This study examines the functional and physiologic outcomes of treatment in a group of 10 patients with chronic dysphagia subsequent to a single brainstem injury. All patients participated in a structured swallowing treatment program at a metropolitan teaching hospital. This program differs from more traditional swallowing treatment by the inclusion of surface electromyography biofeedback as a treatment modality and the completion of 10 hr of direct treatment in the first week of intervention. A retrospective analysis of medical records and patient questionnaires was used to gain information regarding medical history, site of lesion, prior interventions, and patient perception of swallowing recovery. Physiologic change in swallowing treatment, as measured by severity ratings of videofluoroscopic swallowing studies, was demonstrated in nine of 10 patients after 1 week or 10 sessions of treatment. Functional change was measured by diet level tolerance after 1 week of treatment, at 6 months, and again at 1 year posttreatment. Eight of the 10 patients were able to return to full oral intake with termination of gastrostomy tube feedings, whereas two demonstrated no long-term change in functional swallowing. Of the eight who returned to full oral intake, the average duration of tube feedings following treatment until discontinuation was 5.3 months, with a range of 1-12 months. Six patients who returned to oral intake maintained gains in swallowing function, and two patients returned to nonoral nutrition as the result of a new unrelated medical condition.

No abstract

Over the years many studies have been conducted to document the treatment effects of Botulinum toxin type A in adductor spasmodic dysphonia. The results of these studies have led to the view that overall Botulinum toxin treatment is moderately effective. This study reviews efficacy research qualitatively and quantitatively to determine the extent to which this conclusion is fully supported by the data. Although the data indicate moderate overall improvement as a result of Botulinum toxin treatment, they also suggest significant variation across patients, measurements, and treatment conditions. This result, together with methodological limitations and lack of standardization in BT efficacy research, justifies caution when making inferences regarding BT treatment benefit in adductor spasmodic dysphonia.

The influence of verbal and nonverbal contextual factors on intelligibility was examined using sentences produced under varying conditions by a speaker with severe flaccid dysarthria. Contextual factors included (a) concurrent production of communication gestures, (b) predictiveness of message content, (c) relatedness of sentences to specific situational contexts, and (d) prior familiarization with the speaker. Sentences produced by the speaker were audio- and video-recorded and presented to 96 listeners/viewers who were assigned to three different methods of presentation of the stimuli: (a) audio + video, (b) audio-only, or (c) video-only conditions. Results indicated that gestures, predictiveness, and context influenced intelligibility; however, complex interactions were observed among these factors and methods of presentation of the stimuli. Results were interpreted in light of Lindblom's "mutuality model," indicating that when signal fidelity is poor, as in the present speaker with dysarthria, differing combinations of signal-independent information may be employed to enhance listener understanding of spoken messages.

To evaluate expert listeners' perceptions of voice and fluency in persons with adductor spasmodic dysphonia (ADSD) before and after treatment with botulinum toxin type A (Botox), as a function of initial severity of the disorder (while controlling for patients' age at injection). Design: Simple before-and-after trial with blinded randomized listener judgments. Setting: Ambulatory care clinic at a single medical center. Participants: Forty-two consecutive patients with ADSD who underwent examination, with a 3-to 6-week followup, after initial botulinum toxin type A injection. There were also 42 age-and sex-matched healthy control subjects. Interventions: Injections of botulinum toxin type A into the thyroarytenoid muscle(s). Main Outcome Measures: Computer-implemented visual analog scaling judgments of voice quality and speech fluency made by expert listeners under psychoacoustically controlled conditions. Results: Response to botulinum toxin type A varied markedly as a function of pretreatment severity of ADSD. More severe initial symptoms exhibited greater magnitudes of improvement. Patients with mild dysphonia did not exhibit pretreatment to posttreatment change. Following treatment, voice and fluency remained significantly (PϽ.05) poorer in ADSD than in healthy speakers. Older patients exhibited less improvement than younger patients when the effect of initial severity was statistically controlled. Conclusions: Voice quality and fluency improved for most patients following treatment, but older patients and those with milder dysphonia exhibited the least optimal responses to the procedure. Patients who were profoundly impaired demonstrated the greatest amount of improvement. Computer-implemented visual analog scaling provided a reliable clinical tool for determining treatment-related changes in those with ADSD.