Background and Purpose-Magnetic resonance imaging (MRI) methods such as diffusion-(DWI) and perfusion-weighted (PWI) imaging have been widely studied as surrogate markers to monitor stroke evolution and predict clinical outcome. The utility of quantitative electroencephalography (qEEG) as such a marker in acute stroke has not been intensively studied. The aim of the present study was to correlate ischemic cortical stroke patients' clinical outcomes with acute qEEG, DWI, and PWI data. Materials and Methods-DWI and PWI data were acquired from 11 patients within 7 and 16 hours after onset of symptoms. Sixty-four channel EEG data were obtained within 2 hours after the initial MRI scan and 1 hour before the second MRI scan. The acute delta change index (aDCI), a measure of the rate of change of average scalp delta power, was compared with the National Institutes of Health Stroke Scale scores (NIHSSS) at 30 days, as were MRI lesion volumes. Results-The aDCI was significantly correlated with the 30-day NIHSSS, as was the initial mean transit time (MTT)abnormality volume (ϭ0.80, PϽ0.01 and ϭ0.79, PϽ0.01, respectively). Modest correlations were obtained between the 15-hour DWI lesion volume and both the aDCI and 30-day NIHSSS (ϭ0.62, PϽ0.05 and ϭ0.73, PϽ0.05, respectively). Conclusions-In this small sample the significant correlation between 30-day NIHSSS and acute qEEG data (aDCI) was equivalent to that between the former and MTT abnormality volume. Both were greater than the modest correlation between acute DWI lesion volume and 30-day NIHSSS. These preliminary results indicate that acute qEEG data might be used to monitor and predict stroke evolution.

This small study suggests that therapists agreed that evidence-based practice is essential to the practice of speech and language therapy. There are, however, barriers in place that are perceived to prevent its successful implementation. It is hoped that because these barriers have been identified, individual clinicians and organizations can be proactive in aiming to provide an evidence-based service to their clients.

The results showed that MMN responses could be elicited by speech stimuli with large, single acoustic deviances, within a multiple deviant paradigm design. This result has positive clinical implications for the testing of subjects who may only tolerate short testing sessions (e.g., pathological populations) in that responses to a wider range of speech stimuli may be recorded without necessarily having to increase session length. The results also demonstrated that MMN responses were elicited by large, single acoustic deviances but not fine acoustic deviances within the speech stimuli. The poor results for the fine acoustic deviances support previous studies that have used single contrast paradigms and found that when carefully controlled methodological designs and strict methods of analysis are applied, robust responses to fine-grained CV syllable contrasts may be difficult to obtain. The enhanced MMN observed in response to the real word deviants among nonword standards may provide further evidence for the presence of long-term neural traces for words in the brain, however possible contextual effects limit the interpretation of these data. Further research is needed to investigate the ability of the MMN response to accurately reflect speech sounds with fine acoustic contrasts, as well as the ability of the MMN to reflect neural traces for words in the brain, before it can be reliably used as a clinical tool in the investigation of spoken word processing in pathological populations.

Abstract. The purpose of this study was to investigate clinical assessment practices and instrumental examination decision-making by speech and language therapists (SLTs) in Ireland. A 21-question survey (including patient scenarios) was sent to 480 SLTs in Ireland. A total of 261 completed surveys were returned (54%), providing demographic information on SLTs currently working in Ireland and their services. Of these 261 surveys, 70 provided the data for the study, focusing on SLTs currently working in dysphagia, with adults/seniors at least some of the time. The results also showed clinician variability regarding which components are included in a bedside clinical examination of swallowing, with a high degree of consistency for only 11 of the 20 components. Clinicians agreed in their instrumental vs. noninstrumental evaluation recommendations for two of the six patient scenarios, with wide variability in clinical decision-making. Possible influences on clinical decision-making are discussed in relation to the findings of similar previous studies, as well as the current status and future needs of dysphagia training and services in Ireland.Key words: Dysphagia -Bedside evaluation of swallowing -Instrumental assessment -Videofluoroscopy -Speech and language therapyAssessment -Deglutition -Deglutition disorders.It is well-established that speech and language therapists (SLTs) are the lead experts in communication and swallowing disorders, including the assessment, differential diagnosis, intervention and management of individuals with these disorders [1,2]. With regard to the management of individuals with a swallowing disorder (dysphagia), in particular, inappropriate management can place patients at high risk of aspiration, respiratory infections, choking/death, poor nutrition and weight loss, poor health, anxiety and stress within the family, hospital/admission or extended hospital stay, and reduced quality of life [1,3,4]. The goals of swallowing evaluations are to determine the presence, nature, and cause of the swallowing problem, current level of dysfunction, and nutritional status, and to develop strategies for stabilization and rehabilitation [5]. To achieve these goals it is clearly important that dysphagia evaluation and management practices within the SLT profession are consistent, clear, and well-defined.Numerous policy statements have been published by several national professional bodies defining the SLTÕs role in dysphagia management and the requisite knowledge base and skills, policies, and guidelines for intervention, and areas of research [2,6,7]. According to these policies and guidelines, the SLTÕs scope of practice includes both the clinical/ bedside examination and instrumental assessment of the oral, pharyngeal, and upper esophageal phases of swallowing function [1]. The clinical bedside examination for dysphagia is a noninstrumental procedure that usually includes gathering information on the current swallowing problem, reviewing medical history, observing signs relevant to the patientÕs me...

The purpose of this study was to determine whether the presence of subtitles on a distracting, silent video affects the automatic mismatch negativity (MMN) response to simple tones, consonant-vowel (CV) nonwords, or CV words. Two experiments were conducted in this study, each including ten healthy young adult subjects. Experiment 1 investigated the effects of subtitles on the MMN response to simple tones (differing in frequency, duration, and intensity) and speech stimuli (CV nonwords and CV words with a /d/-/g/ contrast). Experiment 2 investigated the effects of subtitles on the MMN response to a variety of CV nonword and word contrasts that incorporated both small (e.g., /d/ vs. /g/) and/or large (e.g., /e:/ vs. /el/) acoustic deviances. The results indicated that the presence or absence of subtitles on the distracting silent video had no effect on the amplitude of the MMN or P3a responses to simple tones, CV nonwords, or CV words. In addition, the results also indicated that movement artifacts may be statistically reduced by the presence of subtitles on a distracting silent video. The implications of these results are that more "engaging" (i.e., subtitled) silent videos can be used as a distraction task for investigations into MMN responses to speech and nonspeech stimuli in young adult subjects, without affecting the amplitude of the responses.

This small study suggests that therapists agreed that evidence-based practice is essential to the practice of speech and language therapy. There are, however, barriers in place that are perceived to prevent its successful implementation. It is hoped that because these barriers have been identified, individual clinicians and organizations can be proactive in aiming to provide an evidence-based service to their clients.

The purpose of this study was to compare the robustness of the event-related potential (ERP) response, called the mismatch negativity (MMN), when elicited by simple tone stimuli (differing in frequency, duration, or intensity) and speech stimuli (CV nonword contrast /de:/ vs. /ge:/ and CV word contrast /del/ vs. /gel/). The study was conducted using 30 young adult subjects (Groups A and B; n = 15 each). The speech stimuli were presented to Group A at a stimulus onset asynchrony (SOA) of 610 msec and to Group B at an SOA of 900 msec. The tone stimuli were presented to both groups at an SOA of 610 msec. MMN responses were elicited by the simple tone stimuli (66.7%-96.7% of subjects with MMN "present," or significantly different from zero, p < 0.05) but not the speech stimuli (10% subjects with MMN present for nonwords, 10% for words). The length of the SOA (610 msec or 900 msec) had no effect on the ability to obtain consistent MMN responses to the speech stimuli. The results indicated a lack of robust MMN elicited by speech stimuli with fine acoustic contrasts under carefully controlled methodological conditions. The implications of these results are discussed in relation to conflicting reports in the literature of speech-elicited MMNs, and the importance of appropriate methodological design in MMN studies investigating speech processing in normal and pathological populations.

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