecise articulation
• Slowed speech rate
7. How common are speech changes?
• Patient report
– Beukelman (1985) 23%
– Hartelius (1994) 44%
– Yorkston (2003) 40%
• Clinical findings
– Darley et al (1972) 41%
– Hartelius et al (2000) 51% prevalence
– Bauer et al (2013) 47%
• Instrumental & subclinical
– Hartelius (2000) 62%
– Feij’o (2004) 70%
– Dogan (2007) 60%
8. Predictors of dysarthria?
• Types of MS
– Progressive>RRMS severity
• MS severity (EDSS scores)
– More severe speech in higher EDSS
– But onset of changes not correlated with EDSS
• Disease duration
– Not usually independently correlated
9. Other communication changes:
Communication?
• Naming
• Word definition
• Word fluency
• Sentence repetition
• Verbal explanation &
reasoning
• High level comprehension
• Murdoch and Lethlan (2000)
• >50 normal language ability
• Self-report: 62% Klugman &
Rose (2002)
Cognition?
• memory
• attention
• speed of information
processing
• executive functions
– (Fraser & Stark, 2003; Pierson
& Griffith, 2006; Shevil &
Finlayson, 2006).
• Kujaja (1996) unimpaired
language in unimpaired cog
10. So we know that…..
• More severe speech and communication
changes more likely if other MS symptoms are
more severe
• But is this the best time to work on speech?
13. VHI
Jacobson et al 1997
• 30 item validated questionnaire
• physical, emotional and impact on function of
voice changes
14. So we know that….
• Speech and communication changes impact
each person differently
• There are tools to look at impact
BUT
• are they routinely accessed?
• Do they capture the lived experience of
someone with MS?
16. Restricted communicative
participation associated with
– Fatigue
– Mobility
– Bladder control
– Visual difficulties
– Cognitive /thinking difficulties
– Depression
– Social support
– Employment status
– Speech usage
– Education levels
o Qualitative e.g. Yorkston 2001; Bringfelt et al 2006,
o Quantitative Baylor et al 2010; Yorkston 2013
17.
18. Communicative Participation
• https://www.youtube.com/watch?v=BrBoB22
HLXs
• Baylor, Yorkston et al 2013:
– Communicative Participation Item Bank
– how much your condition interferes with your
participation in that situation
– Convert scores to logit scale (0 = calibrations
sample) or T scores (50 = calibration sample)
19. So we know that….
• Communicative participation is bigger than
speech and language
• It needs an MDT approach to help
• There is a published tool to explore it
22. Interventions for dysarthria:
oImproving intelligibility
• Articulatory accuracy
• Rate control (Yorkston & Beukelman 1981)
• volume (Sapir et al 2001; Tjaden et al 2014)
• Feedback and Self monitoring
oSpeaker adjustments
oSpeech supplementation / augmentative
oListener adjustments
23. Principles of Motor Learning
• Usage
• Specificity
• Intensity
• Salience
• Feedback
• Blocked vs. random
e.g. Ludlow et al 2008
24. So we know that…
• There is limited evidence for effectiveness of
communication interventions in MS
• BUT
• Can operate at all/any levels of participation
• Need to consider overall MS profile
26. • Andy:
– Self-employed businessman; ataxic dysarthria
with work & social impact
– Self-monitoring
– Rate control with articulatory accuracy for key
salient phrases
– Fatigue awareness
– Alternative communication choices (email,
answerphone)
– disclosure
27. • Stuart:
– Retired, chronic progressive MS, wheelchair
dependent
– Aesthenic voice; participation & QoL issues
– phonatory strength training; self-monitoring;
stepped progression supported through therapy
– Care-giver education
– Amplification for specific circumstances
28. • Cherry
– 18 years old; primary progressive MS; self-image
& social impact
– Prosodic break downs (elongations, intra-word
pauses); degraded voice quality; articulatory
imprecision
– Rate control; normalisation
– Visual-acoustic feedback, targeted phrases
– Disclosure to new college mates
37. How common are swallowing
changes?
• Self-report: 33%
– Hartelius 1994
• Screening Test: 31.7 %
• Poorjavad 2010
• Clinical interview: 31 %
– Solaro 2013;
• Clinical & instrumental examination(FEES):34 %
– Calcagno 2002;
• Higher on instrumental assessment?
• Tassorelli et al 2008; Wiesner et al 2002
• Fernandes et al 2013
• Meta-analysis Guan et al 2015: 36% vs 81%
43. SLT Assessment
• Clinical
o Case history
o Oro-motor exam
o Oral trials
o Meal time
observation
o QoL
• Instrumental
o VF
o FEES
https://www.youtube.com/w
atch?v=G1Enx7lHrrg
44. So we know that…
• There are a range of ways to assess
swallowing
• But
• What do your teams use to identify?
• Do you know what models your SLTs use?
49. Rehabilitative
• Electrical stimulation
– Intraluminal stimulation
– 5Hz
– 20 patients with MS &
aspiration
– Improvement in
swallowing over sham
– Restivo et al 2013
50. Botox
Restivo et al 2011:
• 14 patients with
hypertonic UES
dysfunction
• 10 unit botox
each side CP
under EMG
control
• Improvements
for 18 weeks
51. When to support?
• Emerging evidence with other conditions for
early interventions
• Most research looks at ‘permanent’ symptoms
as inclusion criteria
– How to support dysphagia ‘relapse’?
52. So we know that….
• Range of interventions to use though limited
evidence (especially in MS) embedded in MDT
• But
• Emerging evidence for early interventions in
other conditions & specialist techniques
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